ULNAR NERVE ENTRAPMENT AT THE ELBOW (CUBITAL TUNNEL SYNDROME)

Ulnar nerve entrapment occurs when the ulnar nerve in the arm becomes compressed or irritated. The ulnar nerve is one of the three main nerves in the arm. It travels from the neck down into your hand. The most common place for compression of the nerve is behind the inside part of the elbow. Ulnar nerve compression at the elbow is called cubital tunnel syndrome .

Anatomy
The cubital tunnel is formed by the cubital tunnel retinaculum which straddles a gap of about 4 mm between the medial epicondyle and the olecranon at the elbow, the ulnar nerve travels through this tunnel.
The ulnar nerve runs behind the medial epicondyle on the inside of the elbow. The ulnar nerve gives feeling to the little finger and half of the ring finger. It also controls most of the little muscles in the hand that help with fine movements, and some of the bigger muscles in the forearm that help you make a strong grip. 
The ulnar nerve gives sensation (feeling) to the little finger and to half of the ring finger on both the palm and back side of the hand.

Common Causes of Compression

In many cases of cubital tunnel syndrome, the exact cause is not known.There are several things that can cause pressure on the nerve at the elbow:

• Keeping the elbow bent for long periods or repeatedly can cause the ulnar nerve stretch around the boney ridge of the medial epicondyle and can cause painful symptoms by irritating the nerve.
• Many people sleep with their elbows bent, which can aggravate symptoms of ulnar nerve compression and cause the patient to wake up at night
• Prior fracture or dislocation of the elbow
• Bone spurs/arthritis of the elbow
• Swelling of the elbow joint
• Cysts near the elbow joint

Symptoms

Patients with ulnar nerve compression at any level have altered sensation in the little and ring fingers. Indeed, in most patients, sensory loss is the first symptom to be reported. As the condition progresses, they may also notice clumsiness in the hand.

• Numbness and tingling in the ring finger and little finger are common symptoms of ulnar nerve entrapment. They happen more often when the elbow is bent, such as when driving or holding the phone.
• Weakening of the grip and difficulty with finger coordination (such as typing or playing an instrument) may occur. These symptoms are usually seen in more severe cases of nerve compression.

Home Remedies

There are many things you can do at home to help relieve symptoms.

• Avoid activities that require to keep the arm bent for long periods of time.
• If you use a computer frequently, make sure that your chair is not too low. Do not rest your elbow on the armrest.
• Avoid driving with the arm resting on the open window.
• Try to keep the elbow straight at night during sleeping. This can be done by wrapping a towel around the straight elbow or wearing an elbow pad backwards.

Doctor Examination

The doctor will examine patient’s arm and hand to determine which nerve is compressed and where it is compressed. Some of the physical examination tests the doctor may do include:

• Tap over the nerve at cubital tunnel. If the nerve is irritated, this can cause a shock into the little finger and ring finger (Tinel's sign) — (this can happen when the nerve is normal as well)
• Move the neck, shoulder, elbow, and wrist to see if different positions cause symptoms.
• Check for feeling and strength in the hand and fingers.
• The doctor may take x-rays of the elbow to look for bone spurs, arthritis, or other places that the bone may be compressing the nerve.
• Nerve conduction studies and Electromyography (EMG) can determine how well the nerve is working and help identify where it is being compressed. During a nerve conduction test, the nerve is stimulated in one place and the time it takes for there to be a response is measured.Where the response takes too long is likely to be the place where the nerve is compressed.

Nonsurgical Treatment

• If the symptoms have just started,the doctor may recommend an anti-inflammatory medicine, such as ibuprofen, or steroid such as cortisone to help reduce swelling around the nerve.
• The doctor may prescribe a padded brace or splint to wear at night to keep the elbow in a straight position.

Surgical Treatment

The doctor may recommend surgery to take pressure off of the nerve if:

• Nonsurgical methods have not improved the condition
• The ulnar nerve is very compressed
• Nerve compression has caused muscle weakness or damage

There are a few surgical procedures that will relieve pressure on the ulnar nerve at the elbow.

1)Cubital tunnel release: Cubital tunnel release tends to work best when the nerve compression is mild or moderate. In this operation, the ligament on the roof of the cubital tunnel is cut and divided. This increases the size of the tunnel and decreases pressure on the nerve.
​2)Ulnar nerve anterior transposition: In many cases, the nerve is moved from its place behind the medial epicondyle to a new place in front of it. Moving the nerve to the front of the medial epicondyle prevents it from getting caught on the bony ridge and stretching when you bend your elbow.

Surgical Recovery

Surgery to repair cubital tunnel syndrome does not have a particularly long recovery. The arm can then be used for light activities in a few days. The patient can usually return to most activities in three weeks.

Surgical Outcome
Surgery for cubital tunnel syndrome has a very high success rate of over 90%. Each method of surgery has a similar success rate for routine cases of nerve compression. Many symptoms are relieved quickly after treatment, including tingling sensation in the hands and waking up at night. Numbness may take longer to be relieved, even up to six weeks.