Cubital Tunnel Syndrome
The Cubital Tunnel runs through your elbow and houses the ulnar nerve. This is the nerve that causes that zingy, somewhat uncomfortable sensation when you accidentally whack your elbow on something. It is commonly referred to as “hitting your funny bone”, but the sensation is due to nerve compression at the elbow and has nothing to do with a bone. When the ulnar nerve is compressed constantly at the elbow, Cubital Tunnel Syndrome can develop.
When patients complain of pain and numbness in their pinky (5th) finger and sometimes in their ring (4th) finger, it is usually Cubital Tunnel Syndrome.
A physical examination of the patient’s arm and hand is important for a diagnosis. These questions should be asked of the patient:
1. Where is your pain? Point to the area.
2. Describe the pain or numbness, i.e., throbbing, burning, knife-like, achy
3. Does the pain/discomfort come and go or remain constant?
4. Is there a time of day/night that it is worse?
5. What position is preferred when you sleep?
6. Does the problem cause you to awaken during the night?
7. Does moving your arm into a different position help your pain?
8. Does the hand go to sleep if you talk on the phone with the affected arm?
Usually, a person with Cubital Tunnel Syndrome will say that they have pain when their elbow is bent, and the discomfort is in the 4th and 5th finger. Most will say that they wake up in the night due to the discomfort and numbness.
X-rays of the elbow are usually ordered to rule out other conditions that could be causing the problem. Nerve conduction studies can be used for diagnosis, but can also miss the condition sometimes. The most useful diagnostic tools are usually the physical exam and asking the patient specific questions.
The first order of treating a person with Cubital Tunnel Syndrome is that they keep their elbow straight as much as possible, while working, at home and while sleeping. This can be difficult to do, as many patients work at a computer, talk on the phone and sleep with their elbows bent. To assist them, a nighttime elbow splint is recommended to keep the elbow straight while they are asleep, to let the ulnar nerve recover and the inflammation to decrease.
OTC medicines, such as ibuprofen or Aleve, can help with the inflammation and pain. If the patient has tried those already and they are still having pain, a non-steroidal anti-inflammatory medicine and/or an oral steroid medication may be prescribed.
Unfortunately, many people wait for so long to seek treatment that their ulnar nerve is significantly inflamed and damaged, making it impossible to treat effectively without surgery. Fortunately, there is a very- effective, outpatient surgical remedy called Endoscopic Cubital Tunnel Release that can fix the problem permanently.
The Cubital Tunnel Release surgery is done using a scope, inserted into a small incision near the elbow, which allows me to view the area with a tiny camera. One small incision is made for inserting surgical instruments through which the endoscopic release is done. After going into the Cubital Tunnel, a piece of stretchy tissue, called the fascia, is released to decompress the ulnar nerve and allow for healing and pain relief. It is very much like a Endoscopic Carpal Tunnel Release surgery, except that this procedure is done near the elbow, not the wrist/hand.
The benefits of this type of surgical release are as follows:
1. Outpatient surgery (No hospital overnight stay)
2. Less tissue damage, less blood loss
3. Smaller incision, smaller scar
4. Much quicker recovery time
5. Fewer post-surgical complications
6. Back to work, as soon as tolerated, heavy lifting as tolerated
7. Resume activities immediately, as tolerated
8. Most are working 5 days later.
The typical recovery period for patients is less than one week and they can do any activity in 2 days.
Are there any reasons a person cannot have Endoscopic Cubital Release Surgery?
Only if a patient has other conditions that need to be treated at the same time would that preclude the Endoscopic release. Patients with diabetes require special precautions, as they are more prone to post-operative infections and they take longer to heal. If a patient has any condition that causes them concern BEFORE having surgery, their OSC surgeon would commonly consult with their primary care physician or other specialists, such as Cardiologists, to make sure that it is safe for the patient to undergo the surgical procedure.
What are the complications?
While complications do occur in any surgery, they are rare for Cubital Tunnel Release. Infection can occur, but rarely does so. Because this surgery is minimally- invasive and doesn’t take a long time to perform, the patient is less exposed to infectious agents. Sometimes the Ulnar Nerve can subluxate (move) after the surgery and it may have to be repositioned. There is also a risk of nerve damage when this procedure is done by an inexperienced surgeon.
Cubital Tunnel Release affords the same quick recovery, if not quicker than even Endoscopic Carpal Tunnel Release!
There are other surgical procedures used to address this problem, but unless there is a very compelling reason to use them, they should be avoided. Medial epicondylectomy, where bone is removed from the elbow in order to relieve pressure on the ulnar nerve, is a complex surgery which can be very painful for the patient and can take a long time from which to recover.
Sometimes, the choice is made to move the ulnar nerve to the front of the elbow, but this can also be a very involved surgery and lengthen recovery time for the patient.