Cubital Tunnel Syndrome

This condition involve the compression of the ulnar nerve at the elbow.

What we will see

Pins and needles +/- muscle weakness and wasting in ulnar nerve distribution (little & ring fingers, intrinsic muscle weakness, wasting dorsal 1^st web space)

What we won’t see

Early <6 months intermittent pins and needles in ulnar nerve distribution without trial of non-operative treatment (eg reduced elbow flexion, simple measures at work)
Radicular pain

Specific tests

Nerve conduction studies will be requested in clinic if thought appropriate

Trial of therapy pre-referral

Patient education to avoid elbow flexion with pressure on the nerve

Whom to direct referral to

Any hand surgeon

Cubital tunnel syndrome typically occurs with the elbow in flexion and causes intermittent paraesthesia of the little and ring fingers and ulnar aspect of the forearm. In advanced cases there may be wasting of the hypothenar and intrinsic muscles of the hand and a claw (flexion) deformity of the little and ring fingers.

Conservative treatment includes awareness and avoidance of postures that initiate symptoms and avoidance of prolonged pressure at the elbow. Soft splints can limit elbow flexion and therefore relieve symptoms at night. Surgical decompression may be required and is typically performed as general anaesthetic daycase procedure through a 15-20cm incision overlying the ulnar nerve at the elbow. The speed and degree of symptomatic relief is dependant upon their duration and severity. Post-operatively, the patient may require several weeks off work.

General points

Pain, paraesthesia and weakness may be caused by compression of the involved nerve at any point along its path. Careful history and examination, including that of the neck, will often point to the likely site of compression, but nerve conduction studies (NCS) are often arranged to confirm the diagnosis when the clinical impression is unclear.