About Cubital Tunnel Syndrome
CTS is a medical condition caused by an increase in pressure on the ulnar nerve in the elbow. The ulnar nerve controls the muscles and feeling in the elbow, forearm, wrist, hand, and fingers. This compression can lead to numbness or tingling in a person’s fingers, pain in the forearm and elbow, and weakness in the hand and fingers.
CTS is a very common medical condition for both men and women of all ages who are actively using their arms and bending or flexing their elbows. The direct pressure on the elbow (i.e. laying or leaning on the arm), excessive stretching, or decreased blood flow (from blood clots, cysts, or tumors) are also known causes for this condition. Individuals who have pre-existing damage to their elbows are believed to be at a higher risk for developing this condition.
How Is It Diagnosed?
Medical professionals can diagnose CTS with a series of simple clinical tests. Your healthcare provider will ask you questions about your medical history, your current symptoms, and then work to assess the condition of the ulnar nerve by feeling and observing the movement of your shoulder, elbow, wrist, and fingers.
Your healthcare provider will probably consider this condition if there is numbness of the fourth and fifth fingers but will need to verify this preliminary diagnosis with medical imaging techniques or diagnostic tests that allow them to better understand what is going on under your skin. What are these medical imaging techniques and diagnostic tests used?
An individual may experience the symptoms of cubital tunnel syndrome, but it could result from something else that requires a different form of treatment. Your healthcare provider can use high-tech medical imaging equipment and diagnostic tests for a more accurate diagnosis. These include nerve compression tests, radiographs, electrodiagnostic studies, magnetic resonance imaging, and ultrasonic images, which we discuss next.
Nerve Compression Test
Your healthcare provider may use a nerve compression test to check for numbness, tingling, or pain. This test is relatively simple. A small pointed object is used to tap or apply pressure on your elbow, forearm, wrist, hand, or fingers to see how you respond. They may ask you to bend your elbow for a short period as they conduct this test. If you cannot feel the point and/ or pressure, you may have nerve damage and they will need to use medical imaging technology to determine what is causing the damage.
Radiographs, or x-rays, are used to look at the condition of your bones by the use of gamma rays and x-ray film. Your healthcare provider will use this technique to look at the condition of your elbow to see if there are reasonable causes for your symptoms. Some issues they can see with an x-ray include trauma or arthritis.
Electrodiagnostic studies include nerve conduction studies and electromyography. Each of these studies tests how well your nerves work. Your healthcare provider uses these tests to help identify potential nerve damage and the best way to treat the symptoms. An electromyogram also involves a muscle assessment, making it helpful in the diagnosis of cubital tunnel syndrome.
Magnetic Resonance Imaging (MRI)
Magnetic Resonance Imaging (MRI) can diagnose damage or entrapment to the ulnar nerve. This imaging technique involves scans that use powerful magnets and a computer to make images of your elbow, beneath your skin. They inject individuals with a dye to help improve image quality. Before you pursue this treatment, you must disclose any known allergies, including iodine or shellfish, to your healthcare provider because you may be allergic to the materials in the dye.
Because MRI uses powerful magnets, you are to remove anything that is metal before entering the MRI room because of the damage it can cause to your body and to the medical equipment. Please tell your healthcare provider if you have any metal inside your body (surgical screws or implants, bullets, etc.).
An ultrasound uses sound waves that bounce off surfaces and reflects an image on a computer screen. Your healthcare provider may use this test to take ultrasonic images of your elbow, forearm, wrist, hand, or fingers. This test is often most preferred by individuals because it doesn’t require harmful gamma rays or injected dyes. It is a simple and virtually painless test where they use a handheld ultrasonic device over the target area, applying a little pressure for improved image quality. This test may help show the causes of the pressure against the ulnar nerve so they can better determine which treatment is to be used to solve the problem.
What Causes Cubital Tunnel Syndrome?
This condition is primarily the result of the pressure or constriction of the ulnar nerve in the elbow. This condition is more commonly the result of an elbow contacting a hard surface, weight or pressure on the elbow (i.e. sleeping or leaning on elbow), increased flexing and extending of the elbow.
What Increases the Risk of Getting Cubital Tunnel Syndrome?
- Pre-existing injury to the elbow
- Bending your elbow for long periods of time
- Putting pressure on the elbow (i.e. leaning on it)
- Repetitive motion of the elbow (i.e. painting, playing sports, using hand or power tools, climbing, lifting, exercising, etc.)
- Health conditions, including hypothyroidism, diabetes, or arthritis
- Tumors or cysts on the arm
Signs and Symptoms
The symptoms of any condition will vary depending on the nerve that is being affected. When an individual suffers from cubital tunnel syndrome, they may experience many symptoms, including numbness and tingling of the arms, hands, and fingers (the pins and needles sensation), weakness of the arms and hands, and pain or discomfort from the elbow down to the fingers.
Numbness and Tingling
One of the first signs is numbness and a tingling sensation in the ring and small fingers. This tingling sensation is caused by nerve damage or pressure on the ulnar nerve, and it may radiate through the back of the hand to the elbow.
Individuals may experience a weakness in the hand and fingers. This feeling makes it difficult to hold things and may affect one’s dexterity. This issue also causes curling of the pinky and ring fingers, preventing one from being able to straighten, or fully extend them. The curling of the fingers is a late-stage sign and is a sign of greater nerve damage.
