Cubital tunnel syndrome is the second most common peripheral compression neuropathy in the upper extremity. Cubital tunnel syndrome is due to the ulnar nerve being pinched or compressed at the cubital tunnel of the elbow. This is the nerve responsible for the pain, numbness and tingling people experiences when they hit, “the funny bone.”
Typical symptoms are numbness and tingling in the ring and little fingers. As the disease progresses, patients usually notice that their hands are numb and tingling, especially at night. Their symptoms may keep them awake and it also may become difficult to manipulate small objects. In advanced disease, the muscles of the hand become weak and start to atrophy. Patients may notice that they have wasting of the space between their thumb and index finger, the first web space.
Diagnosis begins with the patient’s history and a physical exam. Most patients will require an EMG, which is a special nerve test. All of these tools are used in conjunction to make the correct diagnosis.
If your cubital tunnel syndrome is mild and found in the early stages it can be treated conservatively with night time extension splinting. My preferred extension splinting at night is to have the patient get a large body pillow to hug while they sleep. Also, patients are advised to avoid long periods of elbow flexion and resting their “funny bone” on anything. If this fails to decrease symptoms or symptoms return after a course of splinting, it may be necessary to proceed with surgery. Surgery is very effective and well tolerated. There are several areas that can typically cause compression of the ulnar nerve at the elbow including most commonly Osborne’s fascia, the arcade of struthers and the two heads of flexor carpi ulnaris. These structures are all approached through a 2 inch incision over the medial aspect of the elbow. Some patients require ulnar nerve transposition anterior to the medial epicondyle of the humerus. This may be necessary due to a patient's specific anatomy and hypermobility of the ulnar nerve when the elbow is flexed.
Your incisions will be covered in a compressive soft dressing from your hand to your upper arm. This dressing will be left in place for 2 days. In 2 days you may remove your dressing, shower and get your incisions wet. You may recover your incision with a bandaid after that. You may not submerge the incisions under water for 3 weeks. You will have an appointment with a certified hand therapist to initiate nerve gliding exercises and range of motion exercises soon after surgery. You may use your hands for all activities that you can tolerate immediately after surgery without risk of injury, with the exception of lifting greater than 5 -10 lbs so that you do not disrupt your incision. I routinely tell patients, “let your pain be your guide,” if it hurts, don’t do it. Your first post op visit will be in 2 weeks at which time your sutures will be removed.
If you have had an anterior ulnar nerve transposition you will be placed in a volar forearm based splint for 4 weeks. You will also have restricted use of the operative arm to include: no lifting, pushing or pulling for 3 weeks while the splint is on. After 3 weeks you will be allowed to start wrist range of motion and strengthening.