Treating Cubital Tunnel Syndrome due to Ulnar Nerve Entrapment

Have you ever wondered what cubital tunnel syndrome treatment looks like - or why it even matters? You might want to pay attention if you’ve ever felt a strange tingling or numbness in your ring and pinky fingers. But why should you care about something called cubital tunnel syndrome?

Imagine this: you’re sitting at your desk, powering through emails. Your arm is propped on the edge of your chair, and everything seems fine - until it isn’t. Your hand feels tingly out of nowhere, almost like it’s waking up after falling asleep. You shrug it off, thinking maybe you leaned on it wrong. But then, it happens again. And again. Soon, you notice it’s not just tingling; it’s a weird, dull ache traveling from your elbow down to your fingers. What’s happening?

That’s when you realize something might be up with your ulnar nerve. Here’s what you should do next!

What is cubital tunnel syndrome?

Cubital tunnel syndrome occurs when the ulnar nerve, often called the "funny bone" gets compressed or irritated as it passes through a narrow space in the elbow known as the cubital tunnel. Cubitus is Latin for elbow, thus “cubital”. Unlike some elbow conditions, which might involve bones or muscles, this one focuses on the nerve that controls sensations in the ring and pinky fingers and even some hand and finger movements.

Think of the cubital tunnel as a narrow hallway in your home. If you’re carrying a bulky box, it’s easy to bump into the walls. Similarly, when the ulnar nerve is squeezed in this tight space, it causes that telltale tingling, numbness, or even weakness in your hand. It’s like when you hit your funny bone—but instead of a quick jolt of electric discomfort, the feeling lingers. That’s how cubital tunnel syndrome makes its presence known.

"Cubital tunnel syndrome is the second most common nerve compression in the arm. Although the symptoms are usually in the fingertips and the hand, the pathology is based in the elbow and is often more difficult to treat then carpal tunnel syndrome. Conservative therapy may potentially solve the problem however surgical intervention is necessary in cases of persistent numbness and/or weakness."

Christian J. Zaino, MD

The Causes of Cubital Tunnel Syndrome

The causes of cubital tunnel syndrome are often tied to repetitive actions, poor posture, or prolonged pressure on the ulnar nerve at the elbow. These activities can gradually irritate the nerve, leading to the tingling, numbness, and/or weakness commonly associated with the condition. Here are a few common culprits: 

• Leaning on your elbows frequently: Resting your arms on hard surfaces can compress the ulnar nerve over time.

• Repetitive elbow bending: Actions like typing, using a mouse, or even talking on the phone for long periods with a bent elbow can increase strain.

• Sleeping with bent elbows: Holding your arms in a bent position while you sleep can restrict blood flow and compress the nerve.

• Direct trauma to the elbow: A sudden bump or injury can cause immediate irritation or inflammation.

Certain groups are more prone to this condition and are more likely to need cubital tunnel syndrome treatment. People with jobs requiring repetitive arm movements, like mechanics, musicians, or desk workers, are at a higher risk. Those with underlying conditions likediabetes may also have an increased chance of developing the syndrome due to pre-existing nerve sensitivity.

• Manual laborers: Tasks requiring constant lifting or bending of the arms can aggravate the nerve.

• Athletes: Sports involving repetitive elbow motion, like tennis or pitching, often put added strain on the cubital tunnel.

• Individuals with pre-existing health conditions: Conditions like obesity or diabetes can predispose people to nerve compression issues.

To wrap up, the causes of cubital tunnel syndrome often boil down to how we use (or overuse) our arms and elbows in daily life. If you suspect you might be at risk, a cubital tunnel syndrome test conducted by a doctor can help determine your next steps.

Cubital tunnel syndrome conservative treatment

There are 3 main conservative approaches to treating cubital tunnel syndrome.  Oral steroid taper, position modification (both while awake, and asleep using a nocturnal brace), and lastly home exercise therapy program called nerve glides.

These modalities aimed to limit the compression of the nerve by reducing inflammation, limiting direct pressure, and freeing the nerve from tight areas. Unfortunately, steroid injections have not been very successful, despite them being very helpful in carpal tunnel syndrome.  If these modalities are unsuccessful, surgery is an option.

Cubital tunnel syndrome surgery

Surgery becomes necessary when ulnar nerve entrapment symptoms - like persistent numbness, tingling, or hand weakness - don’t improve with non-surgical treatments or if the nerve damage worsens. At this point, surgery is often the best option to relieve pressure on the ulnar nerve and prevent further complications. 

It’s crucial to consult an expert, like those at a hand and upper extremity center, to ensure you’re getting the right diagnosis and treatment plan. Specialists in these centers can evaluate your symptoms and recommend the most suitable surgical option for your case.

Here are the common types of surgery for cubital tunnel syndrome:

• Ulnar nerve decompression: The surgeon releases the ulnar nerve compression by opening the cubital tunnel.

• Ulnar nerve transposition: The nerve is moved to a different location to reduce tension and irritation.

The most common procedure, ulnar nerve decompression, involves making a small incision near the elbow to release the pressure on the nerve. This outpatient procedure typically lasts around 30 to 60 minutes, and patients can go home the same day. Recovery involves wearing a soft bandage and gradually returning to normal activities as directed by your doctor.

Recovery Process After Cubital Tunnel Surgery

Recovery time after cubital tunnel surgery varies, but it typically takes 4 to 6 weeks for most people to resume normal activities. You might experience some swelling or discomfort initially, which usually subsides within the first two weeks. Full recovery, including regaining strength and function, can take up to three months, depending on the extent of the procedure and your adherence to aftercare instructions.

To make your life more comfortable during recovery, keep your arm elevated to reduce swelling and avoid activities that strain your elbow. Pain and inflammation can often be managed with prescribed medications or over-the-counter options. Incorporating cubital tunnel syndrome exercises under your doctor’s guidance is key to maintaining flexibility and preventing stiffness. These exercises might include gentle range-of-motion movements to help the nerve and surrounding tissues heal properly.

Sleeping can be tricky during recovery, but small adjustments can make a big difference. If you’re wondering how to sleep with cubital tunnel syndrome, try keeping your arm straight by wearing a lightweight splint or propping it up with a pillow. Avoid bending your elbow too much during the night, as this can strain the nerve. Staying mindful of your sleeping position can significantly improve your healing process.

Wrap up

Cubital tunnel syndrome treatment is essential for relieving pain, restoring nerve function, and improving your quality of life. From understanding the causes and symptoms to exploring surgical options and recovery strategies, taking proactive steps is key. Small adjustments can make a big difference, whether incorporating cubital tunnel syndrome exercises or learning how to sleep with cubital tunnel syndrome.

Relieve your cubital tunnel syndrome symptoms—schedule a consultation with the Orthopedic Institute of NJ to explore personalized treatment options today!

„

Cubital tunnel syndrome is the second most common nerve compression in the arm. Although the symptoms are usually in the fingertips and the hand, the pathology is based in the elbow and is often more difficult to treat then carpal tunnel syndrome. Conservative therapy may potentially solve the problem however surgical intervention is necessary in cases of persistent numbness and/or weakness.

Christian J. Zaino, MD, Orthopedic Surgery, Hand & Wrist