Cubital Tunnel Syndrome occurs when the ulnar nerve in the arm becomes compressed or irritated, as it crosses the elbow. The ulnar nerve is one of the three main nerves in the arm, and travels from the neck down into the hand, and can be constricted in several places along the way. The most common location is in the elbow, where the nerve passes through a groove behind the medial epicondyle called “the cubital tunnel”, an area commonly known as “the funny bone”. At this location the nerve is constrained by a sheet of fibrous soft tissue which prevents it from jumping out of the groove. As the elbow is bent, the tension on all the structures on the back of the elbow increases, and the nerve can become irritated and inflamed. This inflammation and swelling can lead to increased pressure in an already tight environment, and cause damage to nerves cells, which is perceived as numbness, tingling, pain and weakness in the parts of the hand supplied by the ulnar nerve. Symptoms are often worse in the morning or at night when the individual spends some hours sleeping with their elbow bent under their pillow, or tucked in next to the body. Activities and occupations that require repetitive elbow bending, can predispose to the development of the condition.

Typically patients report pain in the hand and sometimes the inner elbow. Commonly there is numbness and tingling in the hand, specifically in the ring and small fingers. A sensation of weakness and the hand “falling asleep” is common as well. These symptoms are generally worse first thing in the morning, or after work that involves repetitive elbow bending.
The diagnosis is typically made by a combination of the patient’s history, and the findings on physical examination. An x-ray can be helpful in identifying bony abnormalities in the area. A nerve conduction study is commonly used to confirm the diagnosis, and also to rule out nerve entrapment at other sites along the course of the ulnar nerve, or involvement of other nerves, that could contribute to symptoms.
The approach to treatment of cubital tunnel syndrome depends on the severity and duration of symptoms and associated debility, as well on the degree of damage to the nerve based on the nerve conduction study. Generally, a trial of conservative treatment is attempted initially, and can help improve symptoms. Those include activity modification, night-time splints designed to keep the elbow straight at night and oral anti-inflammatory medication. If these approaches do not lead to resolution of symptoms, operative treatment can be considered. Surgery involves an ulnar nerve decompression and transposition, which means freeing up the nerve from any tethers in the area and positioning it on the front of the elbow where it is not subjected to high levels of tension when the elbow is bent.

At Oceana Sports Medicine and Orthopaedic Center, Dr. Aboka brings added expertise in minimally invasive treatment of Cubital Tunnel Syndrome, facilitating your return to pain-free function. These procedure are outpatient/same-day surgery, and lead to less pain and scarring and quicker recovery and return to normal function.