WHAT YOU SHOULD KNOW
Cubital tunnel syndrome, also known as cell phone elbow, is better referred to as ulnar neuropathy at the elbow level. The usual cause is compression of the ulnar nerve by a tight band on the inside of the back of the elbow. In addition to pressure, stretch of the nerve around the elbow bones contributes to the problem. Other reasons for symptoms are an unstable nerve that moves too much over the edge of the bone or a nerve that is scarred from previous injury or surgery. Symptoms are made worse by positions of elbow flexion during daytime or nighttime and by direct pressure over the nerve.
MEDICAL HISTORY
Patients usually complain of a persistent ache in the region of the inside of the rear elbow. The pain may radiate towards the hand or the shoulder. Numbness and tingling appears in the ring and small fingers and sometimes can include the whole hand. Symptoms may be worse in the middle of the night and cause waking or in the morning. Driving, fixing one’s hair and time at the computer are other problem activities. When severe patients may even lose coordination and drop things.
EXAMINATION
Pressure applied over the nerve at the elbow will recreate the pain, numbness, and tingling. The doctor will measure strength in the muscles (motor) and feeling ability (sensory) in the skin for specific areas serviced by the median nerve. In more advanced conditions, patients will demonstrate loss of motor and sensory functions.
ADDITIONAL TESTS
Electrical nerve tests provide actual numbers that tell the story of how well or poorly the nerve is conducting signals in the area of the elbow and if the muscles have sustained any damage as a result of prolonged nerve pressure.
TREATMENT OPTIONS
| NON-OPERATIVE | SIMPLE OR ENDOSCOPIC RELEASE | SURGICAL TRANSPOSITION | |
| CONSISTS OF | Ergonomic retraining and sleep positioning | Simple release of the constricting bands over the nerve | After simple release, the nerve is moved to the front of the elbow |
| FEATURES | Therapists recommend changes to work habits | Outpatient surgery, minimal incision | Outpatient surgery, limited incision |
| ADVANTAGES | Avoids surgery | Minimally invasive option | Addresses all causes for the problem |
| DISADVANTAGES | Only effective in mild cases | Only addresses compression not stretch reason for the problem | More invasive than decompression with more scar formation |
RECOVERY
Sutures come out in the office at 2 weeks after surgery. No splints are used. Immediate use of the hand and arm for everyday activities of living is encouraged right away. After simple decompression, there is minimal disruption of activities. Transposition surgery involves a more specific rehabilitation program with nerve stretching exercises and wound massage to prevent scar formation around the nerve. Return to heavy lifting activities takes several months.
