The management of

Cubital Tunnel Syndrome

Dr Nakale

6 April 2017
Cubital Tunnel Syndrome
• Definition: Symptomatic ulna nerve dysfunction at elbow due to
compression, traction, friction
• 2nd common neuropathy after CTS (21: 100 000)
• Untreated: Permanent loss of sensation, muscle weakness, 2⁰ joint
contractures
Cubital tunnel Anatomy
• Borders

• Sites of Compression
• Arcade of Struthers
• Medial Intermuscular septum
• Arcuate Osborne’s Ligament
• Arcade FCU heads
• Anconeus Epitrochlearis
Pathology
• Limited excursion (2.2 cm)
• Cross-sectional area reduces by 30 – 40 % wt elbow flexion
• Tunnel shape changes from ovoid to elliptical

• Increased pressure within tunnel

• Increased Intraneural pressure

Presentation
• Symptoms
• Paraesthesia
• Numbness Ulna 1 ½ Fingers, ulna dorsum&pal of hand
• Advanced: Weakness/Atrophy of intrinsics
• Physical findings
• Elbow deformities (cubitus varus or valgus/malunion)
• Atrophy intrinsic muscles of hand/clawed posture
• Nerve subluxation during ROM
Physical Examination
• Froment Sign
• Wartenburg Sign
• Scratch collapse test
• Crossed finger test
• Provocative tests
• Tinel sign
• Elbow Flexion test
• Examine C-spine
Investigations
• Radiographs: Elbow (AP/Lat/Axial), C-spine
• Electrodiagnostic studies (EMG/NCS)
• Confirm diagnosis (site of compression)
• Evaluate alternate sites of compression
• Prognosticate recovery
• Findings:
• Slowing of motor nerve conduction velocity
• Decline in Amplitude
Classification
 Management
• Conservative (for mild/moderate CuTS)
• Discontinue triceps strengthening exercises
• Avoid direct pressure to medial elbow
• Resting elbow posture (45 - 50⁰ flexion)
• Night elbow towel orthosis
• Nerve gliding exercises
Surgical options
• In situ decompression ( Open/ Endospcopic)
• Medial Epicondylectomy
• Anterior transposition
• Subcutaneous
• Intramuscular
• Submuscular
Trends in use of each procedure
THANK YOU