Cubital Tunnel Syndrome

Cubital Tunnel Syndrome
December 20, 2015

Dr. Gupta, with an experience of 25 years and more than 6000 surgeries in the hand and upper extremity field in simple terms explains, “When the ulnar nerve is compressed or becomes problematic at the elbow it is called the Ulnar Nerve Entrapment or Cubital Tunnel Syndrome. The ulnar nerve is one of the three main nerves in your arm. It travels from your neck down into your hand and can be constricted in several places along the way but the most common place for compression of the nerve is behind the inside part of the elbow usually because here it has to travel through a narrow space with very little soft tissue to protect it.”

CubitalTunnel_SmallThis nerve gives feeling to the little finger and half of the ring finger and controls most of the little muscles in the hand that help with fine movements and some of the bigger muscles in the forearm that helps you to make a strong grip.

The patient should immediately consult our medical team >> click here for appointment

It is difficult to ascertain the exact cause of Cubital Tunnel Syndrome but usually the causes that might trigger it off can be a prior fracture or dislocation of the elbow, arthritis of the elbow and swelling of the elbow joint, cysts near the elbow joint and repetitive or prolonged activities that require elbow to be bent or flexed.

Most of the symptoms of Cubital Tunnel Syndrome occur in your hand accompanied by an aching pain on the inside of your elbow. Numbness and tingling in your ring and little finger are common symptoms of CTS besides which weakening of grip and difficulty in finger coordination (such as typing or playing an instrument) may also be felt and often the patient also feels numbness while answering the phone.

The patient should immediately consult our medical team >> click here for appointment

Dr. Gupta, the first surgeon to perform endoscopic cubital tunnel release in India relatively says, “After discussing your symptoms and medical history, we examine your arm and hand to determine which nerve is compressed and where it is compressed. Thereafter we go in for certain diagnostic tests to ascertain the exact quantum of your problem.”

As regards treatment, in most cases we go in for anti inflammatory medicines, bracing or splinting to keep elbow in a straight position or nerve gliding exercises but if they do not improve your symptoms we may recommend surgery by technique which is best applicable to your condition such as by Cubital tunnel release, Ulnar nerve anterior transposition or by Medial epicondylectomy.

Nerves recover slowly, and it may take a long time to know how well the nerve will do after surgery but recovery is generally good and we did our first case in India of endoscopic cubital tunnel release with excellent results.

Watch Video of Endoscopic Cubital Tunnel Syndrome being performed by Dr. Vikas Gupta :

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FAQ – Cubital Tunnel Syndrome

When the ulnar nerve in the arm is damaged as in compressed or stretched at the elbow, it is termed as Ulnar Nerve Entrapment or Cubital Tunnel Syndrome.
Ulnar nerve is one of the three main nerves in the arm which runs from the neck to the hand. There are several places where the nerve gets restricted and it is most prone to compression behind the inner part of the elbow. At the elbow, ulnar nerve passes through a tunnel made of tissues known as cubital tunnel.
Ulnar nerve is an important nerve that provides feeling and sensation in the little finger and half of ring finger. All little muscles that enable fine movements in the hand are essentially controlled by the ulnar nerve and all bigger muscles in the forearm that are contributory to a strong grip are also governed by it.
The exact cause of why the ulnar nerve tends to compress at the elbow has not yet been ascertained but its vulnerability to it can be deduced on the fact that the narrow tunnel through which it passes indeed has very little soft tissue to protect it. The reasons why the nerve is prone to get compressed at the elbow are:
  • Keeping the elbow bent for long periods or repeatedly bending it for example sleeping with bent elbow can cause compression
  • Leaning on the elbow for a long period can compress the nerve at the elbow
  • Excess fluid in the elbow can cause swelling and make it prone to compression
  • A direct blow at the inside of the elbow can cause the nerve to be compressed

The cubital tunnel syndrome can trigger off if :
  • The patient has had a past history of fracture or dislocation of the elbow
  • The patient is suffering from arthritis of the elbow
  • The patient has cysts in and around the elbow
  • The patient is involved in activities that require long duration of elbow movement to be bent or pressured

An aching and persistent pain at the elbow is the most common sign with all other symptoms visibly eminent in the hand. A feeling of numbness in the ring and part of little finger and feeling of them falling asleep making it difficult to move them and hold objects with them, weakening in the grip strength or difficulty in finger coordination are other signs which indicate presence of cubital tunnel syndrome.
After a complete physical examination and review of medical history the doctor furthers the diagnosis of cubital tunnel syndrome by running an X-ray or nerve conduction study which clearly indicates the severity and the damage to the nerve.
Depending on the muscle damage, the doctor decides on the course of treatment to be followed. Anti inflammatory medicines, splinting or bracing to immobilize the elbow to a straight position and nerve gliding exercises to prevent stiffness are the techniques taken up to cure the cubital tunnel syndrome that is mild.
For severe cases and damage the surgeon will undertake treatment by the following techniques:
Cubital Tunnel Release where the ligament roof of the cubital tunnel is divided to release the pressure on the nerve to bring down the swelling.
Ulnar nerve anterior transposition / subcutaneous transposition / submuscular transposition / intermuscular transposition in which the positioning of the nerve is changed and they are placed either on the top, under, back or inside the muscles depending on the best functionality.
Medial epicondylectomy is another surgical technique to stop it from getting stuck on the ridge and damage when elbow is bent.
The surgeon prescribes gentle nerve stretching exercises for a longer period of time after the surgery and the use of splint to help heal the nerve faster. Since nerves recover slowly it will take time before they are completely usable and the surgeon will only let the patient return to normal routine after a thorough and regular check up plan.
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