Menu

Cubital Tunnel Syndrome (CTS), also known as ulnar neuropathy at the elbow
Presentation Review – Dr Amorgianos

Indroduction

Cubital Tunnel Syndrome (CTS), also known as ulnar neuropathy at the elbow, is among the most common compressive neuropathies of the upper extremity. It results from compression, traction, or irritation of the ulnar nerve within the cubital tunnel behind the medial epicondyle. Typically affecting middle-aged individuals, it may also occur in younger patients due to repetitive elbow flexion or occupational activities. Early diagnosis and appropriate intervention are essential to prevent permanent nerve damage and preserve hand function.

Eight Clinical Signs

  • Medial Elbow Pain: Deep, aching pain localized over the medial epicondyle, worsened by prolonged elbow flexion or direct pressure.

  • Paresthesias in the Ulnar Distribution: Tingling, numbness, or “pins and needles” sensations affecting the medial half of the fourth finger and entire fifth finger.

  • Weakness of Intrinsic Hand Muscles: Difficulty performing fine motor tasks (e.g., buttoning, writing), possibly progressing to a claw-hand deformity.

  • Positive Tinel’s Sign at the Elbow: Tingling along the ulnar nerve distribution upon percussion over the cubital tunnel.

  • Exacerbation with Elbow Flexion: Increased symptoms with elbow flexion (e.g., phone use, sleeping posture), indicated by a positive elbow flexion test.

  • Decreased Grip and Pinch Strength: Reduced strength in tasks requiring precise pinch grip, notably affecting the ring and small fingers.

  • Muscle Atrophy: Visible wasting of intrinsic hand muscles (interossei and hypothenar) in advanced stages.

  • Dynamic Symptom Variability: Fluctuation in symptom severity based on activity or elbow positioning, particularly after repetitive or prolonged elbow flexion.

Essential Diagnostic Studies

  • Detailed Clinical Examination: Provocative tests (elbow flexion test, Tinel’s sign), intrinsic muscle strength assessment to localize ulnar nerve involvement.

  • Electrodiagnostic Studies (EMG and NCS): Slowed nerve conduction across the elbow and EMG signs of muscle denervation confirm ulnar neuropathy.

  • High-Resolution Ultrasound: Non-invasive imaging evaluating nerve swelling, cross-sectional area changes, and nerve subluxation dynamically during movement.

  • Magnetic Resonance Imaging (MRI): Identifies soft tissue abnormalities, space-occupying lesions (tumors, cysts), and nerve signal changes associated with compression.

  • Dynamic Diagnostic Techniques: Ultrasound or MRI studies with elbow flexion to reveal dynamic nerve displacement or compression.

Latest Treatment Options

Management strategies vary according to symptom severity and duration:

1. Conservative Management

  • Activity Modification: Avoid repetitive elbow flexion or direct pressure.

  • Splinting/Bracing: Nighttime elbow splints keeping elbow extended to minimize nerve tension.

  • Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Alleviate local inflammation and pain.

  • Physical Therapy: Exercises for nerve gliding, muscle strengthening, and correcting biomechanical dysfunctions.

2. Corticosteroid Injections

  • Ultrasound-guided corticosteroid injections around the cubital tunnel can reduce inflammation, providing intermediate relief prior to considering surgery.

3. Endoscopic In-Situ Decompression

  • Minimally invasive surgery decompresses the ulnar nerve within the cubital tunnel, reducing soft-tissue trauma and facilitating quicker recovery.

4. Anterior Transposition of the Ulnar Nerve

  • Relocating the nerve anteriorly (subcutaneous, intramuscular, or submuscular) to decrease tension and compression, effective in cases resistant to conservative therapy.

5. Medial Epicondylectomy

  • Surgical removal of part of the medial epicondyle to enlarge the cubital tunnel space, particularly helpful when bone impingement is present.

Conclusion

Cubital Tunnel Syndrome requires meticulous clinical evaluation supported by electrodiagnostic and advanced imaging techniques. Key clinical signs—such as medial elbow pain, paresthesia in the ulnar distribution, intrinsic hand weakness, and dynamic symptom exacerbation—guide accurate diagnosis. Treatment strategies include conservative care, corticosteroid injections, minimally invasive surgical options like endoscopic decompression, anterior nerve transposition, and medial epicondylectomy. A tailored, multidisciplinary approach ensures optimal functional outcomes, emphasizing the importance of early detection and intervention to avoid irreversible nerve damage.

About you

Dr. Christodoulos Amorgianos Orthopedic Trauma Surgeon – Specialist Hand Microsurgery & Interventional Pain Specialist
More

Referrals

Contact

Phone:
(+30)210 6972957

Email:
x_amorgianos@yahoo.com

dramorgianos.gr © 2025