Hey there! Today, I want to chat about an injury that I have recently seen in the clinic which involved the cubital tunnel. If you’ve never heard of it before, the cubital tunnel is a narrow passageway on the inner side of your elbow where the ulnar nerve runs through. You might know the ulnar nerve better as the “funny bone” – though, let’s be honest, there’s nothing funny about it when it’s irritated!

Let’s break it down and go through what can go wrong in this area, and what we can do to get you back on track if you’re having any trouble with it.

What Is Cubital Tunnel Syndrome?

Cubital tunnel syndrome happens when there’s pressure or stretching of the ulnar nerve as it passes through the cubital tunnel. This can cause a range of symptoms, like tingling or numbness in your ring and pinky fingers, weakness in your hand, or even pain along the inside of your elbow.

It’s a bit like when you accidentally lean on your elbow for too long, and your fingers go all tingly and weird. But with cubital tunnel syndrome, that feeling doesn’t go away as quickly, and it might even start affecting your daily life.

Common Causes of Cubital Tunnel Issues

So, what causes cubital tunnel problems? Here are some of the usual suspects:

Repetitive Elbow Movements: If you’re someone who bends and straightens your elbows a lot (think tradies, tennis players), you’re putting more stress on the ulnar nerve.

Prolonged Elbow Flexion: Do you spend heaps of time with your elbows bent? Maybe you’re a desk worker who leans on your elbows while typing, or you’re scrolling through your phone in bed. Both habits can compress the nerve. (Think gamers or office workers)

Direct Pressure on the Elbow: Leaning on hard surfaces can compress the nerve and irritate it over time. (Think truck drivers)

Previous Elbow Injuries: Fractures or dislocations around the elbow can make you more prone to cubital tunnel syndrome.

Anatomical Variations: Some people just naturally have a tighter cubital tunnel, which can make them more susceptible.

Real-Life Example: Meet Sam

Let me tell you about a patient I treated not long ago. We’ll call him Sam. Sam is a 35-year-old electrician who came to me complaining of tingling in his ring and pinky fingers, especially after a long day on the tools. He’d also started noticing that his grip strength wasn’t what it used to be.

Sam’s job required him to use his hands and arms in repetitive movements, like bending his elbows to work on overhead wires. He’d also developed a habit of leaning on his elbows during his smoko breaks, which was making things worse.

After a chat and a physical assessment, it was clear Sam had cubital tunnel syndrome. His symptoms weren’t severe enough to need surgery, but he did need to make some changes and commit to physio exercises.

Symptoms to Watch Out For

Whether you’re an electrician like Sam or just someone who spends too much time on their phone, here are the main signs of cubital tunnel syndrome:

• Tingling or Numbness: Usually in the ring and pinky fingers, especially when your elbow is bent for a while.
• Weakness: You might find it harder to grip objects or do fine motor tasks like buttoning your shirt.
• Pain: Often felt on the inside of the elbow and sometimes radiating down the forearm.
• Clumsiness: Dropping things more often because your hand feels weaker or less coordinated.
• If these symptoms sound familiar, don’t ignore them! The earlier we tackle the problem, the easier it is to manage.

How We Treat Cubital Tunnel Syndrome

The good news is that most cases of cubital tunnel syndrome can be treated conservatively – meaning without surgery. Here’s what we might do:

• Activity Modification: This is step one. If you’re doing something that’s irritating the nerve, we’ll figure it out and make some changes. For Sam, that meant taking more breaks from repetitive tasks and avoiding leaning on his elbows.
• Stretching and Strengthening: Gentle stretches can help take the pressure off the ulnar nerve, while strengthening exercises can stabilise the area and prevent future issues.
• Nerve Gliding Exercises: These are designed to keep the nerve moving freely through the cubital tunnel.
• Forearm and Hand Strengthening: Building up the muscles around your elbow and hand can reduce strain on the nerve.
• Splinting: Sometimes, we’ll recommend a splint to keep your elbow in a slightly extended position, especially at night when you might unknowingly sleep with your arm bent.
• Manual Therapy: This involves hands-on techniques to release tightness in the surrounding muscles and improve joint mobility.
• Education: we will consider someone’s ergonomics and how to set up a workspace or change your habits to protect the elbow.

When Surgery Is Needed

In some cases, conservative treatment might not be enough. If the nerve compression is severe or if there’s significant muscle wasting, surgery might be the best option. The two most common surgical procedures are:

• Ulnar Nerve Decompression: This involves releasing the pressure on the nerve.
• Ulnar Nerve Transposition: In this procedure, the nerve is moved to a new position to prevent further compression.

The good news? Even if you need surgery, physio plays a crucial role in your recovery to get you back to full function.

Tips to Prevent Cubital Tunnel Problems

• Prevention is always better than cure, right? Here are some simple tips to keep your elbows and nerves happy:
• Take Regular Breaks: If you’re doing repetitive tasks or holding your elbows in one position for a long time, take short breaks to stretch and move.
• Avoid Leaning on Your Elbows: Use a cushion or avoid resting on hard surfaces for too long.
• Keep Good Posture: Whether you’re at a desk or on the tools, good posture reduces unnecessary strain on your body.
• Strengthen Your Arms and Hands: Regular exercises can help build resilience and prevent overuse injuries.
• Be Mindful of Symptoms: If you notice tingling, numbness, or weakness, don’t wait to get it checked out.

Back to Sam’s Story

So, what happened with Sam? After a few weeks of physio, he started noticing big improvements. The nerve gliding exercises helped reduce the tingling in his fingers, and the strengthening exercises improved his grip. Most importantly, he’d become more aware of his habits – no more leaning on his elbows during smoko!

By sticking to his treatment plan and making a few lifestyle changes, Sam was able to avoid surgery and get back to doing what he loves without pain or weakness holding him back.

Final Thoughts

Cubital tunnel syndrome might sound daunting, but with the right approach, it’s totally manageable. Whether it’s making small changes to your daily routine, committing to physio, or even undergoing surgery in more severe cases, there’s always a way forward.

If you’re experiencing any symptoms or just want to chat about keeping your elbows healthy, don’t hesitate to reach out. Together, we can keep you moving, working, and living your best life without pesky nerve problems getting in the way. Our number at Xphysio is (02) 9806 3077, give us a call today to get your rehab journey started. 

Resources:
American Academy of Orthopaedic Surgeons (AAOS)

• Cubital Tunnel Syndrome: Surgical Treatment (Ulnar Nerve Decompression and Transposition)
• This resource discusses the surgical options for treating ulnar nerve entrapment, including decompression and transposition.
• URL: AAOS – Cubital Tunnel Syndrome

Mayo Clinic

• Cubital Tunnel Syndrome
• Mayo Clinic provides detailed information about cubital tunnel syndrome, including ulnar nerve decompression and transposition as treatment options.
• URL: Mayo Clinic – Cubital Tunnel Syndrome

Johns Hopkins Medicine

• Ulnar Nerve Transposition Surgery
• Johns Hopkins explains ulnar nerve transposition, detailing how the procedure moves the nerve to reduce compression and prevent recurring issues.
• URL: Johns Hopkins – Ulnar Nerve Surgery

MedlinePlus (National Library of Medicine)

URL: MedlinePlus – Cubital Tunnel Syndrome

Cubital Tunnel Syndrome – Treatment

This resource provides an overview of cubital tunnel syndrome, with a section focused on decompression and transposition procedures.