Cubital tunnel syndrome (ulnar nerve entrapment)
Pain and numbness in the little finger – when the ulnar nerve suffers
Cubital tunnel syndrome means damage to the ulnar nerve caused by pressure. This leads to numbness in the ring and little fingers, to cramping, or to weakness in the hand. On the inner side of the elbow (the "funny bone") the ulnar nerve runs in a narrow bony groove. At the end of the groove it passes beneath a strong layer of fibrous tissue into the compartment of the forearm muscles. Cubital tunnel syndrome can be caused by osteoarthritis of the elbow joint. The nerve can also be damaged by repeatedly slipping out of the groove when the elbow is bent. Finally, activities in which the elbow rests on a surface for long periods can lead to such changes.
Symptoms
Cubital tunnel syndrome usually develops gradually. At first the symptoms occur only occasionally – after holding the elbow bent for a longer period, while on the phone, or at night. Over time, however, the symptoms can increase and persist, particularly if the pressure on the ulnar nerve is not relieved in time.
Numbness
The ring and little fingers go to sleep and tingle
Cramping
The fingers cramp up
Weakness in the hand
Wasting or loss of the intrinsic muscles of the hand and of the hypothenar eminence
When should you seek medical advice?
Early signs of cubital tunnel syndrome – tingling or numbness in the ring and little fingers – are frequently not taken seriously at first. These symptoms often occur at night or after holding the elbow bent for a longer period, and improve on their own to begin with. If the symptoms increase, persist for longer or go together with a loss of strength, a medical assessment is advisable. Only then can lasting damage to the nerve be prevented.
Treatment options for cubital tunnel syndrome
The aim of treatment is to reduce the pressure on the ulnar nerve, preserve the function of the nerve and relieve the symptoms. Depending on how pronounced it is, non-surgical measures or an operation come into consideration.
Treatment options
Non-surgical and surgical – we will find the right approach for you
Relieving pressure with a padded support
The padding and the light guidance of the joint take load off the irritated nerve, the irritation subsides, and symptoms such as tingling, numbness or pain can improve markedly
Night splint
A special splint holds the elbow in a slightly bent position and so prevents the nerve being irritated unconsciously during sleep.
Physiotherapy
Stretching, mobilisation techniques and strengthening of the surrounding muscles can help to take load off the nerve.
Anti-inflammatory painkillers
Ibuprofen relieves the symptoms but does not treat the cause of cubital tunnel syndrome. It is well suited as a bridge, or alongside other measures – immobilisation or physiotherapy, for example.
Simple decompression (open or endoscopic technique)
In a simple decompression the constricting tissue around the nerve – in particular the fibrous layer over the groove (the retinaculum) – is carefully divided. This gives the nerve more room without changing its position.
Moving the nerve (transposition of the ulnar nerve)
In certain cases the nerve is moved in front of the bony groove during the operation, in order to protect it from being constricted again in the long term. This is known as an anterior transposition.
Subcutaneous transposition: moving the nerve directly beneath the skin
Subfascial or submuscular transposition: moving it into deeper tissue or beneath a muscle, for instance in patients who are active in sport or where there is marked instability
Correcting the bone
Where there are accompanying changes in the bone – through osteoarthritis, old fractures or deformity, for example – adjusting the bone can be worthwhile.
Our elbow specialists
Experienced consultants for cubital tunnel syndrome and elbow surgery
