Cubital Tunnel Syndrome

Almost everyone has heard of carpal tunnel syndrome, fewer have heard of cubital tunnel syndrome. 


Cubital tunnel syndrome is a pinch of a nerve at the inner elbow that goes to the little and ring fingers. This is the second most common pinched nerve that occurs in the arm. 


Symptoms of ulnar nerve compression can be variable. Typically there is numbness in the little finger and half of the ring finger. There can be pain at the inner elbow, or this can be pain free. Long-term pressure on the nerve leads to wasting of the muscles in the hand called atrophy, with loss of hand strength and hand functioning. Sometimes when pain is absent and numbness is not noticed, people simply notice that their hand has become weak and that the muscles in the hand have wasted.


Numb hands can originate from a number of sources, and sometimes a combination of issues is present. Pinched nerves in the neck cause arm pain and numbness. Most commonly the ulnar nerve is pinched at the elbow, there is a second much rarer site in the palm called Guyon’s canal where this nerve can also be pinched. Thoracic outlet syndrome is an even rarer diagnosis that can cause numbness in the ring and little finger as well. Accurate diagnosis is important for accurate treatment.


Surgical decompression of the ulnar nerve is the definitive treatment. This is absolutely indicated with moderate to severe pressure on the nerve. Failure to pursue surgery in a timely manner can result in permanent weakness and numbness. The goal of surgery is to eliminate the pressure on the nerve. The longer the pressure on the nerve is present, the greater the risk of permanent nerve damage with permanent numbness and weakness. Physical therapy and chiropractic treatment are not effective for this condition.


The ulnar nerve at the elbow has the most room around the nerve when the elbow is straight. When the elbow is bent, this draws the nerve taut and stresses the nerve. The goal of ulnar nerve protection is to keep the elbow as straight as possible both during the day as well as at night. Do not rest or sleep with your hand behind your head. Do not sleep with your arm all curled up. Do not hold the phone to your ear with this hand. Also avoid leaning on the elbow. Do not rest the elbow on the armrest in the car or at your desk. Also minimize repetitive elbow bending. When lifting weights, stay in a limited range of motion.


Of course all of this is much easier said than done. Elbows are designed to bend. You may also fall asleep in a good position only to wake up with your arm curled up underneath you. You can try wearing an elbow pad at night to keep the arm straight, this typically is not comfortable. At times it is better to proceed with surgery and correct the problem. 


Arm symptoms can be from a number of different causes. Accurate diagnosis is critical for accurate treatment. Do not ignore numb hands, to do so risks permanent nerve damage.



Remember, numb hands are not normal. If you are having these symptoms call Dr Katharine Leppard’s office to schedule an appointment at 719-575-1800.




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