What is the best treatment for cubital tunnel syndrome?

DEAR DOCTOR K:

I have cubital tunnel syndrome. What’s the best treatment for it?

DEAR READER:

Cubital tunnel syndrome is a trapped or pinched nerve problem, much like its better-known relative, carpal tunnel syndrome.

Cubital tunnel syndrome occurs when the ulnar nerve gets compressed. The ulnar nerve extends from the spinal cord in your neck to your forearm and the pinky side of your hand. The nerve passes through a series of passageways, or tunnels. The tunnels are composed of tough layers of fibers that can pinch the nerve running through them.

The tunnel located behind the “funny bone” of your elbow is called the cubital tunnel. If you’ve ever hit your funny bone against something hard, you know that it’s not funny — it just hurts. Most nerves are buried deep inside the body, but in the cubital tunnel, the ulnar nerve is very close to the surface and easily injured. Below isĀ an illustration of hand nerves and muscles:

Inside the hand:

HND1112-2

 

The small but powerful muscles of the hand are located entirely in the palm and forearm. The fingers have no muscles. Fingers are controlled by tendons attached to the muscles of the hand that help to flex and extend them. Two major nerves are the median nerve (leading to the thumb, index, and middle fingers and the inner half of the ring finger) and the ulnar nerve (leading to the small finger and the outer half of the ring finger). The bursa helps cushion the hand.

 

When you bend your elbow more than 90 degrees, it stretches the ulnar nerve, pushing it against a bony canal. Tasks that require you to extend and flex your elbow repeatedly can irritate and inflame the nerve. Leaning or resting on the elbow for long periods (while driving, for instance) can also put pressure on the nerve. So can holding a phone to your ear. Your sleep position may aggravate the problem if you sleep with your elbows bent. Injuries can also damage this nerve.

Nerves carry messages from the brain to the body, and from the body back up to the brain. The ulnar nerve carries signals from the brain that tell the muscles of the arm and hand to move. It also carries sensations — pain, touch, heat — from the arm and hand up to the brain.

The first symptoms of cubital tunnel syndrome typically are numbness or tingling in the ring finger and little finger. Touching your elbow may cause a sudden, sharp pain. Your hands may also become weak and clumsy, and you may have trouble straightening your fingers.

The most important thing is to identify the actions that may have triggered the problem. For instance, switching to a headset-style phone and removing armrests from your office chair may help. Avoid leaning on your elbow, keeping your elbow flexed more than 90 degrees, and repeatedly bending and straightening your elbow. If your sleep position may be contributing to the problem, try sleeping on your side with a pillow supporting the entire length of your arm.

Nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve) can help reduce pain and swelling. So can wearing a splint to keep your elbow straight while you sleep.

If none of these changes help, your doctor may suggest minor surgery to relieve pressure on the ulnar nerve. This is usually effective. Fortunately, simpler measures almost always solve the problem and make surgery unnecessary.