CUBITAL TUNNEL SYNDROME

Cubital tunnel syndrome refers to entrapment of the ulnar nerve in its passage around the medial aspect of the elbow. The ulnar nerve normally passes through the anatomic cubital tunnel, which is a fibroosseous ring formed by the medial epicondyle and the proximal part of the ulna.

Beyond the elbow, the nerve travels under muscles on the inside of the arm and into the hand on the side of the palm with the little finger. As the nerve enters the hand, it travels through another tunnel (Guyon's canal).


The nerve functions to give sensation to the little finger and the half of the ring finger that is near the little finger. It also controls most of the little muscles in the hand that help with fine movements, and some of the bigger muscles in the forearm that help to make a strong grip. (bottom right figure)

The syndrome may result from compression, traction, friction, or direct trauma to the ulnar nerve.  Compression is thought to be the most frequent cause.

Symptoms

The hallmard complaints of the patients are numbness and tingling in the ring and small fingers and medial forearm pain.
Patients with cubital tunnel syndrome frequently suffer from nocturnal symptoms. In addition, complaints of vague ulnar forearm pain, tenderness on the medial aspect of the elbow and hand clumsiness frequently are reperted. Throwing athletes may suffer from chronic traction injury of the ulnar nerve.

CONSERVATIVE TREATMENT
THERAPY: 

Nonoperative management of cubital tunnel syndrome is frequently successful. Prolonged periods of elbow flexion are often the source of nerve irritation. A careful history of work and lifestyle habits often reveals obvious sources of nerve irritation.

Patient should be educated to avoid prolonged periods of elbow flexion and limit resting the elbow on hard surfaces.

Patients with nocturnal symptoms often benefit from night splints.

The corticosteroids injections in to the cubital tunnel is not recommended.
Anti-inflammatory drugs helps to reduce the nerve edema and inflammation

OPERATIVE TREATMENT
THERAPY: 

OPERATIVE TREATMENT

Surgical release of the cubital tunnel considered as the final solution of this common problem.
Indication for nerve decompression refers the situation in which nonoperative treatment has failed to relieve the symptoms.

Absolute indications are:

 

  • Α history consistent with the diagnosis and physical examination findings of muscle atrophy of the ulnar side of hand and below elbow ulnar sited muscle. In addition
  •  
  • electromyography demonstrating moderate to severe nerve damage.

Surgeons use various ways to relieve compression from the nerve around the elbow.
More commonly, the nerve is moved from its place behind the elbow to a new place in front of the elbow. This is called an anterior transposition of the ulnar nerve. The nerve can be moved to lie under the skin and fat but on top of the muscle (subcutaneous transposition), within the muscle (intermuscular transposition) or under the muscle (submuscular transposition). There are many factors that go into deciding where the nerve is moved. The doctor will recommend the best option for you.


Ulnar nerve exposure (microsurgical technique)


The ulnar nerve is behind of medial epicondyle.


The ulnar nerve exposure

The ulnar nerve

Ulnar nerve preperation for transfer.

The ulnar nerve transfer on new place at the front of the elbow joint. This place is very comfortable for the nerve and the symptoms gradually get less.