Ulnar Nerve/Cubital Tunnel

Overview

The ulnar nerve is one of the three large nerves that crosses the elbow (the others are the median and radial nerves). The ulnar nerve passes across the elbow on the medial (inside) side. It lies very near to the medial ulnar collateral ligament. As it crosses the elbow joint, it enters a small tunnel referred to as the cubital tunnel. This tunnel is made up of bone on one side and ligament on the other. Because this space is tight, it is a common place where the nerve can become compressed. This compression is often referred to as “cubital tunnel syndrome,” and it can lead to nerve-related problems such as pain, weakness, numbness, and even muscle atrophy.  

While nerve compression is one cause of ulnar nerve symptoms, nerve instability (meaning the tunnel is too loose and the nerve moves more than it should) can also cause similar symptoms.

  • Pain on the inside (medial) part of the elbow
  • Numbness and/or tingling that goes down the inside part of the forearm and even into the ring and little fingers (4th and 5th digits)
  • Weakness with certain wrist and hand motions
  • Sensation of popping or snapping on the inside part of the elbow
  • Decreased muscle size (atrophy) of certain muscles in the hand

Seek care if you have pain in the elbow that does not improve with a brief period of rest. Also, if you start to notice decreased sensation, numbness, tingling, weakness in the wrist/hand, or atrophy of muscles, you should see your doctor.

  • Cubital tunnel syndrome or ulnar nerve problems can occur involving a number of different mechanisms:
  • Decreased space in the cubital tunnel (can occur for a number of different reasons)
  • Swelling of the nerve, especially the portion that passes through the cubital tunnel
  • Repetitive use of the elbow
  • Prior injury to the inside part of the elbow
  • Elbow dislocation or instability
  • Fracture of the bones near the nerve
  • Significant elbow arthritis
  • Injury or compression of the nerve in other locations such as the neck

There are a number of factors that increase your risk of ulnar nerve problems at the elbow:

  • History of elbow injury
  • Arthritis in the elbow and/or neck
  • Sports or occupations that require repetitive elbow motion such as throwing, hammering, etc.
  • Certain medical conditions, particularly those that cause nerve problems or increased inflammation in the body

Nonoperative management with rest, activity modification, anti-inflammatory medications, and elbow pads/braces are typically considered as the first line of treatment for patients with ulnar nerve problems. The majority of patients will have improvement in their symptoms with these simple treatment methods. For those who continue to have problems despite these treatments, consideration may be given to an injection in the area of nerve compression/inflammation. If symptoms are persistent or severe, surgery may be considered. This typically consists of releasing the tight cubital tunnel that is compressing the nerve, and this is referred to as “nerve decompression.” In some cases where the nerve is unstable or does not tend to stay in its normal location, the nerve is actually moved out of the tunnel altogether and secured in a safer location. This is referred to as a “nerve transposition.”  

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