Cubital Tunnel Syndrome in Northampton & Corby
Your Local Experts in Elbow Pain
Are you struggling with Elbow PAIN and looking for effective, professional treatment? At Team Rehab UK Ltd, our dedicated clinics in Brixworth and Corby offer premium physiotherapy services to help you regain your mobility and live pain-free. With a minimum of 24 years of experience each, our highly skilled chartered physiotherapists are committed to providing personalised care tailored to your specific needs.
Understanding Cubital Tunnel Syndrome
Introduction to Cubital Tunnel Syndrome
Cubital Tunnel Syndrome is a condition caused by the compression of the ulnar nerve in the cubital tunnel area of the elbow. The ulnar nerve travels down the back of the elbow behind the medial epicondyle and through the cubital tunnel, a passageway formed by bone, muscle, and ligaments, with the fascia-covered roof. When the elbow is bent, the ulnar nerve can stretch and catch on the bony bump, leading to nerve compression and entrapment.
Signs and Symptoms of Cubital Tunnel Syndrome
The Signs and symptoms that we commonly see in Cubital Tunnel Syndrome are:
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Intermittent Numbness, Tingling, and Pain: These sensations are typically experienced in the little finger, ring finger, and the ulnar side (inside) of the hand. The symptoms often present themselves intermittently but can become more constant as the condition progresses. They tend to worsen at night and are exacerbated by activities that involve prolonged bending of the elbow, such as talking on the phone or sleeping with the elbow bent. Prolonged resting on the elbow, such as leaning on a desk or armrest, can also intensify these symptoms.
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Aching Pain: This symptom is localised on the inside of the elbow (medial aspect) and can radiate down the forearm. The pain often feels like a deep ache and can be persistent or intermittent. It is typically aggravated by activities that involve repetitive elbow flexion and extension, as well as direct pressure on the elbow.
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Weakness in the Hand: Patients often report a noticeable decrease in grip strength, which can make everyday tasks challenging. This weakness is due to the compromised function of the muscles innervated by the ulnar nerve. Patients may struggle with tasks that require fine motor skills, such as buttoning shirts, writing, or opening jars.
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Diminished Sensation and Fine Motor Control: As the condition progresses, patients may experience a decline in their ability to feel and manipulate objects. This can lead to frequent dropping of objects and a general clumsiness with hand movements. The fine motor control of the hand is compromised, which affects the precision of tasks requiring detailed hand movements.
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Muscle Wasting: If left untreated, Cubital Tunnel Syndrome can lead to atrophy or wasting of the muscles in the hand, particularly those controlled by the ulnar nerve (the hypothenar eminence, interossei, and the lumbricals of the fourth and fifth digits). This muscle wasting can be observed as a visible thinning of the hand muscles, leading to a noticeable change in hand appearance and function. This stage indicates significant and potentially irreversible nerve damage.
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Causes:Trauma: Direct trauma to the elbow, such as a fall or impact, can lead to swelling, inflammation, or structural changes that compress the ulnar nerve within the cubital tunnel. Even minor repetitive traumas, such as frequent elbow bumps, can contribute to nerve compression.
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Prolonged Elbow Flexion: Keeping the elbow in a bent position for extended periods can stretch and irritate the ulnar nerve. Activities that involve holding the elbow bent for long durations, such as talking on the phone, reading a book, or sleeping with bent elbows, increase the risk of developing Cubital Tunnel Syndrome.
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Frequent Pressure on the Elbow: Sustained pressure on the elbow, often due to leaning on hard surfaces like desks or armrests, can compress the ulnar nerve. This is common in individuals who have occupations or habits that involve resting the elbows on hard surfaces for prolonged periods.
Medical Conditions:
Various medical conditions can predispose individuals to Cubital Tunnel Syndrome by altering the anatomy or dynamics of the cubital tunnel. These include:
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Bone Spurs: Bony outgrowths can develop around the elbow joint, narrowing the cubital tunnel and compressing the ulnar nerve.
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Ganglion Cysts: These fluid-filled sacs can form within or around the cubital tunnel, exerting pressure on the nerve.
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Tumors: Benign or malignant growths can occupy space within the cubital tunnel, leading to nerve compression.
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Inflammatory Conditions: Conditions such as arthritis can cause swelling and changes in the joint structure, contributing to ulnar nerve entrapment.
Understanding the signs, symptoms, and causes of Cubital Tunnel Syndrome is crucial for early diagnosis and treatment, potentially preventing permanent nerve damage and maintaining hand function.
Diagnosis of Cubital Tunnel Syndrome
The diagnostic process begins with a thorough medical history to understand the patient's symptoms, onset, duration, and potential causes. The physician will ask about any activities that exacerbate the symptoms, previous injuries, and any underlying medical conditions. The physical examination includes specific tests to assess the ulnar nerve function, such as Tinel's sign, where tapping over the ulnar nerve at the elbow may produce tingling in the little finger and ring finger. The physician will also check for muscle weakness, atrophy, and decreased sensation in the hand and fingers.
Imaging and Electrophysiological Tests:
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X-ray: This imaging test helps identify any bone abnormalities, such as bone spurs or fractures, that might contribute to ulnar nerve compression. It also helps rule out other causes of elbow pain.
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Ultrasound: Used to visualize the ulnar nerve and surrounding structures in real-time, detecting any structural abnormalities.
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MRI (Magnetic Resonance Imaging): Provides detailed images of the soft tissues around the elbow, including the ulnar nerve, muscles, and ligaments, and can identify any masses or cysts causing compression.
