Cubital tunnel syndrome: symptoms, treatment and surgery

East Kent Hospitals says mild to moderate cubital tunnel syndrome is often treated with advice and guidance from a therapist or doctor. In the early stages the main treatment is avoiding or changing any activity that aggravates your symptoms, which may significantly reduce the pressure on the nerve.

Leeds Community Healthcare lists conservative treatments to reduce pain as non-steroidal anti-inflammatory medicines such as ibuprofen, heat and ice, bracing and splinting. If these do not control symptoms, or the condition is severe, surgery may be needed to relieve the pressure on the ulnar nerve.

• Wear a headset when using the telephone.

• Place your keyboard at the edge of your desk and use a chair without an arm rest.

• Avoid bending your elbow for long periods, for example leaning your head on your hand or resting your elbow on a firm surface.

• Take regular breaks from repetitive tasks and rest with the elbow in a comfortable position.

• Wear an elbow splint at night to keep the elbow in a neutral or slightly bent position.

Early symptoms, according to East Kent Hospitals, are pins and needles or numbness that comes and goes, mainly in the little and ring fingers, and pain on the inside of the elbow. Most symptoms happen overnight or first thing in the morning, and as the condition progresses they can start to happen more often.

In more severe cases you may notice muscle wasting between your fingers, which is visible on the back of the hand between the thumb and index finger, and a loss of grip strength, such as finding it harder to open jars or use door handles. Leeds Community Healthcare adds that in severe cases there might be clawing of the fingers.

The ulnar nerve is one of three main nerves running from the spine to the hand. East Kent Hospitals says it provides feeling to the little and ring fingers and powers the small muscles of the hand. It passes through a small passage on the inside of the elbow called the cubital tunnel. Leeds Community Healthcare says that because the opening is narrow it can be easily injured or compressed through repetitive activities or trauma.

When the nerve is squeezed or irritated there it stops working correctly, which is why the problem shows up in the hand rather than the elbow.

East Kent Hospitals says there is no obvious cause in most cases. The factors it lists are below, together with additional ones from Leeds Community Healthcare.

East Kent Hospitals says a night splint keeps the elbow in a neutral or slightly bent position, reducing pressure on the nerve. You can make your own by folding a hand towel in half, wrapping it around the elbow and securing it with tape, taking care that it is not too tight or cutting off circulation, or buy a neoprene elbow splint. Wear it every night for 6 to 8 weeks; it may take several weeks to notice a difference. If symptoms get better but do not stop completely it can be worn up to 12 weeks.

Ulnar nerve gliding exercises can also help move the nerve through the tunnel. You may feel a pulling in the little finger, but they should not be painful or make symptoms worse; if they do, do fewer repetitions or stop. The leaflet describes starting with the arm out to the side, palm down, bending the wrist back and holding for 10 seconds, then bending the elbow so the hand points towards the head and holding for 10 seconds, repeating 3 times and building up gradually.

Leeds Community Healthcare advises stopping immediately if exercises cause an intense shooting pain, and seeking help if tingling or numbness persists after rest.

A doctor or therapist examines you to see whether they can reproduce your symptoms. East Kent Hospitals says the examination and your symptoms are often enough to diagnose the condition. They may also carry out nerve conduction studies, which use small electrodes on the skin that release tiny electrical signals to check how well signals travel along the ulnar nerve and how severe the compression is.

East Kent Hospitals says surgery, called decompression, may be needed in severe cases or when non-surgical treatments have not worked. The surgeon makes a cut about 10cm long around the inside of the elbow and releases the tight tissues squeezing the nerve. It is usually done with local anaesthetic, which numbs the area, or regional anaesthetic, which numbs the arm; you are awake.

Numbness often improves after surgery, but recovery can be very slow, and in the most severe cases feeling in the fingers may not completely recover. Surgery generally prevents muscle weakness from getting worse, though improvements in strength are often slow and incomplete. If you choose not to have the operation, your hand may become weaker, it may be hard to grip with your thumb and you may develop complete numbness in the little and ring fingers.

Serious complications are uncommon. The leaflet lists delayed wound healing or infection, a tender scar, aching around the elbow, reduced feeling in the little and ring fingers that continues after surgery, nerve damage causing a painful spot or numbness near the scar, and, very rarely, complex regional pain syndrome.

See your GP if you have numbness or tingling in the little and ring fingers that keeps returning, or you notice weaker grip, dropping things or muscle wasting between the thumb and index finger. These can mean the nerve is more compressed, and early assessment helps.

After surgery, contact your surgeon or GP if you have ongoing persistent pain or swelling throughout your whole hand after 4 to 6 weeks. Sudden arm weakness, facial drooping or speech difficulty is different: call 999.

On the NHS you are usually seen by a GP and may be referred to a physiotherapist, hand therapist or an orthopaedic hand service; nerve conduction studies and surgery are arranged through the hospital. Private hand and orthopaedic surgeons offer the same assessment and surgery, with different waiting times and charges; ask what the price covers, including tests, the operation and follow-up.