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Cubital Tunnel Syndrome

(Ulnar Neuropathy)

By David R. Steinberg, MD, Associate Professor, Department of Orthopaedic Surgery, and Director, Hand and Upper Extremity Fellowship, Perelman School of Medicine at the University of Pennsylvania

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Cubital tunnel syndrome is compression or traction of the ulnar nerve at the elbow. Symptoms include elbow pain and paresthesias in the ulnar nerve distribution. Diagnosis is suggested by symptoms and signs and sometimes nerve conduction studies. Treatments include splinting and sometimes surgical decompression.

The ulnar nerve is commonly irritated at the elbow or, rarely, the wrist. Cubital tunnel syndrome is most often caused by leaning on the elbow or by prolonged and excessive elbow flexion. It is less common than carpal tunnel syndrome. Baseball pitching (particularly sliders), which can injure the medial elbow ligaments, confers risk.

Symptoms and Signs

Symptoms of cubital tunnel syndrome include numbness and paresthesia along the ulnar nerve distribution (in the ring and little fingers and the ulnar aspect of the hand) and elbow pain. In advanced stages, weakness of the intrinsic muscles of the hand and the flexors of the ring and little fingers may develop. Weakness interferes with pinch between the thumb and index finger and with hand grip. Patients with chronic cubital tunnel syndrome may present with an ulnar claw hand. An ulnar claw hand is metacarpophalangeal joint extension and interphalangeal joint flexion of the small and ring fingers caused by an imbalance between intrinsic and extrinsic hand muscles.

Diagnosis

  • Clinical evaluation

  • Sometimes nerve conduction studies

Diagnosis of cubital tunnel syndrome is often possible clinically. However, if clinical diagnosis is equivocal and when surgery is being considered, nerve conduction studies are done. Cubital tunnel syndrome is differentiated from ulnar nerve entrapment at the wrist (in Guyon canal) by the presence of sensory deficits over the ulnar dorsal hand, by the presence of ulnar nerve deficits proximal to the wrist on muscle testing or nerve conduction velocity testing, and by the elicitation of ulnar hand paresthesias by tapping the ulnar nerve at the cubital tunnel (positive Tinel sign) elbow.

Treatment

  • Splinting

  • Sometimes surgical decompression

Treatment of cubital tunnel syndrome involves splinting at night, with the elbow extended at 45°, and use of an elbow pad during the day. Surgical decompression can help if conservative treatment fails.

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