Cubital Tunnel Syndrome

The cubital tunnel is an area in the elbow where the ulnar nerve is located, which is one of the three major nerves of the hand and forearm. This is often referred to as the “funny bone”. Pressure or irritation of the nerve can occur due to a variety of reasons include direct pressure on the nerve from leaning on it, compression from the surrounding tissues, stretch on the nerve if the elbow is bent for long periods such as while sleeping, subluxation or “snapping” of the nerve if it slides around, or bone spurs from prior fractures or other trauma.

Symptoms of cubital tunnel syndrome typically include numbness or tingling (“paresthesias”) that occur in a characteristic pattern involving the small finger (“pinky”) and half of the ring finger. More severe cubital tunnel syndrome may result clumsiness or in weakness in the hand. With severe compression over a long period of time, muscle atrophy or wasting may occur, which typically is irreversible. When seeing your surgeon, there are specific physical examination maneuvers that are used to test for cubital tunnel syndrome. In some situations, electrodiagnostic testing with nerve conduction studies (NCS) and electromyography (EMG) is necessary. This is a special test typically performed by a neurologist or physical medicine and rehabilitation specialist (PM&R or physiatrist). These tests assess the function of the nerves and can assess for other nerve problems, including a pinched nerve in the neck.

Treatment options depend on the severity of cubital tunnel syndrome and ulnar nerve compression. Non-surgical treatment options typically include avoiding bending or flexing the elbow, which increases pressure on the nerve. This often is needed only at night and can be achieved with a splint or by using a pillow or towel wrapped around the elbow

Surgical treatment involves relieving pressure on the nerve. This may require only a small incision to release tight bands around the nerve or may require a more extensive operation in which either part of the bony prominence at the elbow is removed (known as a “medial epicondylectomy”) or the nerve is moved in front of the elbow to help reduce tension on the nerve (known as an “anterior transposition”). The decision for this is based on the type and severity of symptoms.

In some situations where there is compression on the nerve resulting in muscle weakness, a distal nerve transfer near the level of the wrist known as an AIN (anterior interosseous nerve) to ulnar motor nerve transfer is performed in order to preserve muscle strength in the hand.

Surgery decreases pressure and tension on the ulnar nerve and often results in gradual improvement in the numbness and tingling symptoms. Muscle weakness may or may not improve, but surgery should slow or stop progression of any further weakness. Recovery will depend on which surgery is performed.

Be sure to see an experienced surgeon to treat this condition. Our fellowship-trained specialists at The Buncke Clinic in San Francisco treat patients with cubital tunnel syndrome from across the Bay Area and Northern California. Contact us to schedule a consultation.

Below are links for third party resources

American Society for Surgery of the Hand

American Academy of Orthopaedic Surgeons