Cubital Tunnel Syndrome

Cubital tunnel syndrome is the second most common upper extremity compression neuropathy, caused by excessive pressure on your ulnar nerve. The most common compression site of the ulnar nerve is at the level of your elbow. There, the ulnar nerve lies right next to your “funny bone” where is susceptible to pressure. Occasionally, the nerve can be compressed at the wrist as well.

Because the tunnel is so narrow, if any swelling occurs, it can pinch the nerve and cause ring finger or small finger numbness, tingling, or hand weakness. This condition is common in people who perform repetitive elbow flexing motions, but can happen to anyone, especially diabetic patients.

Patients with diabetes, due to abnormal glucose cell metabolism, over time may develop swelling of the nerve, as well as narrowing of the tunnel itself. This alters the normally perfect relationship between the nerve and its tunnel, making it too narrow for the more swollen nerve, resulting in cubital tunnel syndrome. Therefore, diabetic patients are at much higher risk for experiencing symptoms of cubital tunnel syndrome than general population. (Cubital tunnel syndrome is about three times more common in diabetics than in the general population.) Numbness of the fingers in diabetics that is present despite good blood glucose control requires evaluation by a peripheral nerve surgeon, and early surgical treatment before the nerve is irreversibly damaged. Cubital Tunnel Syndrome can be treated and reversed with surgery, if treated in a timely manner.

Symptoms of cubital tunnel syndrome include:

  • Tingling or numbness in your ring finger or small finger
  • Weakness or clumsiness in your hand
  • Difficulty turning car keys or a doorknob
  • Worsening of symptoms when you hold your elbow in a bent position for a prolonged period of time, such as talking on the phone or sleeping
  • Symptoms may start as intermittent and progress to constant
  • In more advanced cases, muscle atrophy, finger deformities and pain can develop

You should see Dr. Ducic for cubital tunnel syndrome if your symptoms persist:

  • Despite the medical care prescribed to you by your physician
  • Despite supportive medical care, such as activity and work adjustments
  • After three months of prescribed medical and conservative care
  • Despite good medical diabetic care
  • If you had surgery for a different, non-nerve related problem that was complicated by an acute ulnar nerve functional loss (numbness, weakness or pain), timely evaluation and intervention within 6 or (at the most) 12 weeks after its onset is critical to maximize the likelihood of a positive outcome. Restoration of nerve function may be significantly reduced if decompression is done after 3 months from neuropathy onset. This is unfortunately often overlooked by many who instead choose physical therapy and a “let’s wait and see” approach.

Surgical Treatment for Cubital Tunnel Syndrome

There are many treatment options for cubital tunnel syndrome, ranging from conservative methods to surgery. If the pressure is minimal, your doctor may opt to treat you with non-surgical methods. However, many patients find that conservative measures do not treat the cause of cubital tunnel syndrome (excess pressure on the nerve) and they require peripheral nerve surgery for symptoms that persist.

The goal of peripheral nerve surgery for treating cubital tunnel syndrome is to provide more space for your nerve and to reduce the amount of pressure on your nerve. If you do not experience relief with more conservative methods, your doctor may recommend peripheral nerve surgery to treat your pain, in which case you should be evaluated by me.

If nerve compression is confirmed not only at the elbow, but also at the wrist (Guyon’s canal), both sites can be addressed during the same operation. The success of the surgery depends on how long the nerve has been compressed, the severity of the compression, the extent of the intrinsic nerve damage and possible presence of underlying medical or spine problems.

I often perform revision surgeries, which address continued neuropathy following previous surgery in patients who failed to get relief after procedures performed elsewhere.

During surgery for cubital tunnel syndrome:

  • You receive anesthesia so you won’t feel any pain during the surgery.
  • A small incision is made at the inner elbow in order to access the nerve. I use a minimally invasive approach I described and special equipment in order to minimize the incision length.
  • Structures compressing the nerve are released. In addition, sometimes your “funny bone” is shaved to allow even more space for the nerve.
  • The skin is closed in anatomical layers.
  • Cubital tunnel surgery is an outpatient procedure; your dressing will be removed about 5-7 days after surgery, while sutures are removed two to three weeks later.

If you are not sure about your eligibility for surgery, and if you are not in the Washington, D.C. area, you can send me your records so I can determine if you are a good candidate for treatment. Visit my patient forms page for a downloadable form.