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Cubital tunnel syndrome - Ulnar Nerve Compression

Cubital tunnel syndrome is one of the most common compression neuropathies of the upper extremity. Compression, traction, or irritation of the ulnar nerve as it passes through the cubital tunnel of the medial elbow. The cubital tunnel is bounded by the medial trochlea, the medial epicondylar groove, and the posterior portion of the ulnar collateral ligament and is roofed by the triangular arcuate ligament.

Image shows anatomy of Cubital tunnel syndrome
Cubital tunnel syndrome anatomy

Risk Factors

  • Overhead throwing athletes
  • Repetitive upper extremity activities
  • Diabetes
  • Obesity
  • Peripheral neuropathies

Causes:

Likely causes of the compression of the ulnar nerve when it passes the medial elbow include:

  • Subluxation of the ulnar nerve over the medial epicondyle
  • Enlarged medial head of the triceps muscle
  • Cubitus valgus
  • Ulnar collateral ligament instability/tears
  • Triangular arcuate ligament tears in baseball pitchers
  • Osteophytes
  • Ganglia or lipomas
  • Tumors
  • Repetitive elbow flexion and extension

Treatment

  • Conservative treatment is effective in most of the patients.
  • The most effective treatment is cessation of activity that is causing the problem.
  • A splint or foam elbow pad worn at night
  • Physical therapy with attention to nerve-gliding exercises
  • NSAIDs
  • Elbow pad
  • Most important part of treatment is to minimize elbow flexion and pressure on the elbow and to engage in relative rest from repetitive activity.