Cubital Tunnel Syndrome – Treatment of Ulnar Nerve Entrapment
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The term cubital tunnel syndrome (sulcus ulnaris syndrome) refers to an entrapment of the ulnar nerve in the region of the elbow. At the elbow, the ulnar nerve runs relatively exposed in a narrow groove, the ulnar groove – also known as the funny bone – and can be damaged by constant incorrect strain or other irritation.
Because the nerve lies directly on the bone, it is easily exposed to damage. Frequent bending and stretching or habitually leaning on the elbow promote a nerve entrapment syndrome. Initially, most patients feel a slight numbness in the ring finger and little finger of the affected hand. Later, the entire hand musculature may become affected, up to restricted mobility.
A diagnosis of cubital tunnel syndrome can already be made based on the patient's description; however, it is important that you first have an examination by a neurologist, who measures the nerve conduction velocity, for example.
Thanks to Dr. Karl Schuhmann's many years of medical and surgical experience as a hand surgeon, you are in the best hands with Dr. Karl Schuhmann for the treatment of cubital tunnel syndrome.
At a glance
- Symptoms: Tingling and numbness in ring and little finger, later muscle wasting up to claw hand
- Anaesthesia: Plexus anaesthesia (axillary nerves) or general anaesthesia, in a bloodless arm
- Stay: Usually outpatient
- Methods: Splitting the constricting tissue or nerve transposition; also endoscopic minimally invasive
- Immobilisation: With nerve transposition, immobilisation of the arm for 2 weeks
- Result: Stops further progression of the syndrome in 90 % of cases
Cubital Tunnel Syndrome – The Symptoms
Cubital tunnel syndrome leads to sensory disturbances and pain in the hand. If treatment is declined, the hand can only be moved to a limited extent in everyday life. The first symptoms of cubital tunnel syndrome are tingling and a numb feeling in the little finger and the ring finger. This tingling and the numbness frequently also occur along the outer edge of the hand. This sensation can then extend from the outer edge of the hand up into the forearm. Pain is rarer. As the disease progresses, the small hand musculature decreases and the fingers, in particular the 4th and 5th fingers, can no longer be spread forcefully. Paralysis and muscle wasting of the small hand muscles, however, only occur later. In pronounced cases of the disease, a claw hand develops.
The Different Procedures for Treating Cubital Tunnel Syndrome
Initially, splints are used in an attempt to relieve the pressure.
In the case of chronic pain, however, surgery is necessary. During the operation, the tissue constricting the nerve is divided in the region of the elbow and toward the forearm, so that the nerve regains more freedom.
Another method is to relocate the nerve from its original path of movement onto a less stressful path. In this case, immobilization of the arm for 2 weeks is required. Both surgical methods are primarily designed to stop the further progression of the syndrome, which is the case in 90% of patients.
Which procedure is used in your specific case of cubital tunnel syndrome is determined by a thorough examination.
Ulnar Nerve Entrapment – Therapy & Treatment
At the first signs of numbness and tingling, it is often sufficient as therapy for cubital tunnel syndrome to eliminate the causative circumstances. In a desk job, for example, this includes no longer resting the elbows on the table. Such incorrect postures should be corrected, and certain habits of constantly supporting the elbow in a particular way should be changed.
Once the causative factors leading to the condition have been eliminated, conservative treatment methods should be applied as an accompaniment in the early stage, such as relieving the elbow by elevating it and cooling the inner elbow area. It may also become necessary to immobilize the affected elbow for a certain period of time. This is usually done with a plaster cast or splint to allow the ulnar nerve to regenerate. In chronic and advanced cases, conventional and minimally invasive surgical procedures are available.
In the endoscopic, minimally invasive method, disruptive tissue is removed with the help of an endoscope and a cutting instrument in order to relieve the pressure.
Cubital Tunnel Syndrome – The Operation
The operation can generally be performed on an outpatient basis under plexus anesthesia (anesthesia of the arm nerves in the area of the armpit) or under general anesthesia. The procedure is carried out with the arm exsanguinated (in a bloodless field) in order to give the surgeon a good view and to avoid major bleeding.
During the operation, the pressure on the ulnar nerve is relieved by exposing the nerve. Then, for example, scars and adhesions in the area of the ulnar groove at the elbow are released and removed in order to eliminate the causes of the nerve entrapment. If the site of the nerve constriction is at the wrist, this is referred to as carpal tunnel syndrome, which can also be operated on minimally invasively.
Dr. Schuhmann in der Presse
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