Ulnar tunnel syndrome is the second most common compressive neuropathy in the upper extremities. The ulnar tunnel is the most common location for ulnar nerve compression, although there are multiple other possible sites of compression along its course from the neck to the hand. Patients rarely complain of pain. The most common presentation is paresthesia in the distribution of the ulnar nerve.

Ulnar tunnel syndrome is an ulnar nerve neuropathy causing symptoms of numbness and shooting pain along the medial aspect of the forearm, including the medial half of the fourth and fifth fingers.

What causes cubital tunnel syndrome?

Pressure on the ulnar nerve

The ulnar nerve is quite superficial at the medial epicondyle, which is why people can experience shooting pain and electric shock in the forearm if they accidentally bump their elbow on a hard surface.

Ulnar nerve stretch

When the elbow bends, the ulnar nerve is forced to stretch along the bony ridge of the medial epicondyle. Because this tension can irritate the nerve, holding the elbow bent for long periods or bending it repeatedly can cause painful symptoms. As a result, many people sleep with their elbow bent, which can exacerbate the symptoms of ulnar nerve compression and force them to wake up at night with numb fingers. In some people, the nerve slips from behind the medial epicondyle when the elbow is bent. Over time, this sliding back and forth can irritate the nerve.

Elbow joint injuries

(fractures, dislocations, swelling, effusions) can cause anatomical damage that will result in symptoms due to compression/irritation of the ulnar nerve.

What are the symptoms of ulnar tunnel syndrome?

The ulnar nerve gives perception (sensation) to the little finger and half of the ring finger on both the palm and back of the hand.
  • Numbness in the ring and little fingers
  • Weakness of the grip
  • Poor dexterity
  • Atrophy of the muscles of the hand
  • Tingling in the palm and fourth and fifth fingers
  • Sensitivity to cold.
  • Sensitivity of the elbow joint

What are the differential diagnoses of cubital tunnel syndrome?

  • Carpal tunnel syndrome
  • Lateral epicondylitis
  • Medial epicondylitis
  • Thoracic outlet syndrome
  • Medial epicondylitis
  • Thoracic outlet syndrome
  • Medial epicondylitis

Exercices

  • Elbow flexion/extension

Elbow pronation / supination

Exercise advice for tennis elbow | The Chartered Society of Physiotherapy

Joint mobilization techniques

  • Distraction of the humero-ulnar joint
  • Distraction of the joint in flexion (ulna moved upwards)

References

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