Cubital tunnel syndrome is pain coming from the ulnar nerve. It begins in the neck and travels along the inside of the arm, passing behind the ‘funny bone’. It can be injured by direct impact or by compression from bone, muscle or connective tissues. It transmits sensation from the little finger and half of the ring finger. It also delivers impulses from the brain to the muscles that bend the wrist and allow you to pinch things between your thumb and index finger. Most people experience cubital tunnel syndrome as either pain or pins and needles along the inside of the forearm or along the little finger. It’s that same sensation that you get when you hit your funny bone.
--What causes cubital tunnel syndrome?
Cubital tunnel syndrome typically occurs following a direct trauma (hitting your funny bone), through repeated external compression (leaning on it), through repeated compression that causes the nerve to become swollen and/or hypersensitive, or through repeated stretch when there is looseness (laxity) in the ligaments that support the inside of the elbow, such as in throwing or racquet sports. Less commonly, it can occur in specific medical conditions, including diabetes and haemophilia.
When a nerve is exposed to direct or repeated trauma, the nerve can become painful and sensitive to movement or pressure. If the nerve becomes swollen, it can begin to impact on the ability of the nerve to conduct impulses from the body to the brain and vice versa. If this happens, you can experience altered or reduced sensation and/or reductions in muscle strength.
In more severe cases, the pain or pins and needles can progress to loss of sensation along the little finger. This can be accompanied with loss of strength with gripping and pinching tasks, and can lead to a decrease in the size of the muscles on the little finger and side of the hand. In severe cases, the little and ring fingers begin to develop a claw-like appearance.
--How do I know if I have cubital tunnel syndrome?
Generally, the diagnosis of cubital tunnel syndrome is made clinically, through a combination of signs and symptoms, including pain along the inside of your forearm and/or little finger, and tenderness behind your funny bone that reproduces your pain. This can result in numbness along the little and ring finger and/or wrist and hand weakness
Your doctor can arrange nerve conduction testing to assess the condition of the nerve and site of the compression.
--How can physiotherapy help with cubital tunnel syndrome?
Accurate diagnosis is crucial in the selection of the best treatment for cubital tunnel syndrome. Your physiotherapist will be able to accurately assess and differentiate the source of your elbow pain. Through the process of a detailed history and examination, they will determine the source of your pain and the contribution of factors such as posture and workload.
In cubital tunnel syndrome, early management is crucial to try and prevent damage to the nerve through either ongoing trauma or secondary inflammation and swelling. If there is loss of sensation or muscle power, the outcome is generally less-favourable, so time is of the essence.
Part of your physiotherapy management may include taping to try and protect the nerve with the adjacent fat and soft tissue. They may also use pulsed ultrasound or ice.
Another treatment that your physiotherapist may use is mobilisation of your neck, which can assist with the mobility of the nerve. They may also include specific stretches or gliding movements to assist the mobility of the ulnar nerve as it passes behind the elbow.
If there is a posture cause of your symptoms, your physiotherapist will prescribe stretching and strengthening exercises to improve your posture. This may involve a gym-based program or exercises that you can perform at home.
Your physiotherapist will be able to counsel you as to whether you need further medical assessment, whether you may need to discuss medication or injection with your GP, or referral to a specialist. If there is loss of sensation or muscle power, your progress is generally slower and may require nerve conduction testing and an opinion from an upper limb surgeon.
--How effective is physiotherapy for cubital tunnel syndrome?
There are many factors that determine the effectiveness of physiotherapy in the treatment of cubital tunnel syndrome. The following points are associated with positive or negative response:
Positive
- No loss of sensation or muscle strength
- Localised tenderness behind the funny bone
- A reduction in symptoms with taping
Negative
- Loss of sensation or muscle power
- Associated medial ligament looseness (laxity)
- Bone spurs or cysts that compress the nerve
- Coexisting diabetes or neuropathy
--What can I do at home?
There are many things that you can do at home to help reduce the pain of cubital tunnel syndrome.
The first place to start is carefully working out which activities aggravate your pain and trying to modify or eliminate these. This may not always be practical but every little bit counts.
Stretching the muscles across your chest and neck can help reduce any impact that these may have on the function of the nerve. This can be especially effective if there is a postural link to you nerve pain.
It can be worth trialling some ibuprofen, which can help reduce the inflammation, or speaking to your pharmacist or GP about stronger anti-inflammatory medication.
Ice can be helpful, but many people find ice to be too uncomfortable when applied over nerves.
As with all injuries, accurate diagnosis is a crucial part of best management.
--How long until I feel better?
In simple cases, cubital tunnel syndrome can resolve within a number of weeks. This is especially the case if the pain can be relieved with taping. For people who have had their symptoms for more than a couple of months, management of the condition can take up to 3–6 months.
The presence of anatomical compression or loss of nerve function delays recovery and requires a surgical consultation. In these situations, it can take up to 6–12 months for a complete recovery.
