Radiographic features MRIĮvidence of muscle denervation (edema or atrophy) along the posterior interosseous nerve distribution is the most common finding on MRI 4. It is a result of compression of the posterior interosseous nerve (deep motor branch of the radial nerve) as it passes through the lateral muscular septum 1. Pain may radiate up to the shoulder and neck and is aggravated by the use of the hand 1.Įlectromyographic findings that might suggest or confirm the diagnosis are typically absent. Pain on resisted supination of the forearm and pain on resisted middle finger extension is common 2. Cubital tunnel symptoms may not completely resolve after surgery, especially in severe cases.The syndrome is characterized by pain along the radial aspect of the proximal forearm and, despite it being compression of a motor nerve, it is characterized by the absence of neurologic deficits. The numbness and tingling may improve quickly or slowly, and it may take several months for the strength in the hand and wrist to improve. Restrictions on lifting and/or elbow movement may be recommended. Following surgery, the recovery will depend on the type of surgery that was performed. Some surgeons may recommend trimming the bony bump (medial epicondyle). The nerve may be placed under a layer of fat, under the muscle, or within the muscle. Many surgeons will recommend shifting the nerve to the front of the elbow, which relieves pressure and tension on the nerve. When symptoms are severe or do not improve, surgery may be needed to relieve the pressure on the nerve. A session with a therapist to learn ways to avoid pressure on the nerve may be needed. Keeping the elbow straight at night with a splint also may help. Avoiding putting your elbow on hard surfaces may help, or wearing an elbow pad over the ulnar nerve and “funny bone” may help. Changing the patterns of elbow use may significantly reduce the pressure on the nerve. Symptoms may sometimes be relieved without surgery, particularly if the EMG/NCS testing shows that the pressure on the nerve is minimal. Cubital tunnel syndrome occurs when the pressure on the nerve is significant enough, and sustained enough, to disturb the way the ulnar nerve works. Sometimes the connective tissue over the nerve becomes thicker, or there may be variations of the muscle structure over the nerve at the elbow that cause pressure on the nerve. Such sustained bending of the elbow may tend to occur during sleep. Additionally, pressure on the ulnar nerve can occur from holding the elbow in a bent position for a long time, which stretches the nerve across the medial epicondyle. If this occurs repetitively, the nerve may be significantly irritated.
In some patients, the ulnar nerve at the elbow clicks back and forth over the bony bump (medial epicondyle) as the elbow is bent and straightened. If this occurs repetitively, the numbness and pain may be more persistent. For example, if you lean your arm against a table on the inner part of the elbow, your arm may fall asleep and be painful from sustained pressure on the ulnar nerve. The nerve is positioned right next to the bone and has very little padding over it, so pressure on this can put pressure on the nerve. Pressure on the ulnar nerve at the elbow can develop in several ways. When the pressure on the nerve becomes great enough to disturb the way the nerve works, then numbness, tingling, and pain may be felt in the elbow, forearm, hand, and/or fingers. At this site, the ulnar nerve lies directly next to the bone and is susceptible to pressure. This site is commonly called the “funny bone” (see Figure 1). There is a bump of bone on the inner portion of the elbow (medial epicondyle) under which the ulnar nerve passes. Cubital tunnel syndrome is a condition brought on by increased pressure on the ulnar nerve at the elbow.
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