Cubital tunnel syndrome

Cubital tunnel syndrome is a medical condition that affects the ulnar nerve as it passes through the cubital tunnel in the elbow. It is also known as ulnar nerve neuropathy and is one of the most common entrapment neuropathies.

Diagnosis of cubital tunnel syndrome begins with a detailed medical history and physical examination by a doctor. Some of the common symptoms that may suggest the presence of this condition include:

  • Patients with cubital tunnel syndrome often experience pain and numbness in the elbow and the inside of the hand, especially in the little finger and ring finger.
  • Weakness of the muscles of the hand and fingers, in particular, can be a major symptom. This may manifest as difficulty grasping small objects or performing activities that require hand strength.
  • Tingling and "pins and needles" sensation: Patients may feel tingling or a "pins and needles" sensation in the affected hand, especially in the little and ring fingers.

In more advanced cases, muscle atrophy may develop in the hand due to persistent weakness.

Worsening of symptoms in certain positions: Symptoms often worsen when the elbow is bent for a prolonged period or when pressure is applied to the ulnar nerve at the elbow.

To confirm the diagnosis and evaluate the severity of the condition, complementary tests, such as nerve conduction studies and electromyography, may be performed. These tests help determine nerve conduction velocity and muscle function, providing valuable information for diagnosis and treatment monitoring.

Cubital tunnel syndrome can present different phenotypes or patterns of presentation depending on the severity and underlying cause. Common phenotypes include:

  • Simple compression syndrome: In this phenotype, the main cause is compression of the ulnar nerve at the elbow due to prolonged position of the bent arm. It is common in people who work in occupations that require resting the elbow on a hard surface for long periods.
  • Intermittent compression syndrome: In this case, symptoms may come and go, often related to activities that involve repetitive bending of the elbow.
  • Ulnar nerve subluxation or dislocation syndrome: In some patients, the ulnar nerve may subluxate or slip out of its normal position in the elbow, aggravating symptoms.
  • Severe compression syndrome: In severe cases, constant compression of the ulnar nerve can cause permanent damage, including muscle atrophy and significant weakness in the hand.

The phenotype and severity of the condition influence treatment options and prognosis.


Treatment:

Treatment of cubital tunnel syndrome is based on the severity of the condition and its clinical manifestations.

In mild or early cases, conservative treatment may be sufficient. This may include modifying activities that trigger symptoms, using night splints to keep the elbow in a straight position, and physical therapy to strengthen the muscles and improve elbow mobility.

In some cases, corticosteroid injections may be given to the affected area to reduce inflammation and relieve symptoms.

When conservative treatment is not effective or when there is severe damage to the ulnar nerve, surgery may be necessary. Surgery may involve releasing the ulnar nerve or transposing the nerve to a less vulnerable position in the elbow. The type of surgery will depend on the underlying cause and severity of the condition.

After surgery, rehabilitation is essential to restore strength and function to the hand and elbow. This may include physical therapy exercises and regular medical follow-up.