Cubital Tunnel Syndrome is a condition characterized by compression of the ulnar nerve in an area of the elbow called the cubital tunnel.
The ulnar nerve travels down the back of the elbow behind the bony bump called the medial epicondyle, and through a passageway called the cubital tunnel. The cubital tunnel is a narrow passageway on the inside of the elbow formed by bone, muscle, and ligaments with the ulnar nerve passing through its center. The roof of the cubital tunnel is covered with a soft tissue called fascia.
When the elbow is bent, the ulnar nerve can stretch and catch on the bony bump. When the ulnar nerve is compressed or entrapped, the nerve can tear and become inflamed leading to a variety of symptoms, called cubital tunnel syndrome.
Signs and Symptoms
In general, signs and symptoms of Cubital Tunnel Syndrome arise gradually, progressing to the point where the patient seeks medical attention. Left untreated, Cubital Tunnel Syndrome can lead to permanent nerve damage in the hand. Commonly reported symptoms associated with Cubital Tunnel Syndrome include:
The common causes responsible for cubital tunnel syndrome, include:
Your physician will perform the following:
Your physician may order X-ray and electro diagnostic tests such as electromyography and nerve conduction studies. These tests can assist your doctor in determining how well the nerve is functioning and locate areas of muscle wasting and nerve compression.
Your physician will recommend conservative treatment options initially to treat the symptoms unless muscle wasting or nerve damage is present.
Conservative treatment options may include:
If conservative treatment options fail to resolve the condition or if muscle wasting or severe nerve compression is present, your surgeon may recommend a surgical procedure to treat your condition.
The goal of Cubital Tunnel surgery is to reduce the pressure on the ulnar nerve by providing more space for the nerve to move freely and to increase blood flow to promote healing of the ulnar nerve. There are different surgeries that can be performed to treat your condition, such as:
Medial Epicondylectomy: This surgery involves removing the medial epicondyle, the bony bump on the inside of the elbow, enabling the ulnar nerve to glide smoothly when the elbow is flexed and straightened.
Ulnar Nerve Transposition: This surgery involves creating a new tunnel in front of the medial epicondyle and transposing (moving) the ulnar nerve to the new tunnel.
Your surgeon will decide which options are best for you depending on your specific circumstances.
After surgery, your surgeon will give you guidelines to follow depending on the type of repair performed and the surgeon’s preference. Common post-operative guidelines include:
Risks and Complications
Most patients suffer no complications following Cubital Tunnel surgery, however, complications can occur following elbow surgery and include:
Tennis elbow is the common name used for the elbow condition called lateral epicondylitis. It is an overuse injury that causes inflammation of the tendons that attach to the bony prominence on the outside of the elbow (lateral epicondyle). It is a painful condition occurring from repeated muscle contractions at the forearm that leads to inflammation and micro tears in the tendons that attach to the lateral epicondyle. The condition is more common in sports activities such as tennis, painting, hammering, typing, gardening and playing musical instruments. Patients with tennis elbow experience elbow pain or burning that gradually worsens and results in a weakened grip.
Your doctor will evaluate tennis elbow by reviewing your medical history, performing a thorough physical examination and ordering X-rays, MRI or electromyogram (EMG) to detect any nerve compression.
Your doctor will first recommend conservative treatment options to treat the tennis elbow symptoms. These may include:
If conservative treatment options fail to resolve the condition and symptoms persist for 6 -12 months, your surgeon may recommend a surgical procedure to treat tennis elbow called lateral epicondyle release surgery. Your surgeon will decide whether to perform your surgery in the traditional open manner (single large incision) or endoscopically (2 to 3 tiny incisions and the use of an endoscope - narrow lighted tube with a camera). Your surgeon will decide which options are best for you depending on your specific circumstances.
Your surgeon moves aside soft tissue to view the extensor tendon and its attachment on the lateral epicondyle. The surgeon then trims the tendon or releases the tendon and then reattaches it to the bone. Any scar tissue present will be removed as well as any bone spurs. After the surgery is completed, the incision(s) are closed by suturing or by tape.
Following surgery, you are referred to physical therapy to improve the range of motion and strength of your joint.
The biceps muscle is in the front of your upper arm. It helps in bending your elbow, rotational movements of your forearm and maintaining stability in the shoulder joint. It has two tendons, one of which attaches it to the shoulder bone (proximal biceps tendon) and the other attaches it at the elbow (distal biceps tendon). The biceps tendon can tear at the shoulder or elbow with overuse, or injury when you lift heavy objects or fall on your hand.
Biceps tendons can tear partially or completely. The most common symptoms are sudden, severe pain in the upper arm, “pop” sound, swelling, visible bruising, weakness in the elbow, trouble turning your arm from a palm up to a palm down position, and a gap in the front of the elbow caused by the absence of the tendon. A characteristic bulge called a “Popeye muscle” may appear in your arm caused by the recoiled, shortened biceps muscle.
Biceps tendon rupture is usually diagnosed based on your symptoms, medical history and physical examination. During the physical examination, your doctor will look for a gap in the tendon by palpating the front part of your elbow, and diagnose a partial tear by the presence of pain when you bend your arm and tighten the biceps muscle. X-rays may be taken to rule out other conditions causing elbow pain and an MRI scan, to determine if the tear is partial or complete.
Mild biceps tendon tears can be treated with conservative methods such as rest, ice application, non-steroidal anti-inflammatory medications (NSAIDs) and physical therapy. When nonsurgical methods fail to relieve symptoms, surgery is performed to reattach the torn tendon to the bone. This can be done by drilling holes in the bone and anchoring the tendon with stitches or by using small metal implants.