What is cubital tunnel syndrome? Ulnar nerve entrapment syndrome?
Cubital tunnel syndrome/ulnar nerve entrapment is a peripheral nervous disorder in which the ulnar nerve is compressed. This condition is also called entrapment of the ulnar nerve at the joint Attached (not the elbow).
The ulnar nerve runs from the neck to the fingers through a tube or tunnel. When it's compressed, it doesn't get enough blood flow to function properly.
Over time, the pressure causes nerve damage, resulting in pain and numbness in the forearm or hand.
All nerves originate in the upper extremities of the neck and then the brachial plexus forms.
When they descend towards the hands, they branch into 3 main nerves:
- radial nerve
- The median nerve that is affected bycarpal tunnel syndrome
- ulnar nerve
The ulnar nerve travels along the inner side of the arm to the hand.
And stretches the muscles of the forearm and hand, which enables the flexion of the fingers.
It also stretches the skin on the anterior and posterior surfaces of the palm and little fingers to allow sensation.
Who gets ulnar nerve entrapment?
Ulnar nerve entrapment/cubital tunnel syndrome is the second most common peripheral nerve compression disorder after carpal tunnel syndrome.
However, it is relatively rare. Each year, doctors diagnose fewer than 25 cases per 100,000 people.
Cubital tunnel syndrome develops in people of all ages. Men are affected twice as often as women, although researchers don't know why.
You may be at greater risk if:
- You work a job that requires repetitive wrist movements.
- You take a lot of time while bending your elbow (for example, while talking on the phone).
- I had a trauma, like a blow, to the ulnar nerve.
- You have physical differences that increase the risk, such as a difference in the shape of the crankshaft.
- You are obese or have diabetes, rheumatoid arthritis or thyroid disease.
- You were over forty years old.
- you have arthritis
What causes cubital tunnel syndrome?
Continuing to repeat the same task for an extended period of time can stretch or compress the ulnar nerve.
Damage to nerve fibers or chronic fluid buildup can put pressure on the nerve.
Symptoms of cubital tunnel syndrome
If you notice symptoms, it is best to speak with a doctor immediately. If cubital tunnel syndrome is left untreated, it can leave permanent nerve damage.
- Numbness, tingling, or tingling in your hand and fingers
- A burning pain or feels like an ice cube in your forearm
- Weakness in your pinky and fingers
- Difficulty bringing the thumb and pinky together
- Pain along the inner part of the elbow and forearm
- Symptoms are irritated when the elbow is in a bent position for an extended period of time (such as using a mobile phone, driving, sleeping) and repetitive throwing motions
- A feeling of pressure on the inside of the elbow during bending and straightening
- Difficulty using your hand to manipulate objects, especially in tasks that require a high level of finger skill (such as writing or playing an instrument)
- Hand weakness and difficulty grasping
Hand muscle wasting can occur in long-term, chronic cases
Diagnosis of ulnar nerve entrapment in Turkey
At your first visit, doctors will perform a thorough physical examination and ask you about your medical history. Tests may include:
- Electromyography: Your doctor sends a light electrical current into a needle placed in a muscle.
It measures how well the nerve supplies the electrical signals that cause the muscles to contract.
If the nerve is not working properly, this helps locate the nerve damage.
- Nerve conduction velocity test, or nerve conduction study: Your doctor stimulates the nerve with an electrical impulse and measures how fast it moves through the nerve.
Nerve signals that are slower can indicate the type and severity of damage.
Medical history and physical examination
Your doctor will discuss your medical history and general health. He or she may also ask about your work and activities and the medications you take.
After discussing your symptoms and medical history, your doctor will examine your arm and hand to determine which nerve is being compressed.
Some of the diagnostic tests include a physical exam that your doctor may perform:
- Pressure on the nerve at the funny bone. If the nerve is irritated, it can cause trauma to the little finger and ring finger, although this can happen when the nerve is also normal.
- Checking if the ulnar nerve slips out of its normal position when the elbow is flexed.
- Move your neck, shoulder, elbow and wrist to see if different positions are causing your symptoms.
- Check the sensory feeling and strength in your hand and fingers.
Tests and pictures
- X-ray imaging tests provide detailed images of dense structures, such as bones. Although most causes of ulnar nerve compression cannot be seen on X-rays.
However, your doctor may take x-rays of your elbow or wrist to look for bone spurs, arthritis or other places where bone may be pressing on a nerve.
- Nerve conduction tests can determine how well a nerve is working and help determine where it is compressing.
