Cubital tunnel syndrome (CBTS) is the second most widespread illness that results in tingling, numbness, pain, or a burning sensation in the upper limb and down to the ring and little fingers. The condition develops when you compress or pressure the ulnar nerve passing under the bony bump in the elbow. The disorder's symptoms become severe with time, and if you do not seek treatment early, the affected hand could be dysfunctional.
When you experience any warning signs mentioned above or develop CBTS in Las Vegas, NV, do not hesitate to reach out to Suarez Physical Therapy. Our physical therapists (PT) will help lower the pain and inflammation to regain the usual motion and function of your arm, wrist, and hand.
Overview of CBTS
The cubital tunnel is a tissue tunnel that travels under the bony bump inside your elbow. The tunnel is narrow, and because it is protected by little tissue, it exposes the ulnar nerve to irritation or pressure.
Nerves are string-like fibers that allow the brain to send and obtain messages from other body parts through chemical and electrical changes in cells. These nerves give your fingers sensory capabilities by transmitting information to the brain. The primary nerves in your arm are:
- The median
- The radial
- The ulnar
Ulnar drops from your neck down to your arm and hand and helps you control the bigger muscles in your hand, which allows you to perform movements. Also, it gives grip and sensory capabilities on your pinky finger and half of the ring finger.
It is worth noting that the ulnar nerve, also called the funny bone, is not a bone but a nerve. When the nerve is hit or compressed, it causes unique numbness, electrical sensation, pain, or burning inside your arm, ring, and little fingers.
After it passes the bony bump, otherwise called the medial epicondyle, the nerve drops down in the muscles through the forearm into your hand through the Guyon’s canal to the pinky finger. Along its way, the nerve can be compressed or pinched anywhere, but it is most vulnerable in the cubital tunnel. When compression or irritation of the nerves occurs at the cubital tunnel, you develop the CBTS.
Causes of Cubital Tunnel Syndrome
CBTS has multiple causes. One is continued stretching or compression on the ulnar or funny bone nerve. When you keep your arm bent for a prolonged duration, like when holding a phone, the nerve stretches in the cubital tunnel, causing adhesion force that lowers blood flow to the nerve, leading to irritation. Also, if you are typing on a keyboard with the elbow and lower arm leaning on the desk, the position pushes the nerve above the bone. The continued pressure causes numbness, electrical sensation, burning, or pain in your arm.
Additionally, you can develop CBTS when the nerve snaps and moves out of its natural position. Snapping often occurs when you move your elbow over time. The movement causes the nerve to move up and down, and when this continues over time, it irritates. Again, due to the snapping, the tissue covering the nerve becomes thicker or develops extra muscle that hinders the nerve from normal functioning and causes CBTS.
Lastly, the condition could develop due to a painful incident like an elbow fracture.
Warning Signs of the Disease
When you observe any of the following symptoms for at least six weeks, you should contact Suarez Physical Therapy. If you fail to receive treatment on time, you can experience muscle degeneration in the affected hand. However, when you obtain therapy on time, the symptoms will be treated and arrested before they are out of control. Some of the symptoms of the syndrome are:
- Sporadic pain, loss of sensory capabilities, or falling asleep of the fingers after prolonged elbow bending
- Pins and needles on the ring and small finger after continued elbow bending
If these symptoms continue for long without being addressed, you will start to experience severe symptoms like:
- Difficulty holding or gripping objects
- Muscle deterioration
- Ulnar claw hand where the pinky and ring fingers bend inwards
When your symptoms reach this stage where you develop hand deformities or hand wasting, you should reach out to our experienced physical therapist for help.
Diagnosing the Syndrome
When you walk into our offices for an appointment, the PT or physician handling your case will start by asking about the signs and symptoms you are experiencing. The questions you should expect during the meeting are:
- What symptoms are you experiencing?
- How long have you experienced the symptoms?
- Did you take any medications for the symptoms? If yes, what kind of medication?
- Have you lost sensory capabilities?
- Are your fingers and hands falling asleep?
- Do you feel pins and needles when you bend the elbow for a long time?
- What is the extent of your pain?
- Can you perform fine movements like typing on a keyboard?
- Have you suffered a broken or dislocated elbow?
After responding to these questions, the therapist will perform several tests. These tests include:
- A blood test for thyroid disease or diabetes
- An Electromyogram (EMG) test to give a vivid picture of how the nerves and nearby muscles act
- X-rays to find out if you have bone spurs, arthritis or whether there is pressure on the ulnar nerve
These tests determine the nerve capability to conduct signals to the brain along the entire length. Further, tests like the x-ray help identify the location of ulnar nerve irritation or pressure and the compression levels.
On top of these tests, the therapist handling your case will perform multiple examinations. These are:
- Elbow and forearm scrutiny and inspection
- The Tinel’s sign test where the physician taps the nerve at the elbow
- Touch and move the arm around the funny bone to establish its links with the elbow and its steadiness behind the elbow where it passes.
