Houston Methodist. Leading Medicine

Elbow FAQ

Question:

I was just diagnosed with cubital tunnel syndrome. What's the prognosis for this problem?

Answer:

Cubital tunnel syndrome (CTS) is a condition that affects the ulnar nerve where it crosses the inside edge of the elbow. The symptoms are very similar to the pain that comes from hitting your funny bone. When you hit your funny bone, you are actually hitting the ulnar nerve on the inside of the elbow. That's where the nerve runs through a passage called the cubital tunnel. When this area becomes irritated from injury or pressure, it can lead to cubital tunnel syndrome. Pressure on the nerve over time can also lead to muscle weakness and loss of forearm function. I Pressure or traction on the nerve can come from a variety of places. The prognosis may depend on the underlying cause of the symptoms. Part of the problem may lie in the way the elbow works. The ulnar nerve actually stretches several millimeters when the elbow is bent. Sometimes the nerve will shift or even snap over the bony medial epicondyle. (The medial epicondyle is the bony point on the inside edge of the elbow). Over time, this can cause irritation of the nerve. Bending the elbow over and over, such as pulling levers, reaching, or lifting can lead to cubital tunnel syndrome. Constant direct pressure on the elbow over time may also contribute to the problem. For example, the nerve can be irritated from leaning on the elbow while you sit at a desk or from using the elbow rest during a long drive. The ulnar nerve can also be damaged from a blow to the cubital tunnel. Other possible causes include an extra slip of muscle that crosses the nerve, a ganglion cyst, or a bone spur. Any of these extra anatomical structures can cause enough pressure to compress the neural tissue. Sometimes it's not even possible to tell what's causing the problem. These cases are called idiopathic, which means unknown. Nonoperative care can be very successful for mild cases of CTS. This may include antiinflammatory drugs, activity modification, and rest. It is important to stop doing whatever is causing the pain in the first place. Limiting elbow flexion is a key factor. If the symptoms are worse at night, a lightweight plastic arm splint or athletic elbow pad may be worn while sleeping. This will help limit movement and prolonged periods of time with the elbow bent, thus easing nerve irritation. The elbow pad can be worn during the day to protect the nerve from the direct pressure of leaning. Doctors commonly have their patients with cubital tunnel syndrome work with a physical or occupational therapist. Therapist gives patients tips on how to rest the elbow and perform activities without putting extra strain on the elbow. Nerve gliding exercises can be done to keep the nerve moving smoothly and reduce pressure from adhesions or soft tissue obstructions. Exercises are used to gradually stretch and strengthen the forearm muscles. When conservative treatment fails to give patients the relief needed, then surgery may be considered. The results of surgery may vary depending on the severity of the problem, the surgical approach used, and any complications that may occur postoperatively. Studies over time are showing that less disruption of the nerve is better. Moving the nerve and overlying muscle apart from each other (called submuscular transposition) is successful for moderate nerve compression. But instead of moving the nerve away from the compressing forces, it appears that removing the compression may be a better treatment method. For example, the surgeon can do a medial epicondylectomy (shaving off the bump of bone along the inside elbow). This procedure has just as good of results as transposition and is recommended instead. The surgeon uses caution to take just the right amount of bone off to avoid elbow instability. Surgeons have also moved from using an open incision to minimally invasive endoscopic procedures. With a much smaller incision and the use of a scope to see inside the elbow area, surgical techniques are continually refined and improved. The results are better, which means a better overall prognosis. Sohail N. Husain and Robert A. Kaufmann. The Diagnosis and Treatment of Cubital Tunnel Syndrome. In Current Orthopaedic Practice. September/October 2008. Vol. 19. No. 5. Pp. 470-474.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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