Cubital Tunnel Release: Treatment and Recovery

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Cubital Tunnel Syndrome 

Welcome to JOI Online, your reliable source for information on cubital tunnel release. Are you experiencing numbness, tingling, or weakness in your hand or arm? You might be dealing with cubital tunnel syndrome. This article will guide you through the intricacies of this condition, from understanding its causes and symptoms, to knowing how it’s diagnosed and treated. We’ll also discuss how to prevent and manage cubital tunnel syndrome to maintain a healthy lifestyle. At JOI, we’re dedicated to delivering the most current and reliable information, so you can make informed decisions about your health. Let’s dive in and discover more about cubital tunnel release!

Cubital Tunnel Syndrome (CUTS) involves compression of the ulnar nerve as it passes through the cubital tunnel of the elbow which is located on the inside of the elbow. This area is often referred to as the “funny bone.” 

The nerve compression results in numbness in the finger, arm and/ or tingling along the inside of the forearm, the small finger, and the ulnar aspect (inside) of the ring finger.

Cubital Tunnel Syndrome

With prolonged CUTS, there may be muscle weakness and wasting of the lumbrical and interosseous muscles. Clawing of the ring and small finger may occur as a result. With clawing, there is an inability to straighten the last 2 knuckles of the small and ring fingers. 

Another muscle that may be involved in CUTS is the adductor pollicis. When there is weakness of the adductor pollicis, decreased ability to perform lateral pinch is noted along with muscle wasting in the area of the first web space. The hand will feel clumsy and there is a lack of coordination and dexterity, as well as a reduction in grip strength.

What Nerve is Affected?

Cubital tunnel syndrome affects the ulnar nerve as it goes through the cubital tunnel, a narrow passage on the inside of your elbow. Also known as ulnar nerve entrapment or ulnar neuropathy, understanding the causes and symptoms is crucial for effective diagnosis and treatment.

The syndrome can be caused by pressure or stretching of the ulnar nerve, which can occur due to repetitive bending of the elbow, prolonged pressure on the elbow, or a direct injury. If you often lean on your elbows, perform repetitive elbow motions, or have a history of elbow fractures or dislocations, you could be more likely to develop cubital tunnel syndrome.

Symptoms of Cubital Tunnel Syndrome

Typical symptoms include numbness and tingling in the ring and little fingers, elbow or forearm pain, and hand or finger weakness. These symptoms can worsen during activities that involve bending the elbow or applying pressure on the ulnar nerve.  Other symptoms are: 

• Weakened grip strength.
• Elbow or forearm pain or discomfort.
• Difficulty with fine motor skills, like buttoning a shirt or gripping small objects.

Causes of Cubital Tunnel Syndrome

Causes of CUTS include anatomical variances, arthritis/bone spurs of the elbow, cysts, prior fracture/dislocation of the elbow, repetitive motion and sustained faulty postures of the elbow.

Cubital Tunnel Tests & Diagnosis

Your doctor will begin the diagnosis by conducting a detailed physical examination. They’ll assess your symptoms, medical history, and any activities or repetitive motions that may have led to the condition. The doctor will also check for visible signs of cubital tunnel syndrome, like muscle wasting in the hand or forearm.

Tests used to confirm the diagnosis of CUTS are X-rays and nerve testing. X-rays can be utilized to evaluate the bone for the presence of arthritis and bone spurs. Elbow arthritis is a cause of elbow pain. 

Nerve testing can evaluate the status of the ulnar nerve for the both the sensory and motor portions as well as determine where the ulnar nerve is compressed. 

Clinical tests such as the Tinel’s sign and Wadsworth elbow flexion test can be used to evaluate for numbness and tingling in the distribution of the ulnar nerve. 

Other Causes

Other causes of elbow pain such as Golfer’s elbow and elbow strain can be ruled out with the above tests.

If the nerve testing result shows moderate to severe compression, then surgery to decompress the ulnar nerve at the cubital tunnel (Cubital Tunnel Release or CUTR) is indicated. 

With Cubital Tunnel Release, the ligament that forms the roof of the cubital tunnel is cut and divided. This increases the size of the tunnel and reduces pressure on the nerve. Additionally, the ulnar nerve may need to be moved forward to prevent the nerve from being caught on bony ridges. 

This procedure is called Anterior Transposition of the Ulnar Nerve and is performed in addition to the Cubital Tunnel Release.

