The cubital tunnel is made up of the bones in your elbow and the forearm muscles which runs across the elbow joint. Cubital tunnel syndrome (CBTS) is a peripheral nerve compression syndrome. Cubital tunnel syndrome occurs when the ulnar nerve or funny bone nerve is stretched, compressed, or irritated where it crosses the elbow and cause numbness or tingling in the ring and small fingers, pain in the forearm, and/or weakness in the hand.
Causes:
- Repeating bending of the elbows such as pulling, reaching or lifting, leans on their elbow a lot, or has an injury to the area.
- Previous history of arthritis, bone spurs and previous fractures or dislocations, repetitive strain of the elbow.
Signs and Symptoms:
- Hand pain, sensation loss , tingling and/or weakness on the associate hand
- Gripping problem and clumsiness due to muscle weakness in the affected arm and hand
- May present tenderness inside the elbow where the nerve is close to the surface
- Inability to straighten fingers
- As a late symptom we may notice small muscle wasting
- There may present Inflammation of surrounding tissues
Investigation:
- Nerve conduction test. This test measures how fast signals travel down a nerve to find a compression or constriction of the nerve.
- Electromyogram (EMG). This test checks nerve and muscle function and may be used to test the forearm muscles controlled by the ulnar nerve.
- X-ray. We perform X-Ray to check the elbow bones if there any arthritis or bone spurs or any other medical issue.
Physical assessment:
- Observation and inspection of the elbow and forearm.
- Assessing the flexibility of the ulnar nerve.
- Checking the strength of specific muscles, pinching and gripping ability of your hand.
- Check the normal movements and muscle power of the hand.
- Have to perform tinel test
Special Test:
- Scratch Collapse Test
- Elbow Flexion Test
Treatment:
The first effective treatment is to avoid those activities that cause your symptoms. Initial treatment may include:
- Important actions are resting and stopping any activity that aggravates the condition, such as bending the elbow or weight lifting etc.
- Wearing a splint or foam elbow brace at night to limit movement, avoid any wrong pressure and reduce irritation.
- Using an elbow pad to protect the hand from any hard surface or getting hurt.
- To avoid leaning on the funny bone that can reduce the symptoms.
Cubital tunnel syndrome takes around two to six weeks with usually some hand physiotherapy to help getting motion back for patients to feel like they’re getting back to normal. In the long run, mild symptoms should recover fully, whereas severe symptoms may take longer time than normal.
Physiotherapy:
Physiotherapy includes some electrotherapy, therapeutic exercises and rehabilitation stage.
Electrotherapy:
The major aim of electrotherapy is to reduce the severe pain which the patient is feeling now. In this condition we may use:
- IRR (Infra Red Ray ) : It is used for warming purpose
- ( ES) Electrical Stimulation
- UST ( Ultra Sound Therapy)
- HIL ( High Intensive Laser )
Manual :
Stretching: Due to Involvement of ulnar nerve, our main focus is on stretching of the nerve in different ways.
Strengthening: We squeeze a soft ball for strengthening. After some sessions we can start strengthening exercise with 1 kg dumbbell.
Normal movements : Random elbow flexion and extension & medial and lateral rotation.
