Cubital tunnel syndrome
is a pinched nerve at the elbow commonly known as the "funny bone". This
might be caused by trauma or repetitive use of the elbow and may be caused
by continuous use of the elbow in a flexed position. This causes the nerve
to become stretched and irritated as opposed to when the arm is extended
and the nerve is in a relaxed position. The diagnosis can be confirmed
with electrodiagnostic testing including nerve conduction velocity and
the electromyogram. Nerve conduction velocity studies, the speed of the
nerve across the elbow, will be slowed when there is nerve compression
and electromyogram studies, the innervation of the muscles, might be affected
by the pinched nerve.
For this problem there
are three modes of treatment; no treatment, conservative, and surgical.
Unfortunately with conservative treatment, only splinting with the arm
in an extended position has been found to be helpful. Night time splinting
is achieved with a custom made long arm splint that the patient will wear
at night time and as often as possible during the day. Unfortunately it
is cumbersome to keep the arm out straight all the time and therefore
this is usually used only at night.
If the patient has
persistent complaints despite conservative treatment surgery would be
recommended. There are three types of procedures, one is to cut the medial
epicondyle which is the bone pinching the nerve or the other two operations
are to actually move the nerve out of the cubital tunnel either above
or below the muscles of the forearm. This can be performed as an outpatient
procedure with an axillary block where only the arm is put to sleep and
it has a high success rate.