Cubital Tunnel Syndrome

Diagnostic Tests

 Common diagnostic tests for cubital tunnel syndrome include:

• Nerve conduction studies: This test assesses the functioning of the ulnar nerve and can identify any nerve damage.
• Electromyography (EMG): EMG measures the electrical activity in the muscles and can help identify any muscle weakness or nerve dysfunction.
• X-rays: X-rays can rule out other conditions, such as arthritis or bone abnormalities, that could be causing your symptoms.

Cubital Tunnel Release & Treatment 

Non-surgical treatments are often the first step in combating cubital tunnel syndrome. These may include:

• Rest and immobilization: Taking breaks from activities that worsen the symptoms and using a splint or brace to keep the elbow in a neutral position can help reduce pressure on the ulnar nerve.
• Physical therapy: Exercises prescribed by a therapist can help improve flexibility, reduce inflammation, and relieve pressure on the nerve.
• Pain medication: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) or prescription medications may be suggested to manage pain and reduce inflammation.

If non-surgical options aren’t effective, your doctor may suggest cubital tunnel release surgery. This procedure aims to relieve pressure on the ulnar nerve by expanding the space in the cubital tunnel.

Treatment following Cubital Tunnel Release may include range of motion exercises, scar massage, edema control and use of an elbow pad starting at 3-5 days post-op. 

Progressive strengthening exercises are initiated at 6 weeks post-op. Return to normal use is permitted within 6-8 weeks following surgery.

If the nerve testing shows mild compression or if the onset of CUTS is recent, a steroid injection may be indicated to help reduce swelling around the nerve. If you think you need a cubital tunnel release, contact the Jacksonville Orthopedic Institute for a hand surgeon near you.  

Preventive measures for cubital tunnel syndrome

Prevention is key in managing cubital tunnel syndrome. Here are some steps you can take:

• Avoid prolonged elbow bending or pressure on the inside of the elbow.
• Take frequent breaks and avoid repetitive activities that strain the elbow.
• Use padding or ergonomic tools to reduce pressure on the ulnar nerve during activities.  Use of an elbow pad worn during the day to cushion the elbow and prevent it from being struck.  At night, the pad is rotated forward to prevent the elbow from being in postures of excessive flexion that can compress the ulnar nerve. 
• Maintain good posture and avoid keeping the elbow bent for extended periods.

Lifestyle changes to manage symptoms.

In addition to preventive measures, certain lifestyle changes can help alleviate cubital tunnel syndrome symptoms:

• Avoid activities that worsen symptoms and exacerbate pressure on the ulnar nerve.
• Modify your workspace to ensure proper ergonomics and reduce strain on the elbow.  Ergonomic positioning is important to avoid positions of hyperflexion and to keep the joints in a neutral position while at work (i.e. avoid holding a phone up to the ear, avoid prolonged writing while leaning on the elbow and keep the elbows at 90 degrees of flexion while using a keyboard). 
• Take regular breaks to stretch and rest your arms and hands.
• Apply ice or use anti-inflammatory medications to reduce swelling and pain.

Hand therapy and exercises for cubital tunnel syndrome

Physical therapy plays a crucial role in managing cubital tunnel syndrome. A hand therapist can provide exercises and techniques to help:

• Strengthen the muscles around the elbow and improve flexibility.
• Correct any postural imbalances that may contribute to nerve compression.
• Teach nerve gliding exercises to mobilize the ulnar nerve and reduce pressure.
• Provide guidance on activity modifications and ergonomic principles.

By implementing these preventive measures, making lifestyle changes, and incorporating physical therapy into your routine, you can effectively manage cubital tunnel syndrome and potentially avoid the need for cubital tunnel release surgery.

• To schedule an appointment for physical or occupational therapy, call 904-858-7045or call any of the 13 area JOI Rehab Centers.

 JOI & JOI Rehab

If you think you have cubital tunnel syndrome, consult a healthcare professional for an accurate diagnosis. Treatment options range from conservative measures like rest, immobilization, and physical therapy, to surgical interventions like cubital tunnel release, which can alleviate the pressure on the ulnar nerve and restore normal function.  We hope that this article has been helpful to you.  Our staff are here to help you if you have this condition.  To make an appointment by calling (904)JOI-2000 or schedule online. This is a new option for patients who would like to avoid the emergency room if they have suffered a fracture or soft tissue injury. To learn more about this service, read this article about fracture and injury care.

By Diana Cratem, Occupational Therapist, Certified Hand Therapist