Because nerves are like “electrical cables” that travel through your body and carry messages between your brain and your muscles.
When a nerve isn't working well, it takes longer for it to transmit the nerve impulse.
During a nerve conduction test, a nerve is stimulated in one location and the time it takes for a response to occur is measured.
Several places along the nerve will be tested and the area where the response takes the longest to respond is likely to be where the nerve is compressed.
Nerve conduction studies can also determine whether stress is also causing muscle damage.
During the test, small needles are placed into some of the muscles controlled by the ulnar nerve.
Muscle damage is a sign of a more severe nerve compression.
Nerve conduction studies also measure the signals that travel through the nerves in your arm and hand.
Treatment and management
Unless nerve compression causes a lot of muscle wasting, your doctor will likely first recommend nonsurgical treatment.
Treatment of ulnar nerve entrapment without surgery
- Anti-inflammatory medications: If your symptoms are just starting, your doctor may recommend anti-inflammatory medications, such as ibuprofen, to help reduce swelling around the nerve.
Although steroids, such as cortisone, are very effective anti-inflammatory drugs, steroid injections are generally not used due to the risk of nerve damage.
- A brace or splint: Your doctor may prescribe a padded brace or splint to wear at night to keep your elbow straight.
- Nerve gliding exercises: Some doctors believe that exercises that help the ulnar nerve glide through the cubital tunnel at the elbow and Guyon's canal at the wrist can improve symptoms. These exercises may also help prevent arm and wrist stiffness.
Surgical treatment of ulnar nerve entrapment in Turkey
Your doctor may recommend surgery for ulnar nerve entrapment if:
- Non-surgical methods did not improve your condition
- The ulnar nerve was very compressed
- Nerve injury causes muscle weakness or damage
There are a few surgical procedures that will relieve pressure on the ulnar nerve at the elbow.
Your orthopedic surgeon will talk with you about the best option for you.
These procedures are often done on an outpatient basis, but some patients prefer an overnight hospital stay.
- Cubic tunnel release: In this procedure, the cubital ligament is severed and divided. This increases the size of the tunnel and reduces pressure on the nerve.
After the operation, the ligament begins to heal and new tissue grows through division. As the perineurial ligament increases in length, this allows more room for the ulnar nerve to slip through.
Cubular tunnel release tends to work best when nerve compression is mild or moderate and the nerve does not slip past the bony edge of the medial epicondyle when the elbow is flexed.
- Transposition of the anterior ulnar nerve: In many cases, the nerve is transferred from its position behind the medial epicondyle to a new location in front of it.
Moving the nerve to the front of the medial epicondyle makes it possible to stretch when you bend your elbow.
The nerve can be moved to lie under the skin and fat but above the muscle (subcutaneous shunt), within the muscle (intermuscular shunt), or under the muscle (submuscular shunt).
For the anterior transposition of the ulnar nerve, an incision is made along the inner part of the elbow or along the posterior side of the elbow.
- Treating a pinched nerve with a medial epicondylectomy: Another option to release the nerve is to remove part of the medial epicondyle.
Like the ulnar nerve transposition, this technique also prevents the nerve from getting caught in the edge of the bone and stretching when you bend your elbow.
Recovery period after surgical treatment of ulnar nerve entrapment
Depending on the type of surgery you're having, you may need to wear a splint for a few weeks after the procedure.
A submuscular shunt usually requires a longer time (3 to 6 weeks) in a cast.
Your surgeon may recommend physical therapy exercises to help you regain strength and movement in your arm.
He or she will also talk to you about when it will be safe to return to all of your normal activities.
The results of surgery for ulnar nerve entrapment are generally good. Each method of surgery has a similar success rate to routine cases of nerve compression.
If the nerve is compressed too badly or if there is muscle wasting or paralysis, the nerve may not be able to return to normal and some symptoms may remain even after surgery.
Nerves recover slowly, and it may take a long time to learn how well the nerve is working after surgery.
home remedies For the treatment of cubital tunnel syndrome
There are many things you can do at home to help relieve symptoms and treat ulnar nerve entrapment
. If your symptoms interfere with normal activities or persist for more than a few weeks, be sure to make an appointment with your doctor.
- Avoid activities that require you to keep your arm bent for long periods of time.
- If you use a computer frequently, make sure your seat is not too low. Do not rest your elbow on the armrest.
- Avoid leaning on your elbow or pressing on the inside of your arm. For example, don't drive with your arm on the open window.
- Keep your elbow straight at night when you are sleeping. This can be done by wrapping a towel around your straight elbow or wearing the elbow pad backwards.