What is it?
Cubital tunnel syndrome is a set of symptoms most often brought on by chronic pressure on the ulnar nerve at the elbow in the bone-tendinous-muscular shaft , called cubital nerve groove
What causes it:
The cubital nerve is surrounded in the groove by the bone part: medial epicondyle of the humerus and soft tissues including muscles and tendinous structures of the forearm and arm. Increased pressure in the groove results in disturbance of nerve conductivity and leads to development of symptoms of the disease in a patient.
The pressure in the shaft can develop in a number of ways.
Inflammation conditions of soft tissues passing in the vicinity of the elbow joint may result in their overgrowth and increased pressure on the ulnar nerve in the shaft through outside tightening of the nerve .
Exerting outside pressure on the nerve by placing the elbow on a hard surface very often results in development of symptoms, particularly in a situation when the nerve is not properly isolated from the skin, e.g. by a layer of fat tissue.
The anatomic structure of this area very often predisposes development of the syndrome as in the situation when unhampered shift of the nerve in the groove is disturbed during repetitive bending and straightening of the elbow – the nerve is excessively stretched then and the symptoms appear. At times, the nerve is lying too loosely and when bending and straightening the elbow it rubs against the epicondyle which, if persistently repeated, results in occurrence of symptoms in the hand.
Signs and symptoms
Cubital tunnel major symptoms usually include numbness and tingling in the ring and little fingers and hypothenar – doctors call such symptoms paraesthesiae. Paraesthesiae are often accompanied by pain and loss of sensation in fingers.
The symptoms develop or worsen when the pressure in the groove increases, e.g. during repetitive elbow bending and straightening (while working) or when the nerve is repeatedly stretched, for example when talking over the phone.
Because the ulnar nerve in the hand is responsible for the sensation and movement, it is also connected with development of muscular atrophy on the hand.
In severe cases of the disease, dyspathia – as the Patients call it “”numb fingers”, can sustain and atrophy of the intrinsic muscles of the hand, which results in weakness while pinching, occasional clumsiness, and/or tendency to drop things. The hand may lose its efficiency and its looks may change.
Examination and diagnosis
Information obtained from a patient during his/her visit in the surgery – medical history of the patient – are the most important in diagnosing a disease. History taking applies to symptoms, time of their occurrence, their intensity, activities that cause them, a patient’s occupation and any coexisting diseases that might have influenced development of the Cubital Tunnel Syndrome.
It is very important to examine the efficiency and strength of a hand in order to determine the function of the intrinsic muscles of the hand.
Examination of the area of the groove allows provisional determination whether the nerve is “too tight” or “too loose” in its location.
Certain coexisting diseases often bring on development of disease symptoms, e.g. thyropathy, rheumatism, gout, diabetes.
The doctor may also ask how a patient has been treated earlier in connection with the occurrence of his symptoms.
Examination of the hands – doing specialist diagnostic tests and performing the electroneurography (ENoG) and electromyography (EMG)- helps to confirm the basic diagnosis and determine the degree of progression of the disease.
It is also useful to have certain biochemical bloodtests made, as well as X-ray/CT/MRI made of the cervical segment of the spine or X-ray of the elbow.
Sometimes the symptoms of the disease may spontaneously subside. Change of working condition or customs burdening the elbow area can also relieve or eliminate the symptoms.
Putting soft pads under the elbow while working, using immobilization in straightening the elbow for the night, may result in reduction or elimination of the symptoms of the disease, Applying physiotherapy in certain patients may lead to elimination of the symptoms of the disease.
When the intensification of the symptoms is more acute or there is no improvement following non-surgical treatment, a doctor may recommend a surgery, which involves releasing the ulnar nerve from the pressure in the groove, when the nerve is “too tight”, or stabilizing the nerve when the nerve is “too loose”.
Alleviation of the pressure is obtained by cutting through all the structures exerting external pressure on the structures of the ulnar nerve, and sometimes even performing partial, medial epicondylectomy. The nerve can be left in its place or transposed from the groove under the muscles or skin, the so called ulnar-nerve transposition.
Stabilization of the position of the nerve involves ulnar-nerve transposition.
Follow-up after the surgery
After the surgery, the symptoms of the disease may subside immediately or after a dozen or so months following the surgery. In case of an advanced disease, a patient may feel improvement in the form of decreased suffering, though some of the symptoms, such as finger numbness, muscular atrophy may sustain until the end of their life. A patient may also not notice any significant improvement in his or her hand efficiency, or any changes in the looks of the hand.
In some patients, further development / recurrence of the disease may occur, which is connected with coexisting diseases or performed occupation or, at times, for no apparent reason.
Another surgery may also be necessary in such case. Depending on the type of the performed surgery, a doctor always recommends follow-up treatment (e.g. restriction of elbow mobility, rehabilitation).
It should be noted that the final effect of the treatment depends of the degree of development of the disease as well as on cooperation between patients and their doctors.