Composed of bones, muscles, and ligaments inside the elbow, the cubital tunnel is a passageway for the ulnar nerve. The ulnar nerve extends from the side of the neck down the shoulder and elbow to the fingertips. When this tunnel becomes compressed, it can cause nerve entrapment. Many patients report that cubital tunnel syndrome pain feels like they’ve hit their “funny bone” causing an aching sensation in the elbow, along with tingling, pins and needles, and weakness in the hand. Tingling and numbness associated with cubital tunnel syndrome are felt in the ring and little finger – the two digits innervated by the ulnar nerve. These symptoms are usually worse at night.
Treatment options for cubital tunnel syndrome include resting, wearing a splint or elbow brace, taking anti-inflammatory medications, completing physical therapy, and opting for cubital tunnel release surgery.
Diagnosing Carpal Tunnel Syndrome
It’s important to see a physician for a proper diagnosis, because other conditions – such as medial epicondylitis, or golfer’s elbow – may cause related symptoms.
Patients with ulnar nerve entrapment can present with a range of symptoms based on the severity of the condition. When you meet your hand surgeon for your cubital tunnel syndrome consultation, they will complete a physical exam to test sensation and weakness in the affected fingers and look for other signs of inflammation and ulnar neuropathy.
Your surgeon will conduct a physical examination of the elbow, wrist, and hand to look for signs of paresthesias in the ring and small finger and/or intrinsic muscle atrophy. They will perform an elbow flexion test and will tap areas above the cubital tunnel and elbow to see if you get tingling sensations in your ring and little finger. This is a positive indication that your cubital tunnel is inflamed and causing impingement of the ulnar nerve. Your doctor will also look for signs of ulnar-innervated intrinsic muscle atrophy.
Nerve conduction velocity and electromyography studies can also help detect prognosis severity. Your surgeon may also ultrasound your elbow to assess ulnar nerve compression.
Cubital Tunnel Release: What to Expect
Our qualified hand surgeons may recommend cubital tunnel release surgery if you are experiencing:
- Persistent pain or weakness in the hand or fingers
- Numbness or tingling in the ring and little fingers
- Muscle wasting or atrophy in the hand or fingers
- Loss of grip strength or fine motor skills
- Difficulty with daily activities such as holding objects, typing, or playing an instrument
Cubital tunnel release is a highly effective procedure that provides significant relief for many patients. The surgery is typically performed under regional anesthesia on an outpatient basis at our ambulatory surgery center in Flagstaff. The entire surgery takes about 15-30 minutes. During the procedure, your surgeon will release common sites of ulnar nerve compression in the cubital tunnel. Some practitioners offer endoscopic carpal tunnel surgery, but as this has a lower success rate and higher complication rate it is not commonly performed.
Ulnar Nerve Anterior Transposition
If the nerve is significantly compressed and unstable, your surgeon may relocate the ulnar nerve anteriorly to the front of the medial epicondyle, the bony ridge on the inner side of the elbow. This procedure is commonly performed in patients with an unstable ulnar nerve that subluxates anteriorly during flexion. By moving the nerve to a more protected and stable position, patients gain relief from ulnar nerve irritation.
Medical Review: This procedural information has been medically reviewed by plastic and reconstructive surgeon, Brian A. Cripe, M.D.