Cubital Tunnel Syndrome
Cubital Tunnel Syndrome is one of the most common peripheral nerve entrapment syndromes that are experienced by humans.
This condition causes great discomfort leading to the disability of the patient and in chronic cases, there might be a loss in the hand’s function.
The main problem is that this condition remains among the most misdiagnosed conditions.
The cubital tunnel is created by the cubital tunnel retinaculum which leaves a gap of about 4 millimeters between the olecranon and the medial epicondyle.
The floor is created by the posterior band of medial collateral ligament and the capsule of the elbow joint. Anyone can get cubital tunnel syndrome but diabetes mellitus patients are at a higher risk.
This condition is also more common in people who take part in activities that involve long period of elbow flexion especially those that place their elbows on hard surfaces.
Any individual who has had a traumatic blow on the ulnar nerve will be at a greater risk of getting cubital tunnel syndrome.
In most cases, the compression is the culprit and is believed to cause the peripheral neuropathic damage. The damage is either by direct mechanical compression of there the compression of the intrinsic blood supply to the affected nerve; this will cause local ischemia.
Signs and Symptoms
Patients suffering from cubital tunnel syndrome will have disturbed sensation in the ring and little fingers.
In most patients, the first symptom to be reported is sensory loss. In the progression of the condition, other symptoms will start showing such as clumsiness sore weakness of the hand.
This is because the ulnar nerve is the motor supply to the hand’s intrinsic muscles. If the case is well developed there might be wasting of the hand’s small muscles and the ulnar sided muscles located in the forearm.
In general, the symptoms will either be sensory or motor and in some cases, a mixture of both. This will depend on the affected nerve.
The motor symptoms will be the weakness of the muscle controlled by the involved nerve. In sensory symptoms, there will be tingling and numbness in the area receiving sensory input through the ulnar nerve.
Causes
The ulnar nerve is the telephone cable connection between the forearm, the skin on the little finger side, and the spinal cord.
This nerve passes through the elbow and behind the bump on the inner part of the upper side of the arm bone. This bump or the medial epicondyle is where the nerve makes a bend around the elbow.
Hitting this area will result in a tingling or a shock. When this part is pressed or compressed due to external or internal pressure the resulting condition is what is referred to as cubital tunnel syndrome.
When the elbow is bent, the nerve is stretched and pushed against the bony bump. Most of the patients of cubital tunnel syndrome are people with a habit of sleeping with their elbows bent, their arms up their head or both positions.
Though the positions might not cause the condition, they will aggravate it. Over a long period of time, the condition might fully show and will start with symptoms such as numbness of the small and ring finger, weakness of involved muscles and pain.
Some of the other causes include pressing the elbow on a hard surface when typing or when taking calls, resting the elbow on the armrest in a vehicle, intense exercising or strain due to manual activities and bench pressing.
It is apparent that the condition is caused by pressure applied on the elbow over a long period of time.
Prevention
It is possible to prevent the development of cubital tunnel syndrome. This can be successfully done through the adoption of a good posture especially when using the arms and elbow.
This involves wearing splint when sleeping and maintaining a straight position and avoiding keeping the elbow bent tightly.
This simply means that people who work on long hours on computers should avoid resting the elbow of the chair arm or on a hard surface that might exert pressure on the elbow as this might lead to the compression of the nerve and ultimately to cubital tunnel syndrome.
Services
Diagnosis
In general cubital tunnel syndrome is confirmed through nerve conduction studies. In cases that are considered mild, nerve conduction studies will be used.
Electrodiagnostic tests will be part of the overall clinical process. The diagnosis of the cubital tunnel syndrome can be by symptoms alone especially because of the distinct innervations of the hand.
Imaging studies such as MRI or ultrasound might be useful and will reveal atomic abnormalities, or any other masses that might be behind the nerve impingement.
Additional imaging may be used in the confirmation of secondary nerve damage. The signs of nerve damage include swelling of the nerve close of the injury site, abnormal nerve appearance, nerve flattening and characteristic alteration to the muscles innervated by the nerve in question.
Treatment
The alleviation of the pain caused by cubital tunnel syndrome can involve the use on non-steroidal anti-inflammatory drugs (NSAIDs), vitamin B6 supplementation, or amytriptaline.
However, for the condition to be treated properly, the physician must first identify and treat the underlying cause.
In mild and moderate cases, conservative methods are used in the treatment program. It is significant that the physician identifies the activities and the positions responsible for the symptoms.
When these factors are identified, they should be avoided to keep the pain and other symptoms at bay. Good postures are also recommended during sleep as a lot of people area at great risk of developing the syndrome based on the position of their elbows when they are sleeping. Avoiding the activities behind the symptoms can assist in the healing process.
When conservative medication and therapy fail to address the condition, surgery may be used especially in cases where the symptoms are progressive or serious.
The surgical procedure performed will vary depending on the impingement cause and the location.
It is important that anyone with the aforementioned symptoms sees a medical practitioner for better diagnosis and a treatment plan that will eliminate the symptoms and allow them to handle their daily life activities as usual.
