Cubital tunnel syndrome is a nerve pressure syndrome causing pain, numbness, and pins and needles. Many people have heard of carpal tunnel syndrome, which is a nerve pressure problem in the wrist. Cubital tunnel syndrome is caused by nerve pressure at the elbow. How do we treat cubital tunnel syndrome and does a steroid injection for cubital syndrome work?
Why call this condition cubital 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.
In general, long-term pressure on the nerve in the tunnel causes typical cubital tunnel symptoms. Causes of pressure on the nerve include bony spurs, a cyst or ganglion in the tunnel. Also, repeated bending of the elbow 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.
Usually, pinching of the ulnar nerve at the elbow causes the following symptoms:
- pain, numbness and pins and needle in the ring and little fingers
- weakness of the hand muscles.
- 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 level of the elbow. Second, diagnostic ultrasound can see a thickened nerve and a possible cause of pressure such as a bony spur, ganglion, or abnormal muscle bands. In fact, ultrasound is very useful to follow the ulnar nerve through the whole of the cubital tunnel. In some cases, we suggest an MRI scan of the elbow as well.
It is important to see a doctor to rule out other causes such as a pinched nerve at the neck or inflammation of the nerve due to diseases such as diabetes.
Treatment including steroid injection for cubital 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 important role in relieving symptoms.
In more difficult cases, a steroid shot for cubital tunnel syndrome can be very helpful.
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 bending the elbow, also known as ulnar nerve transposition. However, as not all surgery is successful, we suggest a trial of conservative treatment first.
More on steroid injection for cubital tunnel syndrome
Cortisone is a powerful 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 is to put cortisone above and below the site of nerve trapping. In general, ultrasound improves the accuracy and effectiveness of cortisone injection by targeting the exact location of nerve compression.
Final word from Sportdoctorlondon
Overall, it is important 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 first before considering injections or surgery.