The condition known as cubital tunnel syndrome is the result of compression of the ulnar nerve in the area where it passes under a bony bump on the inside of the elbow.
This condition can occur on one or both elbows. The ulnar nerve is fairly unprotected in the area on the inside of the elbow and can end up trapped between the bone and the skin in the cubital tunnel.
While this particular area is not actually a bone, it is often referred to as your “funny bone.” So, when you hit this area just right and experience that tingling pain, you’re actually hitting your ulnar nerve.
This sensation goes down the inside of your arm to your pinky and ring fingers. When the ulnar nerve becomes compressed, it causes the same types of symptoms- only they don’t disappear so quickly. Of course, this nerve can be pinched at any point along its length, but the most common is in the cubital tunnel.
This condition most often results from prolonged pressure or stretching of this nerve. When you have your arm bent for a long period of time, such as when you’re holding the phone, the ulnar nerve is stretched across the inside of the elbow, which causes a reduction in blood flow and can result in irritation of the nerve.
Signs and Symptoms of Cubital Tunnel Syndrome
The condition of cubital tunnel syndrome can occur following a traumatic injury or incident such as a fracture of the elbow or can develop gradually over time.
Typically, it begins with sensations of tingling and/or numbness on the inside of your forearm and down to your hand. The typical signs and symptoms of this condition include:
- Intermittent numbness and/or pain and tingling that occurs as a result of bending the elbow over a period of time
- Tenderness on the inside of the elbow where the ulnar nerve is
- A decrease in sensation or problems determining the difference between dull and sharp objects when they are touched to the inside of the arm.
Some of the more advanced symptoms of this condition include the following:
- Difficulty holding on to objects
- Hand deformity where the fingers are bent inward, known as the “ulnar claw hand”
- Wasting away of the small muscles in the hand
Diagnosing Cubital Tunnel Syndrome
The condition of cubital tunnel syndrome must be officially diagnosed by a general practitioner or a physical therapist, or PT.
In most cases, the physical therapist will perform a comprehensive evaluation, including an assessment of your neck in order to rule out compression of the nerve where it starts.
Once the determination has been made that the nerve that is compressed is the ulnar nerve, the physical therapist is most likely to use the following tests:
- Observing and inspecting the forearm and elbow
By touching and moving the arm where the nerve is, the relationship to the elbow and the stability of the nerve can be determined.
- Tapping the ulnar nerve at the elbow, known as Tinel’s Sign Test
This is a sensory exam that includes a light touching and testing of the individual’s ability to tell the difference between temperature and dull/sharp stimuli.
- Checking the individual’s hand strength
- Checking the individual’s ability to grip and pinch
This condition can be clinically diagnosed without any additional testing. However, in some cases, your physician or physical therapist may refer you for tests such as electromyography, or EMG and/or a nerve conduction study, known as NCS.
These tests are meant to evaluate the ability of your nerve to conduct signals along its full length. They will reveal exactly where the compression is as well as estimate the extent of the compression.
What Can a PT do?
In most cases, the condition of cubital tunnel syndrome can be treated without the necessity of surgical intervention. Your PT can help you to figure out which activities cause your symptoms.
Once this determination has been made, your PT will most likely recommend avoiding any activity that aggravates your signs and symptoms for a period of time.
After all, the nerve is swollen and irritated. If the swelling and irritation can be reduced, the signs and symptoms should resolve on their own.
On the other hand, if you have a more advanced case of cubital tunnel syndrome, your PT will most likely make some modifications to your normal activities and may recommend that you use a splint to reduce/remove pressure from the nerve. As your condition improves, your PT will teach you the following:
Exercises to increase the range of motion: these will help you return muscles that have shortened due to protective posturing to full length and maintain the normal length of those that have not been affected.
Exercises to strengthen muscles: these exercises will help to restore strength that was lost- your PT will choose the exercises that will work best for you.
“Nerve gliding” exercises: your nerves have an ability to “stretch out” and your PT has been educated in the correct positions for nerve stretching and will work with you to make sure that you do safe, gentle stretching.
With regards to cubital tunnel syndrome, the nerve can end up becoming shortened and these exercises are the best way to return it to its normal length.
In some cases, surgery will be required. The longer the symptoms have been present, and the more you have experienced symptoms such as pain, tingling, numbness, and weakness, the more likely you will be to require surgery to correct your condition. A primary goal of surgery is to relieve any pressure on the nerve.
Your PT will take the time to design a personalized program after surgery based on the operation that is performed and the instructions of the surgeon.
Of course, every surgery will require unique treatments, but rehab after surgery will encompass many of the pre-surgery elements that were discussed above, except “nerve gliding.”
Modification of activities after surgery will be a major part of your rehab in order to prevent any recurrence of the symptoms of cubital tunnel syndrome in the future.
Prevention of Cubital Tunnel Syndrome
There is very little that is known at this time about preventing cubital tunnel syndrome. In most cases, the condition is not diagnosed until the symptoms are present. However, there are some general precautions that can be taken.
Some researchers have linked obesity to cubital tunnel syndrome- a healthy lifestyle and losing some weight can help prevent the development of this condition.
Individuals who work in careers that require holding their elbow in a bent position should change positions occasionally in order to prevent too much stress on the ulnar nerve.
One of the risk factors that has been identified is diabetes.
Some recommendations for modifying activities can cause disruptions in employment, but these modifications have been proven to offer the best response to treat cubital tunnel syndrome without surgery.