Cubital Tunnel Syndrome
Have you ever suddenly realized that one of your pinky fingers and sometimes one of your ring fingers has gone numb? Do you have trouble making your pinky finger entirely straight? Do you awaken at night with your pinky finger tingling and full of pins and needles? These are all symptoms of a nerve being obstructed and producing the tingling and numbness you feel. Nerves bring electro-chemical energy to the muscles and trigger them to reduce and relax, thereby creating movement. Nerves can become pinched or obstructed from body structures. These body structures may be bone fragments, bones, ligaments or osteophytes (bulging of bone edges, from arthritis), or soft tissue structures that hold the joints stable. Here are some possible causes for a numb pinky finger:
- You recently broke your elbow, and a bone fragment is causing outside pressure on the Ulnar Nerve.
- You have arthritis creating pressure on the Ulnar Nerve at the elbow.
- The repetitive movement that you perform may cause stress on your elbow or soft tissue ligaments.
- A lot of people sleep with their elbows bent, which can intensify Ulnar Nerve compression symptoms and cause some to wake up at night with their fingers tingling and numb.
- Resting on the elbow for long periods can place stress on the nerve.
- Fluid buildup in the elbow can produce swelling that compresses the nerve.
- If you drive a lot, you may rest your elbows on your seat’s armrests while driving. This action can cause issues.
- Holding a phone to your ear a lot may cause the elbow to bend to the phone to your ear may cause extra stress on the nerve and can cause your pinky finger to go numb.
What is the Cubital Tunnel?
The cubital tunnel is the area where the Ulnar Nerve travels through in the elbow. The Ulnar Nerve is one of three primary nerves in the arm; it extends from the neck to the fingers and can become constricted in several places along the way. The Ulnar Nerve provides the pinky and half of the ring finger with sensory communication. The most common location for the Ulnar Nerve to become compressed is at the Cubital Tunnel near the elbow. Past the elbow, the Ulnar Nerve is located under muscles on the inside of the forearm and goes into the hand on the side of the palm where the little finger is located. As the Ulnar Nerve moves into the hand, it goes through another tunnel called Guyon’s canal. This is another location where the Ulnar Nerve can become compressed.
Some issues may put you more at risk for developing cubital tunnel syndrome. These include:
- Previous fracture or dislocation of the elbow
- Swelling of the elbow joint
- Bone spurs/arthritis of the elbow
- Cysts close to the elbow joint
- Recurring activities that require the elbow to be bent.
How Cubital Tunnel Syndrome is diagnosed
A complete medical history and physical exam, including questions about activities, work, and medications. Frequently, diagnostic tests will be performed:
Electromyogram (EMG) – This exam establishes nerve and muscle function and may be utilized to assess the forearm muscles regulated by the Ulnar Nerve. If the muscles do not work correctly, it may be an indication that there is an issue with the Ulnar Nerve.
X-rays – These imaging tests provide detailed pictures of the bones to see if any arthritis or bone spurs exist at the elbow. Frequently, the cause of the compression of the Ulnar Nerve cannot be observed on an x-ray.
Nerve conduction studies – These tests can determine how fast signals travel down a nerve to locate the compression of the nerve. Nerves travel through your body, transmitting messages between the brain and muscles. If a nerve is not working correctly, it takes longer for it to conduct.
Nerve conduction studies can also establish whether the compression is also causing muscle damage. Small needles are inserted into selected muscles that the Ulnar Nerve controls. Muscle damage is a sign of more severe nerve compression.
Treatment for Cubital Tunnel Syndrome
The physician will likely recommend a nonsurgical treatment first unless the nerve compression has caused a lot of muscle wasting.
Nonsteroidal anti-inflammatory medications – If the symptoms have just begun, the physician may recommend an anti-inflammatory medication, such as ibuprofen, to help reduce swelling around the nerve. Even though steroids, like cortisone, are very effective anti-inflammatory medicines, steroid injections are usually avoided since there is a risk of injury to the nerve.
Bracing – Your physician may prescribe a padded brace to wear at night to keep your elbow in a straight position.
Nerve flossing exercises – Some doctors believe that exercises to help stretch the Ulnar Nerve aid movement through the cubital tunnel. Nerve flossing exercises may also help prevent stiffness in the arm and wrist.
Your doctor may recommend surgery to take compression off of the nerve if:
- Nonsurgical treatments have not improved your condition.
- The Ulnar Nerve is very compressed.
- Nerve compression has created muscle weakness and or damage.
Some surgical procedures will help to relieve compression on the Ulnar Nerve at the elbow. The orthopedic surgeon will discuss available options with you.
Usually, this type of procedure is performed on an outpatient basis, but some patients may need to stay at the hospital overnight.
Cubital tunnel release- In this surgical procedure, the ligament on top of the cubital tunnel is cut and divided. This enlarges the size of the tunnel and decreases compression on the nerve.
Afterward, the ligament starts to heal, and new tissue grows across the separation. The new tissue restores the ligament and permits more space for the Ulnar Nerve to glide through.
Cubital tunnel release works best when the nerve compression is mild to moderate, and the nerve doesn’t slide out from behind the medial epicondyle when the elbow is bent.
Ulnar Nerve anterior transposition – In some cases, the nerve is relocated from its place behind the medial epicondyle to a new area in front of it. Repositioning the nerve to the front of the medial epicondyle keeps it from getting stuck on the bony ridge and stretching when the elbow is bent.
There are a couple of options where the surgeon can move the nerve. It will lay under the skin and fat, but it can go on top of the muscle, or within the muscle, or under the muscle.
Medial epicondylectomy – Another possible option to release the nerve is to remove part of the medial epicondyle. This technique also keeps the nerve from getting stuck on the boney ridge when the elbow is bent.
Recovery from Surgery
Depending on the type of surgery, you may need to wear a splint for 3-6 weeks after the surgery.
Your orthopedic surgeon may suggest physical therapy to help you regain motion and strength in your arm. The orthopedic surgeon will discuss with you when it will be safe to return to all normal activities.
The outcome of nerve surgery is generally good. Each type of nerve compression surgery has a similar success rate. If the nerve is seriously compressed or if muscle wasting has occurred, the nerve might not return to normal, and some symptoms may continue even after the surgery. Nerves recover slowly, and it may take a while to know how well the nerve will do after surgery.