elbow-elbow cubital tunnel

8/11/2019 Elbow-elbow Cubital Tunnel

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Patients Guide toubital Tunnel Syndrome

The Methodist Hospital SystemMethodist Orthopedics6565 Fannin StreetHouston, TX 77030Phone: 713-790-3311

The Methodist Hospital System


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A Patient's Guide to Cubital Tunnel Syndrome

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DISCLAIMER: The information in this booklet is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information sho uld NOT be used in place of a visit with your health care provider, nor should you disregard the advice of your health care provider because of any information you read in this booklet.

All materials within these pages are the sole property of Medical Multimedia Group, LLC and are used herein by permission. eOrthopod is aregistered trademark of Medical Multimedia Group, LLC.


The Methodist Hospital SystemMethodist Orthopedics6565 Fannin StreetHouston, TX 77030Phone: 713-790-3311http://www.methodistorthopedics.com



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Introduction

Cu ita tunne syn rome is a condition thataffects the u nar nerve where it crosses theinside edge of the elbow. The symptomsare very similar to the pain that comes fromhitting your funny bone. When you hityour funny bone, you are actually hittingthe ulnar nerve on the inside of the elbow.There, the nerve runs through a passagecalled the cu ita tunne . When this areabecomes irritated from injury or pressure, itcan lead to cubital tunnel syndrome.

This guide will help you understand what causes this condition ways to make the pain go away what you can do to prevent future

roblems

natomy

hat is the cubital tunnel?

The ulnar nerve actually starts at the side ofthe neck, where the individual nerve rootsleave the spine. The nerve roots exit throughmall openings between the vertebrae. These

openings are called neura foramina .

The nerve roots join together to form threemain nerves that travel down the arm to thehand. One of these nerves is the ulnar nerve.

The ulnar nerve passes through the cubital tunne just behind the inside edge of theelbow. The tunnel is formed by muscle,ligament, and bone. You may be able to feelit if you straighten your arm out and rub thegroove on the inside edge of your elbow.

The ulnar nerve passes through the cubitaltunnel and winds its way down the forearmand into the hand. It supplies feeling to thelittle finger and half the ring finger. It worksthe muscle that pulls the thumb into the palmof the hand, and it controls the small muscles(intrinsics ) of the hand.

Causes

hat causes cubital tunnel syndrome?

Cubital tunnelyndrome haseveral possible

causes. Part ofthe problem may

lie in the waythe elbow works.The ulnar nerveactually stretcheseveral millime-

ters when theelbow is bent.

ometimes the



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nerve will shift or even snap over the bony media epicondy e . (The medial epicondyleis the bony point on the inside edge of theelbow.) Over time, this can cause irritation.

One common cause of problems is frequentbending of the elbow, such as pulling levers,

reaching, or lifting. Constant direct pressure onthe elbow over time may also lead to cubitaltunnel syndrome. The nerve can be irritatedfrom leaning on the elbow while you sit at adesk or from using the elbow rest during along drive or while running machinery. Theulnar nerve can also be damaged from a blowto the cubital tunnel.

Symptoms

hat does cubital tunnel syndrome feel like?

Numbness on the inside of the hand and in thering and little fingers is an early sign of cubitaltunnel syndrome. The numbness may developinto pain. The numbness is often felt when theelbows are bent for long periods, such as whentalking on the phone or while sleeping. Thehand and thumb may also become clumsy asthe muscles become affected.

Tapping or bumping the nerve in the cubital

tunnel will cause an electric shock sensationdown to the little finger. This is called Tine 'ssign .

agnos s

How will my doctor know I have cubitaltunnel syndrome?

Your doctor will take a detailed medicalhistory. You will be asked questions aboutwhich fingers are affected and whether or notyour hand is weak. You will also be askedabout your work and home activities and anypast injuries to your elbow.

Your doctor will then do a physical exam.The cubital tunnel is only one of several spotswhere the ulnar nerve can get pinched. Yourdoctor will try to find the exact spot that iscausing your symptoms. The prodding mayhurt, but it is very important to pinpoint thearea causing you trouble.

You may need to do special tests to get moreinformation about the nerve. One commontest is the nerve con uction ve ocity (NCV)test. The NCV test measures the speed of theimpulses traveling along the nerve. Impulsesare slowed when the nerve is compressed orconstricted.

The NCV test is sometimes combined withan e ectromyogram (EMG). The EMG teststhe muscles of the forearm that are controlledby the ulnar nerve to see whether the musclesare working properly. If they aren't, it may bebecause the nerve is not working well.

rea men

How can I make my pain go away?

