The FitRehab Podcast, Episode 5: Treat Cubital Tunnel Syndrome.
Do you have numbness and/or tingling in your pinky and ring finger(s)? This is commonly a symptom of Cubital Tunnel Syndrome. In today's episode, I'll discuss what cubital tunnel syndrome is and 5 tips you can start now to treat this condition and prevent it from worsening.
So let’s begin by explaining the purpose of the ulnar nerve. There are three nerves that travel from our spine all the way down to the hand: The median nerve, the radial nerve, and the ulnar nerve. The ulnar nerve (commonly referred to as the “funny bone”) supplies sensation along the front and back of the pinky side of the hand, to the entire pinky front and back, and to the half of the ring finger that is closest to the pinky finger.
Therefore, one of the earliest signs of disruption to the ulnar nerve is numbness or tingling in these areas and/or feeling like this part of your hand “fell asleep.” Many times this is after either sitting with your elbow resting on a hard surface for an extended period of time or when waking up after sleeping with your elbow bent behind your head.
This is actually quite common, but symptoms typically resolve on their own within a few minutes or so once you change positions and relieve pressure on the nerve.
The ulnar nerve also controls muscles that are responsible for three movements:
bending the pinky and ring fingers (which is crucial for holding onto objects as the pinky and ring fingers actually produce a lot of strength and power for gripping which many people don’t realize. They assume that’s the role of the thumb, index, and middle fingers but those three fingers are moreso recruited for dexterity and manipulation whereas the ring and pinky fingers supply the power and strength.). To help visualize this, I’d like for you to take a second to make a fist with one of your hands. Now, flip your fist over so that your palm is facing up and look at the orientation of your knuckles. Do you notice how the index finger’s knuckle rests higher than the middle knuckle, and the middle knuckle rests higher than the ring knuckle, and the ring knuckle rests higher than the pinky knuckle? This is what we call a normal cascade for the fingers. Losing the strength and ability to pull those fingers down below the other two, makes it harder to hold onto an object, such as a cup.
The second movement the ulnar nerve controls is spreading the fingers apart and bringing them back together, which, of course, is also important for being able to grab and release objects.
A third movement that is controlled by the ulnar nerve is bringing the thumb in toward the index finger. Picture how you hold a key. The key rests between your thumb and index finger, right? Well, the ulnar nerve controls the primary muscle that keeps your thumb secured on the key as you lock and unlock the door. If this muscle is weak and ineffective, holding a key becomes difficult and you would then likely notice the very tip of your thumb having to bend more as a muscle that is controlled by the median nerve is recruited to help out (this is called Froment’s sign). A simple test you can administer on yourself to check that this muscle is working effectively is to hold a piece of paper between your thumb and index finger. Now, use your other hand to try and pull that piece of paper out from between your thumb and index finger but try to not allow the paper to come loose. If the muscle controlled by your ulnar nerve is effective, you should notice your thumb stays relatively straight with little to no bending of the thumb’s top knuckle. If this muscle is lacking, you’ll notice that the top knuckle on your thumb bends more and more as the median nerve is being recruited to assist the ulnar nerve.
So, now that we’ve discussed the importance of the ulnar nerve, let’s move on to what exactly is cubital tunnel syndrome.
What is Cubital Tunnel Syndrome?
Cubital Tunnel Syndrome simply refers to compression of the ulnar nerve at the elbow. The ulnar nerve travels from the inside of the upper arm down through the inside of the elbow, forearm, wrist, and into the hand.
There are five primary locations around the elbow where the nerve most commonly becomes compressed:
The intermuscular septum which is essentially the area in which the nerve changes from being in the front of the arm where it lies underneath the biceps muscle (or anterior compartment for the scientific term) to the back and inside (or posteromedial compartment).
The Arcade of Struthers which comprises parts of the triceps muscle, as well as facia. This area lies about 8 cm above the inside of the elbow and is estimated to be the most common site of compression for cubital tunnel syndrome (occurring in about 70% of all cases) (Masker & Klein, 2021).
The condylar groove: if you feel along the inside of your elbow, you’ll notice two solid bumps, one in front of the other. The area in between those two bumps is called the condylar groove and is right where the ulnar nerve passes through. This is the area most susceptible to compression when leaning on your elbow as it rest on a surface, such as the table or armrest in the car, as the nerve lies very close to the surface in this area with not much padding to protect it from external pressures (such as resting on a hard surface). This is also the area that is commonly bumped when people say the “hit their funny bone” and it sent a jolt or tingly feeling down their forearm.
