What is cubital tunnel syndrome?
The ulnar nerve is one of three main nerves, which runs from your spine to your hand. It provides feeling to your little finger & half of ring finger, and powers the small muscles of your hand. It is vital for hand function and often called the musicians nerve as it controls most of the piano playing muscles.
Cubital tunnel syndrome is when your ulnar nerve is squeezed and irritated within a tunnel on the inside of your elbow (where your ‘funny bone’ is). This compression or irritation causes pins and needles in the small fingers and stops the nerve from working correctly.
Symptoms of Ulnar nerve entrapment
Pins and needles or numbness, that comes and goes, mainly in your little and ring fingers; and sometimes pain on the inside of your elbow.
Symptoms more at night or early morning in the beginning, but gets worse in time. As time advances, you may notice poor dexterity and still late, some muscle wasting in some of your muscles between your fingers. You will see this on the back of your hand between your thumb and index finger. You may notice a loss of grip strength, for example, you may find it harder to open jars or use door handles.
How is it diagnosed?
A doctor or therapist will carry out a physical examination to see if they can reproduce your symptoms. The results of this examination and your symptoms are often enough to diagnose the condition.
Nerve conduction studies (NCS) may be needed to diagnose or grade the severity of the nerve damage.
Operation of Ulnar nerve release
Operation is needed when there is moderate or severe entrapment with some loss of function of the nerve, like numbness or muscle dysfunction. The nerve does not recover very well like in Carpal tunnel operation. It is slow and often incomplete.
The numbness will often improve after surgery, but this can be a very slow recovery. Occasionally in the most severe cases the feeling in your fingers may not completely recover. The operation generally prevents worsening of the muscle weakness, but improvements in muscle strength are often slow and incomplete. In musicians and who need to be very dexterous with their hand early operation is recommended.
DUPUYTRENS CONTRACTURE
Dupuytren’s contracture is a common condition that usually arises in middle age or later and is more common in men than women. Firm nodules appear in the ligaments just beneath the skin of the palm of the hand, and in some cases they extend to form cords that can prevent the finger straightening completely. The nodules and cords may be associated with small pits in the skin. Nodules over the back of the finger knuckles and lumps on the soles of the feet are seen in some people with Dupuytren’s disease
The cause is unknown, but it is more common in Northern Europe than elsewhere and it often runs in families. Dupuytren’s disease may be associated with diabetes, smoking and high alcohol consumption, but many affected people have none of these. It does not appear to be associated with manual work. It occasionally appears after injury to the hand or wrist, or after surgery to these areas.
Dupuytren’s disease begins with nodules in the palm, often in line with the ring finger. The nodules are sometimes uncomfortable on pressure in the early stages, but the discomfort almost always improves over time. In about one affected person out of every three, the nodules extend to form cords that pull the finger towards the palm and prevent it straightening fully. Without treatment, one or more fingers may become fixed in a bent position. The web between thumb and index finger is sometimes narrowed. Contracture of fingers is usually slow, occurring over months and years rather than weeks.
There is no cure. Surgery can usually make bent fingers straighter, though not always fully straight; it cannot eradicate the disease. Over the longer term, Dupuytren’s disease may reappear in operated digits or in previously uninvolved areas of the hand. But most patients who require surgery need only one operation during their lifetime. Published evidence does not support the use of radiotherapy. Injection of collagenase is helpful in some cases.
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