Cubital Tunnel Syndrome: Symptoms & Treatment
There are three primary nerves when we talk about sensation in the hand. One of them is called your median nerve, and that is going to give you sensation in your thumb, index finger, long finger, and half of your ring finger. The second nerve is called your ulnar nerve, which we colloquially call your “funny bone.” It runs right behind that area at your elbow and gives you sensation to your small finger and part of your ring finger. Then your radial nerve gives sensation on most of the back of your hand.
There are a couple different places where the ulnar nerve can be compressed as you see in cubital tunnel syndrome. Almost all of the time, it’s at the elbow, between the point of your elbow and the bump on the inside. That ulnar nerve runs there in a tunnel called the cubital tunnel.
A compression on the nerve initially is going to be felt by the patient as numbness, usually. It frequently will start off as intermittent numbness. In the case of cubital tunnel syndrome, that intermittent numbness tends to occur when the elbow is in a flexed position, so for a lot of people, the initial presenting symptom will be numbness at night from sleeping with their elbow in a bent position, or numbness in their ring and small finger when they talk on the phone.
The procedure for cubital tunnel syndrome at its simplest involves just taking the pressure off the nerve. All the different ways for taking the pressure off the nerve seem to work about the same. In that instance my general approach is, I’m going to do the one that’s least invasive. So that is something we call an ulnar nerve decompression. That’s an incision about [1-2 inches big] – that’s what we start with. We go in, and we just merely open the tunnel and remove the pressure off the nerve. Now there are some people who – after you open that tunnel up and bend the elbow during the procedure – their nerve is unstable…it’s moving around too much. In that instance, what we need to do is called an ulnar nerve transposition, and that’s actually to take the nerve and move it up in front of the boney bump.
Some people need to do physical therapy after cubital tunnel syndrome surgery, but there are a lot of people who actually don’t need to do any therapy. I think the likelihood that you need therapy is a little bit higher if you’re doing the ulnar nerve transposition.
I encourage people, if they’re having symptoms of cubital tunnel syndrome with numbness and tingling, it’s something to get evaluated. It may be that it’s going to get better on its own. It may be that you can manage the cubital tunnel symptoms for a long period of time without needing surgery, but the risks associated with leaving a compression on that nerve in terms of long term function of your hand is very high.