What's the best way to treat cubital tunnel syndrome? I've had this condition for two years and finally have time to deal with it.

Cubital tunnel syndrome is a problem with nerve entrapment affecting the ulnar nerve of the arm. The ulnar nerve stretches several millimeters when the elbow is bent. Sometimes the nerve will shift or even snap over the bony medial epicondyle (the bony point on the inside edge of the elbow). Over time, this can cause irritation to the nerve.

One common cause of cubital tunnel syndrome is frequent bending of the elbow, such as pulling levers, reaching, or lifting. Constant direct pressure on the elbow over time may also lead to cubital tunnel syndrome. The nerve can be irritated from leaning on the elbow while you sit at a desk or from using the elbow rest during a long drive or while running machinery. The ulnar nerve can also be damaged from a blow to the cubital tunnel.

Rest and activity modification are often recommended at first. Anti-inflammatory medications may help control the symptoms. However, it is much more important to stop doing whatever is causing the pain in the first place. Limit the amount of time you do tasks that require a lot of bending in the elbow. Take frequent breaks. If necessary, work with your supervisor to modify your job activities.

If your symptoms are worse at night, a lightweight plastic arm splint or athletic elbow pad may be worn while you sleep to limit movement and ease irritation. Wear it with the pad in the bend of the elbow to keep the elbow straight while you sleep. You can also wear the elbow pad during the day to protect the nerve from the direct pressure of leaning.

Doctors commonly have their patients with cubital tunnel syndrome work with a physical or occupational therapist. At first, your therapist will give you tips on how to rest your elbow and how to do your activities without putting extra strain on your elbow. The therapist may be able to mobilize (move) the nerve in ways that take pressure off it. Exercises are used to gradually stretch and strengthen the forearm muscles.

But if it's been two years already you may need more than a conservative approach -- especially if these steps don't bring about relief of your symptoms. Surgery may be considered. The goal of surgery is to release the pressure on the ulnar nerve where it passes through the cubital tunnel.

There are different kinds of surgery for cubital tunnel syndrome. A simple nerve decompression involves removing any adhesions from around the nerve or cutting any soft tissues that might be pressing on the nerve. A second procedure is called an ulnar nerve transposition. In this procedure, the surgeon forms a completely new tunnel from the flexor muscles of the forearm. The ulnar nerve is then transposed (moved) out of the cubital tunnel and placed in the new tunnel.

The third approach is to remove the medial epicondyle (bony bump) on the inside edge of the elbow, a procedure called medial epicondylectomy. By getting the medial epicondyle out of the way, the ulnar nerve can then slide through the cubital tunnel without pressure from the bony bump.

The best thing to do is see an orthopedic surgeon and/or a hand therapist for an evaluation. Once the full extent of your problem has been determined, then an appropriate treatment program can be prescribed.

Reference: 

Sheina A. Macadam, MD, et al. Outcomes Measures Used to Assess Results After Surgery for Cubital Tunnel Syndrome: A Systematic Review of the Literature. In The Journal of Hand Surgery. October 2009. Vol. 34A. No. 8. Pp. 1482-1491.

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