HAND/WRIST
Many of us either have, or know someone who has carpal tunnel syndrome. At the very least, the majority of individuals have heard of it. This is not surprising since carpal tunnel syndrome is the most common nerve compression in the upper extremity. The second most common nerve compression….. cubital tunnel syndrome, the not as well known cousin of carpal tunnel syndrome. Knowledge of this condition, its diagnosis and treatment are important when evaluating anyone with numbness or tingling in the hands.
Cubital tunnel syndrome is a condition that involves pressure or stretching of the ulnar nerve and commonly leads to numbness or tingling in the small and ring fingers. The ulnar nerve travels in a groove on the inside (medial side) of the elbow and travels down to the hand. The nerve can be stretched by keeping the arm bent at the elbow for prolonged periods of time, for example during sleep. Direct pressure to the nerve can also play a role since it is not well padded. Leaning on an arm rest or resting your arm out an open car window may result in symptoms.
The most common presenting symptom is a lack of sensation which can effect the small and ring fingers. This lack of sensation is usually described as “pins and needles”. Some individuals will present with hand weakness or discomfort in their forearm. All or some of these symptoms may be experienced while sleeping, driving or talking on the phone, actions that keep the elbow bent for an extended period of time.
The diagnosis of cubital tunnel syndrome can often be made by combining a thorough history and physical exam. Sometimes nerve studies are needed, especially when there is a question of a pinched nerve in the neck. A nerve study helps evaluate how the ulnar nerve and the muscles it supplies are working.
Treatment options are dictated by symptoms, exam findings and nerve study results. For mild cases, the first line of treatment is to avoid actions that cause symptoms. Simply wrapping the elbow in a towel at night is an easy way to keep it from bending. Also modifying any activities that apply direct pressure to the inside of the arm. In more severe cases that involve muscle weakness/wasting and/or near constant numbness and tingling, surgery may be required. A detailed nerve study and its interpretation can guide surgical options which include: nerve release (at the elbow and/or wrist), nerve transposition or moving the nerve out of its groove under the elbow or removing a portion of elbow bone. In the appropriate individual a nerve transfer is also possible. A nerve transfer takes a properly working nerve and plugs it into the ulnar nerve to help regain function.
Used with permission from Dr. Susan E. Mackinnon, Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine
Cubital tunnel syndrome is common nerve compression condition. Recognition of early symptoms is the best way to ensure a meaningful recovery. This is important because in advanced conditions, complete recovery is not always possible.