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Electromyography (EMG) and Nerve Conduction Studies (NCS): These tests measure the electrical activity of muscles and the speed of nerve signals, respectively. EMG assesses muscle response to nerve stimulation, indicating areas of muscle wasting or nerve damage. NCS evaluates the conduction speed and amplitude of electrical signals through the ulnar nerve, helping to pinpoint the location and severity of the nerve compression.
Ensuring Optimal Treatment Outcomes
At Team Rehab UK, we emphasise that treatments which are not effective should not continue beyond accepted clinical timescales without further in-depth investigations. We prefer these additional assessments to be conducted by consultant specialists outside our company’s financial interests. This approach ensures we receive an unbiased second opinion, guaranteeing that the care you receive is the most clinically appropriate.
Treatment of Cubital Tunnel Syndrome
Conservative Treatment:
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Activity Modification: Patients are advised to avoid frequent elbow bending and activities that put prolonged pressure on the elbow. Simple changes like avoiding resting the elbow on hard surfaces and using ergonomic adjustments at work can be effective.
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Elbow Protection: Using elbow pads can help reduce direct pressure on the ulnar nerve. Elbow pads can be particularly useful for those who need to lean on their elbows frequently.
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Night Splints or Braces: Wearing a splint or brace at night keeps the elbow in a slightly extended position, minimising nerve compression during sleep. A towel wrapped loosely around the arm can also serve this purpose.
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Anti-inflammatory Medications: Over-the-counter NSAIDs (nonsteroidal anti-inflammatory drugs) can help reduce pain and inflammation.
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Physiotherapy: Physiotherapy focuses on exercises to strengthen the muscles around the elbow, improve flexibility, and reduce nerve compression. Ergonomic training and education on activity modification are also integral parts of therapy.
Surgical Treatment
If conservative treatments do not alleviate symptoms or if there is evidence of muscle wasting or severe nerve compression, surgical intervention may be necessary. The primary goal of surgery is to relieve pressure on the ulnar nerve and allow it to move more freely.
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Medial Epicondylectomy: This procedure involves removing part or all of the medial epicondyle, the bony prominence on the inside of the elbow. This creates more space for the ulnar nerve, reducing compression and irritation when the elbow is bent and straightened.
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Ulnar Nerve Transposition: This surgery involves creating a new pathway for the ulnar nerve. The nerve is moved from its position behind the medial epicondyle to a new location in front of it. This transposition can be subcutaneous, intramuscular, or submuscular, depending on the severity of compression and the surgeon's preference.
Post-Operative Care:
Post-surgical care is crucial for recovery and preventing complications. The specific guidelines may vary depending on the type of surgery performed.
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Immobilisation: A bulky dressing with a plaster splint is applied immediately after surgery to immobilize the elbow and protect the surgical site for 10-14 days.
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Elevation and Movement: Patients are advised to keep the arm elevated above heart level and move their fingers to reduce swelling and improve circulation.
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Suture Removal: The arm dressing is removed after 10-14 days, and sutures are taken out.
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Continued Immobilisation: Depending on the type of surgery, the elbow may need to be immobilised for an additional 3 weeks or longer to allow for proper healing.
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Ice Therapy: Applying ice packs to the surgical area helps reduce swelling. Ice should be used for 20 minutes every hour, with a towel placed between the ice and the skin.
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Wound Care: The surgical incision must be kept clean and dry. Patients are instructed to cover the area with plastic wrap when bathing or showering.
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Physiotherapy: Physio usually begins a few weeks after surgery, focusing on strengthening and stretching exercises to maximize the use of the hand and forearm.
Risks and Complications:
While most patients do not experience significant complications, potential risks include:
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Infection: Post-operative infections can occur, necessitating prompt medical attention and potentially antibiotics.
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Nerve Damage: Surgery carries the risk of causing additional nerve damage, leading to permanent numbness around the elbow or forearm.
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Elbow Instability: Changes in the elbow's structure can lead to instability.
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Elbow Flexion Contracture: This condition involves the inability to fully straighten the elbow, which can result from scar tissue formation.
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Pain at the Scar Site: Some patients may experience chronic pain at the site of the surgical scar.
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Unresolved Symptoms: In some cases, symptoms may persist even after surgery, requiring further treatment or intervention.
We have included this video animation to help you visualise the anatomy that we, as professionals, often take for granted. At Team Rehab UK, we are dedicated to helping our patients understand the causes of their symptoms, empowering them to effectively manage their condition both during and after their treatment.
Please note that some of our videos may be of American origin and might contain slightly different professional terms or approaches compared to those used in the UK. However, the content remains highly informative and beneficial. You should seek advice form your UK based specialist before trying any advice contained, or inferred, in the video you ensure it complies with UK best practice standards.
Summary
Cubital Tunnel Syndrome results from the compression of the ulnar nerve at the elbow, causing pain and weakness in the hand or elbow. Treatment involves relieving the pressure on the ulnar nerve through non-surgical methods or, if necessary, surgery. Proper diagnosis and timely intervention are crucial to prevent permanent nerve damage.
If you are experiencing persistent elbow, consult with a physiotherapist in Northampton (Brixworth) and Corby for a comprehensive evaluation and personalised treatment plan. At our clinic, we offer extensive physiotherapy in Northampton, including sports massage in Northampton, to support your recovery. We are recognised providers for Bupa Northampton and Axa Northampton, ensuring high-quality care for our patients.
Book your appointment at Team Rehab uk in Northampton (Brixworth) or Corby, and take the first step towards a pain-free life. Share this information with friends or family who might benefit from our services, and let's help everyone get back to their best selves.
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