Cubital Tunnel Syndrome

Abstract

Compression neuropathy of the ulnar nerve at the elbow, more familiarly known as cubital tunnel syndrome, is a common condition in part caused by complex underlying anatomy. Cubital tunnel syndrome is described under a variety of classification systems, and several diagnostic tests and treatment options are available for it. Both extrinsic and intrinsic factors contribute to cubital tunnel syndrome, and its symptoms present initially as paresthesia in the distribution of the ulnar nerve. Severe cases are marked by loss of sensory function and intrinsic muscle weakness and atrophy. The diagnosis of cubital tunnel syndrome is based on a history and physical examination, but may be helped by electrodiagnostic tests. Provocative findings consist of a positive Tinel sign in the retrocondylar groove and positive findings on an elbow flexion test, and occasionally the presence of nerve hypermobility. The management of cubital tunnel syndrome includes nonsurgical treatment or any of various surgical procedures directed at relieving nerve traction and compression. Nonsurgical treatment is aimed at reducing direct pressure on the ulnar nerve and avoiding prolonged elbow flexion through activity modification and the use of night splinting. Historically, the options for surgical treatment have included medial epicondylectomy, in situ decompression without transposition (open vs endoscopic) of the ulnar nerve, and anterior transposition of the ulnar nerve via subcutaneous, intramuscular, or submuscular positioning. Early diagnosis and appropriate treatment will contribute to improved outcomes of the management of cubital tunnel syndrome.

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