The fourth site of compression for cubital tunnel syndrome is the cubital tunnel itself. This is located in that same area as the condylar groove that I just mentioned. This area is referred to as a tunnel because it is just that. A tunnel. And just like a train tunnel has a roof, two walls, and a floor; so does the cubital tunnel. The floor of the cubital tunnel is comprised of one of the elbow’s ligaments (the medial collateral ligament) and the capsule of the elbow joint itself. The walls are those two bony bumps I mentioned earlier (known as the medial epicondyle and olecranon). And the roof is made up of another ligament and some connective tissue that extends into the forearm. When the elbow is held in a bent position for extended periods, the ulnar nerve is most commonly compressed here in the cubital tunnel as the tunnel narrows more and more the further the elbow is bent.
The fifth site of compression is between the two heads of a muscle in the forearm. The risk for compression at this site is higher in people with big muscles in the forearms and/or in manual laborers that operate heavy machinery and power tools.
What are Symptoms of Cubital Tunnel Syndrome?
Numbness/tingling in ring and pinky fingers BUT there will still likely be feeling in the backside of hand
"Snapping" feeling at inside of elbow when bending beyond 70-90 degrees
Frequent dropping of objects
Clumsiness using hand(s)
Difficulty/weakness spreading fingers apart
Claw hand deformity (in severe cases)
What Are Conservative Treatments for Cubital Tunnel Syndrome That You Can Start Now?
1.) Wearing an elbow brace to limit bending of elbow:
Begin by wearing overnight to prevent yourself from sleeping with your arm curled up.
Many of the braces (such as the one below) come with removable plates. I usually recommend clients remove those plates and see if the brace fabric itself is enough to limit flexion. Clients commonly report doing so is more tolerable and comfortable and thus increases likelihood they'll continue to wear it.
(The above link will direct you to Amazon's website. As an Amazon Associate I earn from qualifying purchases if purchased through a link provided by me. This occurs at no extra cost to you.)
2.) Avoid Ice:
As tempting as it may be to ice the elbow, try to avoid doing so. Nerves are very sensitive to cold and cold temperatures slow their ability to send signals to and from the brain. This, in turn, slows the healing process and can even increase pain and symptoms.
3.) Protect the Nerve:
Do not lean your elbow directly onto a hard surface (such as the dinner table, desk, or car door). If you must rest your elbow on the surface, ensure there is padding between your elbow and the surface. The nerve lies very close to the surface and thus is very susceptible to compression at the elbow.
When operating power tools and/or heavy machinery, make sure you wear anti-vibration/impact personal protective equipment. High vibrations and impacts irritate a nerve. Ensuring you are using specifically designed equipment can help to reduce the forces on, not only the ulnar nerve, but the other nerves in your hand as well.
(The above link will direct you to Amazon's website. As an Amazon Associate I earn from qualifying purchases if purchased through a link provided by me. This occurs at no extra cost to you.)
4.) Limit Repetitive Bending of the Elbow Over 70 Degrees:
Bending the elbow over 70 degrees increases risk for two occurrences: (1) subluxing an unstable nerve in and out of place, and (2) narrowing the tunnel that the nerve passes through which can cause compression of the nerve.
You do not have to completely avoid bending your elbow (nor should you as this could cause stiffness). Just try to be mindful of how often you are doing so and limit repetitive movements at the elbow as much as you can.
5.) Stimulate/Desensitize the Sensory Fibers of the Ulnar Nerve:
Depending on the severity of the injury, you may be experiencing sensitivity or lack of sensation along the pinky side of your palm and/or into your ring and pinky fingers. Continuing to expose these areas to different textures can be effective at "retraining" the nerve to sense these stimuli.
Make sure you try different textures (smooth, rough, bumpy, felt, etc)..
It is also very important to be mindful that, because of these sensory disruptions, you might not be as accurate in determining how hot an object is and/or where exactly your hand is in space. Therefore, make sure you keep an eye on your hand frequently to allow your vision to help keep your hand safe.
So there you have it. A run down on cubital tunnel syndrome and 5 tips you can start now to resolve this condition before it worsens.
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Thanks for reading. See ya next time! :)
Reference
Masker, K., & Klein, K. (2021). Peripheral nerve injuries. In K. Masker, & H. Gift (Eds.), Test prep for the CHT exam, 4th edition: Study outline and clinical reference (pp. 253-255) American Society of Hand Therapists.
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