Pain or Discomfort
Another symptom of this condition is pain or discomfort. The pain will begin at the inner elbow and extend downward to the forearm, wrist, hand, and fingers. The pain makes it difficult to function properly in everyday situations.
How to Manage the Symptoms?
While the symptoms can be uncomfortable, there are five ways you can manage them to help the healing process:
Avoid Putting Pressure on the Elbow
There are certain positions that can put pressure on the ulnar nerve in your elbow. Leaning or sleeping on a bent elbow can exacerbate the symptoms in this condition.
Applying ice can help decrease the swelling and pain one may experience. The ice may also help prevent any tissue damage. By using an ice pack or crushed ice in a plastic bag, cover the ice pack with a towel and place it on the target area for 15 to 20 minutes at a time and repeat every hour, or as needed.
Resting the Arm
For a speedy recovery time, it is best to rest the injured arm as often as possible. By preventing oneself from using the injured arm to perform activities that require repetitive use of the elbow, the arm will begin healing more effectively.
Seek Physical Therapy
If the ice therapy and resting the arm are not helping, you may seek the service of a physical therapist. A physical therapist can assess the issues in your body’s movement and provide you with a series of exercises to help improve motor functioning, flexibility, and strength. Physical therapy can also help ease some pain or discomfort you may experience with CTS.
Use Elbow Splint or Brace
If an individual cannot perform ice therapy, physical therapy, or rest the arm because of their lifestyle, a medical brace or splint on the elbow can help protect the elbow and prevent excessive movement of the arm and elbow. The restricted movement will help to ease the pressure on your ulnar nerve and can help the healing process.
How Is the Condition Treated?
Cubital tunnel syndrome may go away by itself over time, especially if you use the symptom management techniques listed above. In other cases, you may need additional help. Medications, injections, and surgical intervention may help those who require more powerful forms of treatment. The following treatments can help decrease your symptoms:
Nonsteroidal Anti-Inflammatory Drugs
Nonsteroidal Anti-inflammatory Drugs, or NSAIDs, are medicines that decrease the amount of swelling and pain in the body. NSAIDs are available without a doctor’s prescription but it is best to consult with your healthcare provider before taking any medication. Ask your healthcare provider which medicine is right for you and how much to take and use the recommended medicine as directed. NSAIDs can cause other undesirable symptoms, including stomach bleeding or kidney problems if not taken correctly.
While the injection itself may provide temporary discomfort around the injection area, corticosteroid injections have been clinically proven to reduce inflammation in the joints. With reduced inflammation or swelling, there is increased circulation and reduced pain.
Because of the risks involved with surgery, including potential damage to the surrounding nerves, and the recovery time, this is most often recommended for severe cases. Others may consider surgical intervention if they are highly susceptible to this painful condition and have suffered from it frequently. Surgery may help ease the pressure on the ulnar nerve.
Your healthcare provider may also move the nerve to a different area to prevent it from being stretched or compressed, which may prevent the symptoms from coming back. Your healthcare provider may also elect to remove part of your bone if it causes pressure on the nerve.
How to Prevent Cubital Tunnel Syndrome
Prevention of this condition can be accomplished by protecting the elbow and from avoiding frequent exposure to hard surfaces, prolonged bending, or repetitive flexing and extending of the arm. Individuals may also start an exercise regimen that allows you to improve your motor function by improving flexibility and strength.
We discuss the exercises in more detail below, however, before starting any exercise regimen, it is important to keep in mind that you should not strain yourself in performing the exercises, especially if you suffer from CTS. If you are experiencing pain, it is best not to take action.
Therapeutic and Preventative Exercises
There are a few different exercise regimens developed with the goal of preventing or treating and easing the various symptoms. It is the focus of these exercises to relieve pain or discomfort or improve the flexibility, strength, and mobility of the elbow and fingers. Each of these exercises needs to be completed up to three times a day for optimal results.
Ulnar Nerve Glide
The Ulnar Nerve Glide is performed by first extending the arms out to the sides. With the arms extended outward on each side, place the palm of the hand in a “stop” position, the bending of the wrist with the fingers facing upward. After that, slowly bend the elbows while reaching for the back of the ears. Repeat this process up to ten times for the best therapeutic results.
Finger Adduction and Abduction
This exercise should be done with the affected fingers, but you may also perform the exercise if you are not suffering from CTS. Adduction refers to the movement of the fingers towards the limb, while abduction refers to the movement of the fingers away from the limb. To complete this exercise, hold out your arm, palm up in the “stop” position. With your palm up, extend the fingers outward, where your fingers aren’t touching, and hold that position for a few seconds, and bring them back inward to the “stop” position, where the fingers are touching. Repeat up to ten times for the best therapeutic results.
Extension of the arms with the elbows straight can help reduce some tension in the arm, providing the sensation of relief. This exercise routine is completed by extending the arms out to the side, holding the position for a few seconds, then gently bending the arms upwards toward the head, or downwards, toward the hips. Repeat these steps up to ten times for the best therapeutic results.
Consult With a Professional Today!
Are you experiencing the signs or symptoms of CTS? Do you need more information about it but don’t know where to turn? The staff at Plymouth Bay Orthopedic Associates, Inc. is knowledgeable and available to help you. Contact Plymouth Bay Orthopedic Associates, Inc. in Plymouth, Massachusetts today to schedule your consultation.