In this video, elbow specialist Dr. J Michael Bennett describes the anatomy of the elbow and the causes, symptoms and treatments of cubital tunnel syndrome. In many cases cubital tunnel syndrome can be treated, without surgery, by wearing an elbow brace at night. In the video, Dr. Bennett demonstrates how you can use an elbow pad to treat cubital tunnel syndrome.
Dr. J. Michael Bennett is a Board Certified Orthopedic Surgeon and a Fellowship Trained Sports Medicine Physician with offices in Houston, near the Galleria and in Sugar Land, TX. Call our Sugar Land office at 281-633-8600 and our Downtown Houston office at 713-234-3152. Dr. Bennett specializes in treating injuries and pathologies of the shoulder, elbow and knee.
Welcome. I’m Dr. J. Michael Bennett; I’m Orthopedic Sports Medicine Specialist. I specialize in injuries and pathologies of the shoulder, elbow, and knee. Welcome to the Whiteboard Series. Today, we’re going to talk about a very common problem, and this is called Cubital Tunnel Syndrome. This actually is similar to Carpal Tunnel Syndrome, but it occurs in a different area of the body; it actually occurs up in the elbow region. Some people also call this your funny bone.
If you happen to notice that you have a recurrent numbness and tingling, particularly fourth and fifth digits in fingers on the hand, that usually indicates you may have one of two issues going on. It’s definitely a nerve issue if you’re having the tingling and burning sensation.
It could be a compression of the ulnar nerve, and there’s a couple of areas where that nerve can get compressed. Sometimes it can get compressed in the wrist, sometimes it can get compressed in the elbow. More commonly, it’s in the elbow region. That’s why it’s called Cubital Tunnel Syndrome, because this is the Cubital Tunnel.
If you look at a diagram of the elbow, and this is a side view of the elbow, if you’re looking at a bony anatomy of the elbow. This is the outside of the elbow, the inside of the elbow. Here’s the inside of the elbow, this big bone here is called the medial epicondyle. You can feel it on yourself if you palpate it. Looking at it from a side view like this, is going to look like this circle. That represents the medial epicondyle.
Behind that epicondyle, is the nerve, and that’s the ulnar nerve that traverses behind this. The problem is that occasionally you get some squeezing of this nerve behind this bone. There’s a band of tissue behind that area, and that band of tissue can actually, over time, squeeze that nerve and keep the blood flow from getting to that nerve. That nerve can actually become very irritated, sometimes it can actually get scarred and it can create symptoms.
Most of the time, taking an anti-inflammatory and making sure you don’t bump that elbow, making sure that you’re not sitting with that elbow flexed for a long period of time, most of the time, will take care of it. That’s what we call transient Cubital Tunnel Syndrome, meaning that if you go to sleep at night and you sleep with your arms flexed and your wrists curled, then you get this numbness and tingling in the fourth and fifth fingers.
All that means is remember try to sleep with your arms extended. During the day, make sure you’re not sitting with your arms flexed for a long period of time on the telephone or hanging on the windowsill. Make sure you just take a break every now and then. Move your elbow; make sure you straighten it out. That will help decrease the pressure and the tension across that nerve, and most likely, your symptoms will resolve on their own. Sometimes an anti-inflammatory could be helpful, as well. Just make sure you check with your doctor first if you can take an over-the-counter anti-inflammatory.
If you do sleep like I mentioned before with your elbows flexed and your wrists flexed, we call this praying mantis position, there are some things that you can use if, for instance, you can’t seem to keep your elbows straight at night or you can’t find a position that’s comfortable.
One thing that I do recommend for patients to try is to use some sort of night splint. There’s different types of splints out there. You can get a fancy splint that’s made especially for you, which would actually be a hard splint that you strap behind your elbow to keep your elbow straight. I find what works best for us and our patients here in our clinic is just a regular elbow pad that you can get over-the-counter at any sporting goods store. You take the pad, and instead of putting the pad on the back of the elbow, you move it to the front of the elbow.
With the pad in the front of the elbow when you’re sleeping at night, you’re not going to be able to flex your elbows and your wrist, because this pad was going to make you keep it extended. When you’re asleep and unconscious, you have no control over that, so automatically, you’re elbow will extend. Another thing that you can use is a stack of towels and use an Ace wrap around it, as well. That will actually keep you from flexing your elbows at night, as well.
I would recommend if you do have this transient ulnar nerve symptoms, that you try this first and see if that takes care of the symptoms. Give it at least a week or so, see if it makes it any better. If it does not improve, then I’d probably recommend that you be evaluated by an orthopedic specialist to actually rule out any chronic issues with this nerve. If you do not address these issues, these are not going to go away. If they don’t go away by themselves over the first few weeks to a month, they’re probably not going to go away on their own. I would recommend you be evaluated by an orthopedic specialist.
Sometimes you can have other symptoms like wasting or muscle fatigue and atrophy of the hand. You do not want to let that get out of control because these symptoms can become irreversible if you ignore them. The muscle wasting can actually become irreversible. You’ll first notice it, primarily, in this first web space, as well as this little padding area in the hand. That is primarily . . . that’s actually innervated by the ulnar nerve in the inside of the elbow.
Carpal tunnel; that addresses these 3 fingers. We’re going to talk about that in another session. This is primarily about Cubital Tunnel Syndrome.
If you have any questions, please feel free to call my office, 281-633- 8600, or visit our website at OrthopedicSportsdoctor.com or JMichaelBennett.com. I appreciate you listening. Thank you.
Dr. J. Michael Bennett is a Board-Certified Orthopedic Surgeon and a Fellowship Trained Sports Medicine Physician with offices in Houston and in Sugar Land. He specializes in treating injuries and pathologies of the shoulders, elbows, knees and certain injuries of the wrists and hands. Call our Houston office at 713-234-3152 and our Sugar land office at 281-633-8600. You can book an appointment online by clicking the “Book an Appointment” button at the top of the page.