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Cubital Tunnel Syndrome

Carpal Tunnel Syndrome which is the sister condition is very common and familiar to many is trapped median nerve at the wrist. Cubital Tunnel Syndrome is also quite common and affects the ulnar nerve which gets trapped at the elbow (the funny bone). The cause is not very clear but it is seen in all age groups but less so below the age of 30. The nerve passes behind the elbow where it is held by a ligament forming the Cubital tunnel. This is where the nerve is commonly trapped.

Symptoms

Initial symptoms are pain, pins and needles or tingling which is typically felt in the little finger and half of the ring finger. It is intermittent and comes on at night or during work especially when the arm is bent. Pain is felt at the funny bone and extends along the side of the forearm to the little and ring fingers. Later on these symptoms become constant. When the condition is advanced, there is weakness and wasting of muscles in the hand and forearm. This leads sometimes to clawing of little and ring fingers and clumsiness of movements of fingers and thumb.

Diagnosis

Diagnosis is reached by listening to patient symptoms and examination of hand and elbow. There is tenderness along the nerve at the elbow and touching and tapping the nerve causes tingling in the little finger. Bending the elbow fully worsens the pins and needles. Close examination of hand shows wasting and weakness and clawing of little and ring fingers.

Diagnosis is confirmed by Nerve conduction studies and EMG. This not only detects the level at which the nerve is trapped but also the severity and likelihood of recovery after treatment.

Treatment

In very early cases some adjustment in work and life style may help but for most patients the treatment is surgical release of the nerve. This is a small operation which is done under regional or general anaesthesia as a day case. The operation helps the pain and discomfort within a few days. The sensory symptoms (pins and needles) can take some months to improve. Recovery of motor symptoms such as muscle weakness and wasting is often incomplete and could take years. Even in severe cases the operation at least stops the condition from getting worse which is very likely if it is left untreated.

Recovery from the operation is swift and sutures are removed at 10 to 14 days. The risks of operation are infection and lack of full nerve recovery. Risk of nerve damage is very low.

Another operation which is also sometimes performed is release of nerve and then the nerve is transferred to the front of the elbow (Anterior Transposition) and therefore a more direct route. This is usually done for cases where there have been previous operations at the site and scarring around the nerve.

Nasser Hyder
FRCS (Trauma & Orth)
Consultant Trauma and Hand Surgeon

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