Understanding Cubital Tunnel Syndrome

What is Cubital Tunnel Syndrome (CuTS)?

Cubital Tunnel Syndrome is a prevalent compression neuropathy affecting the ulnar nerve, a major nerve running down the inside of the arm. This nerve passes through a narrow space called the cubital tunnel, which is located behind the "funny bone." There is very little soft tissue protection around this area for the nerve. For active individuals, especially climbers, the concern arises when the ulnar nerve is stressed, typically in fully flexed positions – a common posture in climbing. Although we see lots of Climbers at Quay Kinetics Physio with this condition, we also see it in people who do a lot of computer/office work who lean on their elbows on their desk for prolonged periods and don’t do much upper body mobility exercise. For some people who sleep with their elbows bent, this can sometimes aggravate the nerve too. And occasionally you can get entrapment of the nerve from bony spurs or arthritis of the elbow too.

Anatomy Involved:

The cubital tunnel is the crucial pathway for the ulnar nerve, starting from the shoulder and running along the inside of the arm. People who frequently engage in activities requiring flexed arm positions, put additional strain on this nerve, making them more susceptible to Cubital Tunnel Syndrome. The ulnar nerve gives feeling to the little finger and half of the ring finger. It also controls most of the little muscle sin the hand that help with fine movements, and some of the bigger muscles in the forearm that help you make a strong grip.

Common Symptoms:

These are the common symptoms associated with Cubital Tunnel Syndrome:

1. Pain/Tingling/Weakness: Typically felt along the inside of the forearm and may extend to the pinky and ring fingers.

2. Funny Bone Sensation: The classic "funny bone" sensation is a common early sign.

3. Worsening Symptoms during sport/exercise/manual work: Symptoms often intensify during activities involving repeated flexion of the elbow such as Climbing.

4. Medial (pain on the inside of the elbow) elbow pain often associated with Golfer’s Elbow. There can sometimes be both conditions occurring at the same time.

5. Sometimes the weakness can make using the wrist and hand difficult too. So lifting and gripping activities can become challenging.

Evidence-Based Management and Treatment Strategies:

For those who love staying active, evidence-based strategies are crucial for effectively managing and treating Cubital Tunnel Syndrome:

1. Education and Activity Modification:

Understand your body's limits and modify activities accordingly. Listen to what your body is telling you. If you are climbing a lot for example, and your elbow pain is worse the next day – consider your total volume and modify it accordingly.

Regular nerve glides can be incorporated into your warm-up routine to prevent nerve compression during physical activities. Your Physiotherapist can help you learn about the correct exercises and mobility glides to perform and when.

2. Avoid Certain Movements:

Steer clear of activities that involve excessive stretching, compression, or tight elbow angles whilst the nerve pain and discomfort are present. You can often rehab and wean yourself back to these activities over time whilst following a rehab programme.

Avoid leaning on your elbow for prolonged periods.

Avoid repeated trauma to the elbow such as through regular use of strong power tools or heavy instruments that may aggravate Golfers Elbow.

Don’t drive with your elbow leaning on the window.

3. Mindful Splinting:

While splints may seem inconvenient, they can significantly reduce flexion.

Use a towel wrapped around your elbow at night to discourage elbow flexion when sleeping.

4. Physiotherapy.

Your Physiotherapist will be able to diagnose the problem and teach you a series of shoulder/elbow/wrist and hand stretches and exercises to perform to alleviate tension through the nerve and strengthen the muscles that may have begun to get weaker. They may also tape the elbow for temporary pain relief and use manual therapy techniques to aid function too.

5. Trial Period of 6-12 Weeks:

Commit to a trial period focusing on lifestyle modifications and interventions. This allows time to gauge the effectiveness of the chosen strategies.

6. Surgical Release as a Last Resort:

If conservative management fails to bring relief over 3-6 months, surgical release may be considered. This is called a Cubital Tunnel Release and results from surgery are generally good but if the nerve is very badly compressed, or if the muscle wasting is significant, some symptoms may remain after surgery. Nerves recover very slowly so it may be some time before you know if the operation was successful.

Conclusion:

Cubital Tunnel Syndrome doesn't have to hinder your active lifestyle. By understanding the anatomy, recognising symptoms, and adopting evidence-based strategies, you can effectively manage and mitigate the impact of CuTS on your outdoor pursuits. Proactive measures, including education, activity modification, and targeted interventions, can help you continue enjoying your active lifestyle while safeguarding your arm health. Please get in touch with us if you think you may be suffering with this problem.