Nonsurgical Treatment

The early symptoms of cubital tunnelyndrome usually lessen if you just stop

whatever is causing the symptoms. Anti-inflammatory medications may help controlthe symptoms. However, it is much moreimportant to stop doing whatever is causingthe pain in the first place. Limit the amount oftime you do tasks that require a lot of bendingin the elbow. Take frequent breaks. If neces-ary, work with your supervisor to modify

your job activities.



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If your symptoms are worse at night, a light-weight plastic arm splint or athletic elbowpad may be worn while you sleep to limitmovement and ease irritation. Wear it with thepad in the bend of the elbow to keep the elbowtraight while you sleep. You can also wear the

elbow pad during the day to protect the nervefrom the direct pressure of leaning.

Doctors commonly have their patients withubital tunnel syndrome work with a physical

or occupational therapist. At first, your thera-pist will give you tips how to rest your elbowand how to do your activities without puttingextra strain on your elbow. Your therapist mayapply heat or other treatments to ease pain.Exercises are used to gradually stretch andtrengthen the forearm muscles.

Surgery

Your symptoms may not go away, even withhanges in your activities and nonsurgical treat-

ments. In that case, your doctor may recommendurgery to stop damage to the ulnar nerve.

The goal of surgery is to release the pressureon the ulnar nerve where it passes through theubital tunnel. There are two different kinds ofurgery for cubital tunnel syndrome. It is notlear whether one operation is better than the

other.

Ulnar Nerve Transposition

One method is called ulnar nerve transposition . In this procedure, the surgeon forms acompletely new tunnel from the f exor musclesof the forearm. The ulnar nerve is then moved(transposed out of the cubital tunnel and

placed in the new tunnel.

Medial Epicondylectomy

The other method simply emoves the medial

epicondyle on the inside edge of the elbow,a procedure called me ia epicon y ectomy .



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By getting the medial epicondyle out of theway, the ulnar nerve can then slide through theubital tunnel without pressure from the bony

bump.

Cubital tunnel surgery is often done as anoutpatient procedure. This means you won't

have to stay in the hospital overnight. Surgeryan be done using a genera anest etic , which

puts you to sleep, or a regiona anest etic Aregional anesthetic blocks the nerves in onlyone part of your body. In this case, you wouldhave an xi ary oc , which would affectonly the nerves of the arm.

Rehabilitation

hat can I expect after treatment?

Nonsurgical Rehabilitation

If nonsurgical treatments are successful, youmay see improvement in four to six weeks.Your physical or occupational therapist workswith you to ease symptoms and improve elbowfunction. Special exercises may be used to helpthe ulnar nerve glide within the cubital tunnel.Treatment progresses to include strengtheningexercises that mimic daily and work activities.

You may need to continue wearing your elbowpad or splint at night to control symptoms. Tryto do your activities using healthy body andwrist alignment. Limit repeated motions of thearm and hand, and avoid positions and activi-ties where the elbow is held in a bent position.

After Surgery

Recovery after elbow surgery depends on theprocedure used by your surgeon. If you onlyhad the medial epicondyle removed, you'll

have a soft bandage wrapped over your elbowafter surgery. Therapy can progress quicklyafter this type of surgery. Treatments start outwith range-of-motion exercises and gradually

work into active stretching and strengthening.You just need to be careful to avoid doing toomuch, too quickly.

Therapy goes slower after ulnar nerve trans-position surgery. You could require therapyfor three months. This is because the flexor

muscles had to be sewn together to form thenew tunnel. Your elbow will be placed in aplint and wrapped in bulky dressing, and your

elbow will be immobilized for three weeks.

hen the splint is removed, therapy will beginwith passive movements. In passive exercises,your elbow is moved, but your muscles stayrelaxed. Your therapist gently moves your armand gradually stretches your wrist and elbow.You may be taught how to do passive exer-

cises at home.Active therapy starts six weeks after surgery.You begin to use your own muscle powerin active range-of-motion exercises. Lightisometric strengthening exercises are started.You may begin careful strengthening of yourhand and forearm by squeezing and stretchingpecial putty. These exercises work the

muscles without straining the healing tissues.

At about eight weeks, you'll start doing moreactive strengthening. Your therapist will giveyou exercises to help strengthen and stabilizethe muscles and joints in the wrist, elbow, andhoulder. Other exercises are used to improve

fine motor control and dexterity of the hand.

ome of the exercises you'll do are designedget your elbow working in ways that areimilar to your work tasks and sport activities.

Your therapist will help you find ways to doyour tasks that don't put too much stress onyour elbow. Before your therapy sessions end,your therapist will teach you a number of waysto avoid future problems.



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