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Cubital Tunnel Syndrome

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Introduction

Cubital Tunnel Syndrome is a condition that involves pressure on the ulnar nerve (also known as the “funny bone” nerve) which can cause numbness or tingling in the ring and little digits, pain in the forearm, and/or weakness in the hand. This known as an Ulnar Neuropathy.

 

A diagnosis can be made by your specialist Physiotherapist or General Practitioner. Examination is very important to ensure the correct diagnosis made as this diagnosis can present in a similar way to other pathologies around the neck and shoulder area.

Signs & Symptoms

  • Paraesthesia or numbness of the small finger, outside half of the ring finger and the adjacent areas of the palm and knuckle side of the hand.
  • You may experience night pain including numbness and tingling, particularly when the elbow is bent.
  • Reduced grip strength resulting from muscle weakness in the affected regions of the hand that are supplied by the ulnar nerve.
  • Commonly you may also experience a dull aching pain on the inside of the elbow as the nerve passes from the upper arm to the lower arm through the inside of the elbow.
  • You may also report non-painful snapping or popping during active and passive flexion and extension of the elbow.

 

 

On observation, there may be atrophy (muscle wasting) of the intrinsic muscles of the hand pads, associated with certain aspects known as the hypothenar and thenar eminence. This may often lead to an abnormal claw posture of the 4th and 5th fingers – also known as Bishops deformity.

Causes

There are a number of mechanisms that lead to an ulnar nerve problem, but mainly it is caused as a result of direct pressure on the nerve causing impingement; known as a mechanical factors. Direct trauma or other space-occupying lesions may compress the ulnar nerve.

 

In addition, co-morbidities such as inflammatory arthritis, anatomical irregularities, metabolic disorders, congenital abnormalities and certain occupations which require repetitive bending and straightening of the elbow, may contribute to the development of cubital tunnel syndrome.

Assessment & Diagnosis

Your Physio will ask for a history of your symptoms proceeded by carrying out a clinical examination so that a precise and timely diagnosis can be given, ensuring the most effective treatment can be put in place immediately. Your Physiotherapist will work closely with you to set individualised treatment goals for you to aim at, and will regularly re-assess you to measure your progress and make any necessary modifications in your treatment.

Self-Management

Depending on the severity and irritability of your symptoms, your specialist Physiotherapist may initially recommend a splint to immobilise the elbow joint to reduce symptom severity. Alongside the use of a splint, medical management is often employed to treat symptoms including the associated neuropathic pain and inflammation. You will also be educated on the condition and your Physio will recommend useful strategies for performing certain activities in different ways to avoid aggravating your symptoms.

Physiotherapy

Your musculoskeletal clinician will devise a specific exercise programme for you, aimed at offloading the mechanical compression of the ulnar nerve and increase the resilience of the articulating soft tissue structures. Your Physio may also use hands on treatment techniques focused on reducing your pain and restoring any function which may be lost. You will be provided with ongoing advice and support so that you feel confident in managing your symptoms and preventing re-occurrence.

Escalation of Treatment

Often conservative management is utilised for 8-12 weeks before surgical consideration. In severe cases and where limited progress is made, a corticosteroid injection may be deliberated; particularly in those cases where cubital tunnel syndrome is associated with inflammatory arthropathies such as Ankylosing Spondylitis, Rheumatoid Arthritis, Gout and Psoriatic arthritis.

References

Kooner, S., Cinats, D., Kwong, C., Matthewson, G., & Dhaliwal, G. (2019). Conservative treatment of cubital tunnel syndrome: A systematic review. Orthopedic reviews, 11(2).

 

Wojewnik, B., & Bindra, R. (2009). Cubital tunnel syndrome–Review of current literature on causes, diagnosis and treatment. Journal of hand and microsurgery, 1(02), 76-81.

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