October 31, 2023

Cubital Tunnel Syndrome

Cubital tunnel syndrome happens when the ulnar nerve, which passes through the cubital, a tunnel of muscle, ligament, and bone on the inside of the elbow, is injured and becomes inflamed, swollen, and irritated. Cubital tunnel syndrome causes pain that feels a lot like the pain you feel when you hit the ulnar nerve which is a nerve in the elbow, the ulnar nerve begins in the side of your neck and ends in your fingers.

Causes and risk factors:

Arthritis of your elbow (Degeneration of the joint)
Bending your elbow for a long time
Bone spurs
Cysts near your elbow
Past elbow fracture or dislocation
Swelling of your elbow joint

Just because you’ve had these symptoms doesn’t mean you’ll automatically get cubital tunnel syndrome. It just means that you’re more at risk than the average person.

Symptoms:

Numbness in your hand and fingers that comes and goes
Tingling in your hand and fingers that comes and goes
Difficulty moving your fingers when they’re numb or tingling (falling asleep)
Pain on the inside of your elbow

Inner elbow pain and numbness and tingling in your hand are the most common symptoms. This happens most often when your elbow is bent. Your elbow might be bent when you:

Drive
Hold a phone
Sleep

Diagnosis:

Your healthcare provider will likely start the diagnosis process by asking questions about your symptoms.

What are your symptoms?
What medications do you take?
Do you feel numbness?
Do you feel like your hand or fingers are falling asleep?
Do you feel pins and needles?
Have you ever had a fractured or dislocated elbow?

Then they’ll do specific manual tests and order several others, which may include:

Blood tests for diabetes or thyroid diseases
Electromyogram (EMG), which will show your provider how your nerves and nearby muscles are acting.
X-rays to check for bone spurs, arthritis and places where bone might compress the ulnar nerve.

Physical Therapy Management:

A nonsurgical approach should be followed for at least a 3 month period before considering a surgical intervention, especially with mild cases. Conservative treatment may include: a 4-6 week period of immobilisation with the elbow splinted at 45 degrees of flexion and the forearm in neutral rotation.

The physical therapist will perform joint mobilisations, neural flossing, neural gliding, and then starts exercises and patient education.

Some specific exercises are the following:

Elbow Flexion and Wrist Extension:

Sit tall and reach the affected arm out to the side, level with your shoulder, with the hand facing the floor.
Flex your hand and pull your fingers up toward the ceiling.
Bend your arm and bring your hand toward your shoulders.
Repeat slowly 5 times.

Head Tilt:

Sit tall and reach the affected arm out to the side with elbow straight and arm level with your shoulder.
Turn your hand up toward the ceiling.
Tilt your head away from your hand until you feel a stretch.
To increase the stretch, extend your fingers toward the floor.
Return to starting position and repeat slowly 5 times.

Arm Flexion in Front of Body:

Sit tall and reach the affected arm straight out in front of you with your elbow straight and arm level with your shoulder.
Extend your hand away from you, pointing your fingers toward the ground.
Bend your elbow and bring your wrist toward your face.
Repeat slowly 5-10 times.

A-OK:

Sit tall and reach the affected arm out to the side, with elbow straight and arm level with your shoulder.
Turn your hand up toward the ceiling.
Touch your thumb to your first finger to make the “OK” sign.
Bend your elbow and bring your hand toward your face, wrapping your fingers around your ear and jaw, placing your thumb and first finger over your eye like a mask.
Hold for 3 seconds, then return to starting position and repeat 5 times.