Cubital tunnel syndrome, defined as nerve compression at the elbow, causes numbness and loss of strength in the little and ring fingers due to compression of the ulnar nerve at the elbow level. The ulnar nerve follows the structure called medial epicondyle, which is located in the back and inner part of the elbow. As a result of any compression occurring at this level, the hand is directly affected.
If any pressure on the ulnar nerve, which lies next to the bone and is open to external pressure, reaches a level that disrupts the functioning of the nerve; Numbness occurs in the elbow, forearm, wrist and fingers. The feeling of numbness is accompanied by pain and tingling.
When the elbow is bent, the ulnar nerve is stretched and compressed by being pushed towards the medial epicondyle, which is actually a bony protrusion. Cubital tunnel syndrome is common in those who sleep with their elbow bent and their hand under their head, and in those who constantly lean on their elbow while sitting at the table. As a result of constant trauma, the ligament sheath surrounding the nerve thickens and if the conduction quality of the nerve fibers deteriorates, symptoms of cubital syndrome occur.
Cubital tunnel syndrome occurs due to any pressure on the ulnar nerve. There is very little protective covering over the ulnar nerve, which is located right next to the bone. Therefore, the pressure applied to this area directly affects the nerve. Constantly leaning on the elbow while sitting at the office/desk puts pressure on the nerve. Pain may occur due to this pressure.
If trauma or pressure is applied continuously, a feeling of numbness may occur along with the pain and may become permanent. If the elbow is kept bent for a long time, the connective tissue thickens as the pressure on the nerve increases.
Deterioration in the bone structure due to a previous elbow fracture, swelling that compresses the ulnar nerve around the elbow, conditions such as cysts or calcification may lead to the formation of cubital tunnel syndrome. can play an important role. It is recommended that people with these types of health problems do not bend their elbows for long periods of time. People who are prone to cubital tunnel syndrome may have problems talking on the phone for long periods of time, working by holding the keyboard close to them, or using guitar or similar musical instruments for long periods of time. It is recommended that people avoid habits such as sleeping with their elbow bent at night.
The main symptom of cubital tunnel syndrome is pain accompanied by numbness in the little and ring fingers of the hand. This pain and numbness seen in cubital tunnel syndrome usually extends to the inner side of the elbow. Keeping the elbow bent during the period of pain and numbness causes the pain to become more severe.
Cubital tunnel syndrome causes loss of strength and dexterity in the patient's hand over time. Therefore, over time, the patient begins to have difficulty even picking up an object from the floor and opening the door with the key. At this stage, the thin muscles of the hand begin to thin. This thinning can be easily noticed by placing both hands side by side. In advanced cases, the patient's 4th and 5th fingers become completely curled and have difficulty opening them.
In the diagnosis of cubital tunnel syndrome, a physical examination is first performed. The degree of the disease is determined by sensory and muscle strength examination. Some physical examination tests are performed to diagnose cubital tunnel syndrome. In the first of these tests, thin blows are made with the fingertip on the nerve at the level of the cubital tunnel. If there is electricity towards the little finger during these blows, the result is positive.
In another test, the flexion test, the elbow is bent all the way and the wrist is lifted backwards. The patient is kept in this position for a certain period of time and if drowsiness is felt after 3 minutes, it is significant for the diagnosis of cubital tunnel syndrome. In addition to physical examinations, the EMG test performed by neurologists is of great importance. The area of nerve compression can be detected with EMG testing. EMG is very guiding for surgeons in terms of interventional/surgical interventions.
In cases where nerve damage is minimal, treatment is applied with non-surgical methods. It is very important for the patient to avoid resting his elbow on the hard ground during the treatment process. For this reason, the patient should minimize the habit of taking support from the elbow. During this process, it will be beneficial for the patient to use a splint while sleeping at night to keep his elbow straight.
If the symptoms are very severe, surgical intervention is performed. Although the surgical procedures applied may vary, Usually, in surgery, the ulnar nerve is moved to the front of the elbow (ulnar nerve transposition) and thus tension and pressure are minimized. The less commonly used method is based on the principle of relieving the nerve by correcting the bone protrusion around the nerve.
After the surgical intervention, the patient is recommended to restrict his movements, while numbness and tingling in the hand may continue for several months. Hand therapy may also be beneficial after surgery. However, in very severe or delayed cases, there may be no improvement despite surgical intervention.
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