There are two main nerves to the hand, the Median and the Ulnar nerves. There are also two diseases that cause compression of these nerves: Carpal Tunnel (see separate information sheet) and Cubital Tunnel Syndromes.
At the back of the elbow is a tight tunnel, The Cubital Tunnel, through which the Ulnar nerve pass into the forearm. This is where it is called “the funny bone” as trauma to this will give an electric shock to the hand. The floor of this tunnel is made by the elbow bones and the roof by a tough ligament (Osborne Ligament). Cubital Tunnel Syndrome (CuTS) is when the Ulnar nerve is compressed in this tunnel. The Ulnar nerve supplies the muscles of the hand that are responsible for the fine precise function of the hand as well as the hand grip. It also provides sensation to the little and half of the ring fingers. The deformity with an ulnar nerve dysfunction is called a “claw hand”.
Symptoms of CuTS are typically pins and needles and tingling or numbness in the above fingers as well as clumsiness of the hand. It is worse when the elbow is bent. In its most severe forms the small muscles in the hand may even be wasted. It can be from a previous broken elbow, lumps in the elbow or just in people who are genetically more susceptible to get CuTS.
Cubital Tunnel Syndrome Treatment
Mild CuTS may be managed by non-surgical means. Some of these include splinting to rest the elbow, activity modification (especially to avoid bending the elbow), nerve gliding, steroid injection around the ulnar nerve and anti-inflammatory tablets.
Moderate to severe CuTS usually requires surgery. In the majority of the cases a Cubital tunnel release to relieve the pressure on the Ulnar nerve is all that is needed. In the more severe cases, recurrent disease or for throwing athletes sometimes the nerve needs to be moved to a new position under the muscles at the elbow. In cases of previous fractured elbow or if there is a bony spur, then the bone needs excision too.
The incisions are about 7-10 cm behind the elbow. CuTR is performed in an accredited hospital, usually under a general anaesthetic. The operation takes about an hour.
The procedure is done as a day only procedure without the need to stay overnight in hospital. The elbow is usually wrapped in a bulky bandage plaster and patients are discharged with a sling to elevate their arm. The plaster and the dressings need to stay dry and intact for one to two weeks when Dr Safvat will remove them.
Nerve recovery may take up to 12 months, depending on the extent of damage to the nerve prior to the surgery. In cases where there is wasting of the small muscles of the hand this will take a long time to recover and in rare cases it may never do so.
All operations have risks and Dr Safvat will discuss these in details with his patients beforehand.
The Ulnar nerve can be compressed at other sites and Dr Safvat insists that all his patients have a Nerve Conduction Study before the operation to confirm the diagnosis and site of ulnar nerve compression as well as an objective measurement to gauge Ulnar nerve recovery after the CuTR.