Cubital tunnel syndrome is a nerve pressure syndrome causing pain, numbness, and pins and needles. Many people have heard of carpal tunnel syndrome, a nerve pressure problem in the wrist. Cubital tunnel syndrome, or ulnar tunnel syndrome, is caused by nerve pressure at the elbow. How do we treat cubital tunnel syndrome, and does an ulnar nerve injection for cubital tunnel syndrome work?

Why call this condition cubital tunnel syndrome?   

cunital tunnel syndrome

The ulnar nerve courses along the inside of the elbow to supply muscles in the hand. As the nerve passes along the inside of the elbow, the nerve sits between to bony point (medial epicondyle) and the back of the elbow (olecranon). This position is like a tunnel, also called the cubital tunnel.

Causes

Long-term pressure on the nerve in the tunnel generally causes typical cubital tunnel symptoms.

Causes of pressure on the nerve include bony spurs, a cyst, or ganglion in the tunnel. Also, repeated elbow bending with weight, such as gym exercises, can lead to excess pressure. Finally, in some cases, the nerve can move excessively with repeated elbow bending, causing nerve irritation and pressure.

Symptoms 

cubital tunnel syndrome

Usually, pinching of the ulnar nerve at the elbow causes the following symptoms:

  • pain, numbness and pins and needles in the ring, and little fingers
  • hand weakness.
  • symptoms are worse with the elbow bent
  • in severe cases, there may be clawing and wasting of the muscles of the hand

Overall, the diagnosis is made through a clinical assessment combined with tests. First, nerve studies confirm pressure on the nerve at the elbow level. Second, diagnostic ultrasound can see a thickened nerve and a possible pressure cause, such as a bony spur, ganglion, or abnormal muscle bands. Third, ultrasound is beneficial for following the ulnar nerve through the whole cubital tunnel. Finally, in some cases, we also suggest an MRI scan of the elbow.

It is essential to see a doctor to rule out other causes, such as a pinched nerve at the neck or nerve inflammation due to diseases such as diabetes or inflammatory neuritis. 

Treatment including ulnar nerve injection for elbow tunnel syndrome

Generally, we start with simple treatments to reduce pressure on the nerve. Examples include padding for the elbow, wearing a splint at night, and anti-inflammatory medication. Also, physiotherapy, such as massage, nerve stretches, and strengthening exercises, can play an essential role in relieving symptoms.

Here are a few tips that you can try yourself:

  • Wear a soft neoprene elbow brace if you work at a desk. These braces help protect the ulnar nerve from more compression.
  • If you experience pain at night, wearing an elbow splint will stop your elbow from bending and protect the ulnar nerve.

A steroid shot for cubital tunnel syndrome can benefit more complex cases.

Finally, in cases that fail other treatments, surgery may be required. Usually, surgery involves moving the nerve to the front of the elbow. This procedure reduces pressure when elbow bending, also known as ulnar nerve transposition. Sometimes, surgeons remove bone from the inside of the elbow – also called the medial epicondyle. However, as not all surgery is successful, we suggest a trial of conservative treatment first.

More on steroid injection for ulnar tunnel syndrome

Cortisone is a potent anti-inflammatory that reduces inflammation and pain.

In cases of cubital tunnel syndrome, cortisone is injected at the site of the nerve trapping. Generally, the key to an ulnar nerve injection is to put cortisone above and below the site of ulnar nerve trapping. In general, ultrasound improves the accuracy and effectiveness of cortisone injection by targeting the exact location of nerve compression.

Recent evidence suggests an ulnar nerve injection done with ultrasound improved pain and nerve function. 

Other frequently asked questions about cubital tunnel syndrome:

Can cubital tunnel syndrome cause shoulder pain? 

Sometimes. Pressure on the ulnar nerve inside the elbow can move up to the shoulder and neck. It may be hard to determine whether the pain comes from the elbow or a trapped nerve in the neck. Your doctor should examine you to determine the likely site of nerve trapping. Also, nerve studies can clarify the site of trapping.

What other causes mimic cubital tunnel syndrome? 

Some other diseases can produce similar symptoms to cubital tunnel syndrome. These conditions include nerve trapping at the neck, thoracic outlet syndrome, and brachial plexopathy. Also, medical diseases such as diabetes and hypothyroidism can increase your chances of developing ulnar nerve trapping.

Is an ulnar nerve injection effective? 

Yes. But we suggest you have an ulnar nerve injection done under ultrasound guidance. Ultrasound allows perfect placement of cortisone around the precise site of ulnar nerve trapping. Risks of an ulnar nerve injection include infection (rare), cortisone flare, skin changes and damage to other structures. However, we think these risks are reduced by using ultrasound. If you are considering an ulnar nerve injeciton with ultrasound, you should ask the following four questions of your practitioner before undertaking an ultrasound-guided injection. 

Final word from Sportdoctorlondon about cubital tunnel syndrome

Overall, it is essential to confirm the diagnosis of ulnar nerve trapping at the elbow and rule out other causes of nerve trapping elsewhere. In addition, we suggest you try simple treatments before considering injections or surgery. 

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Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.