Neurological Disorders: Cubital Tunnel Syndrome

Cubital Tunnel Syndrome is a neurological disorder and results from the ulnar nerve getting compressed at the tunnel by the above name, in the elbow area. A neurologist is frequently involved in the management of this condition.

Ulnar nerve is an important nerve of the upper limb and mainly supplies the muscles and sensation of the hand. It originates in the brachial plexus and descends downwards through arm and forearm to reach the hand.

Along its path it may get pinched at various locations, and compression at the elbow is the most frequent one. Note that not all ulnar neuropathies at the elbow are necessarily due to this above syndrome rather there are many different mechanisms that can trigger ulnar nerve damage, however this is the commonest cause.

This tunnel is formed behind the elbow between the two heads of the FCU (flexor carpi ulnaris) and related with a ligament by name Osborne ligament. During the flexion of the elbow a stretching of this ligament takes place causing flattening of the tunnel and pinching the nerve.

This syndrome is more frequent in adult a as compared to extremes of age. No racial or ethnic predilections. Tasks or jobs requiring repetitive movements of the elbow is blamed many times but never proved.

• Numbness
• Tingling (pins & needles)
• Muscle wasting (atrophy)
• Weakness

Most of the symptoms will manifest in the hand. The tingling and/or numbness involves the little finger and about medial ½ of the ring finger. Medial aspect of the hand is involved too. Ulnar nerve is the main nerve supplying the muscles of the hand (median nerve supplies only few of them) so the muscle atrophy is seen throughout the hand. In later stages a claw hand deformity may be seen too.

An EMG/NCS (electromyography and nerve conduction studies) is required to confirm the diagnosis.

The definitive treatment is surgical; the tunnel area is surgically explored and the nerve is decompressed (cubital tunnel release surgery).

In mild cases an elbow brace and some occupational therapy might be sufficient.

For symptomatic management pills like gabapentin, pregabalin or duloxetine can be tried