- Evaluating the funny bone nerve’s flexibility
- Examining specific muscle strengths
- Evaluating your grip and pinch
If the PT rules your symptoms as severe, they will send you to a doctor or physician for further assessment.
After a thorough evaluation by our professionals, we will determine whether your condition is mild, moderate, or severe. When you have a mild or moderate CBTS, our PTs will establish the actions that trigger the symptoms. They will then advise you to drop or change these activities until you arrest the symptoms. The common symptoms in the mild stages of the syndrome include inflammation or tenderness in the arm. If you stop the actions that cause the symptoms, the discomfort and inflammation can be reduced, resolving the problem.
Non-Invasive Treatment Option
Other non-invasive or non-surgical treatment options are:
1. Splinting or Bracing
Wearing a brace or splint at night can prevent the affected hand from bending while asleep, reducing the symptoms by avoiding compression on the nerve.
2. Muscle Strengthening Exercise
Your PT will recommend exercises to strengthen the muscles around the nerve to enhance functionality and lower pain during movement.
3. Range-of-motion Exercise
When your arm is affected by the CBTS, the full muscle length can shorten because of protective posturing. Your physical therapist can help the affected muscles regain their standard size through range-of-motion exercise.
4. Nerve Gliding Exercise
Nerves are very similar to joints and muscles because of their ability to stretch. The ulnar nerve is susceptible to stretching because it is the longest and strongest body tissue. You develop CBTS when this nerve is trapped in the cubital tunnel preventing adequate blood flow and stretching. When you develop the syndrome because of this problem, our PTs at the Suarez Physical Therapy recommend gliding exercises for the nerves to allow them to slip over the tunnel without tightening or stiffening, improving the hand and wrist symptoms.
When performing this exercise, you should hold your arm in the front and straighten the elbow. Afterward, you should twist your wrist and fingers, move them away, and curve your elbow.
5. Ergonomic Training
As indicated earlier, CBTS can be triggered by irritation stemming from work or other daily routines. When this is the case, our therapists will train you on ways to circumvent postures that put pressure on or stretch the nerve, irritating the nerve. Sometimes, the physical therapist will require you to modify your work or self-care undertakings causing nerve irritation.
6. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
One of the symptoms of CBTS in the initial stages is swelling or inflammation around the ulnar nerve. Our therapists arrest this symptom by recommending NSAIDs like ibuprofen to lower the swelling and relieve the pain. We do not encourage our patients to use steroids like cortisone because even though they effectively reduce swelling, an injection elevates the risk of nerve damage.
Other non-surgical treatment options you can try at home include:
- Putting on elbow pads during the day
- Avoid keeping your arm bent at night
- Wearing an elbow brace when going to bed
- Steering clear of activities that require you to bend or extend your arm for a prolonged duration
Surgical Treatment for CBTS
Our physical therapists at the Suarez Physical Therapy will recommend surgery when:
- You have experienced the symptoms for a prolonged duration and severe symptoms
- Non-invasive treatment options have failed to yield results
- The ulnar nerve is under extreme pressure
- The pressure on the ulnar nerve has led to muscle or joint damage
Your physical therapist will explore a few invasive procedures to help relieve pressure from the nerve around the elbow. The procedure's orthopedic surgeon will explain the options and advise you on the best treatment. Typically, the treatments are performed on a single visit to the doctor, although sometimes spending the night at the health facility is best.
Cubital Tunnel Release
Under this highly invasive procedure, your physician makes an incision on the cubital tunnel’s ligament roof to divide it. The cut on the ligament roof increases the tunnel size and releases or relieves pressure on the ulnar nerve.
Once the procedure is completed, the ligaments start healing, and new soft tissue grows where the incision has been made. With the new tissue growth on the cut area, the ligaments heal and leave more room for the nerve to pass through without being compressed. The treatment is more effective when the CBTS is in the mild or moderate stage, and the funny bone does not slide off the medial epicondyle upon elbow bending.
Ulnar Nerve Anterior Transposition
When the ulnar nerve is in its original place at the back of the medial epicondyle, anterior transposition of the nerve is necessary to return it to the front. If the nerve is behind the medial epicondyle, it does not slide freely and can easily be trapped or held on the bonny ridge or stretched when bending your hand. Once your doctor performs the anterior transposition surgery, the nerve is moved to the front preventing trapping and stretching when you bend the elbow.
Alternatively, you can release pressure surgically from the ulnar nerve by extracting a portion of the medial epicondyle. The procedure works like the anterior transposition by preventing the nerve from being trapped or stretched when you bend the elbow.
After undergoing a surgical procedure, the next step is to work with our PT at the Suarez Physical Therapy to design postsurgical physical therapy based on the surgeon’s instructions and the kind of surgical procedure performed. A significant part of the postsurgical rehabilitation involves charge in activities to arrest reoccurring symptoms.
After the surgery, the surgeon will issue instructions on caring for the operated area. The standard guidelines are:
- For 10 to 14 days, apply a large bandage with a plaster splint
- Raise the affected hand above the heart area and move the fingers to deter inflammation
- The dressing on the arm should be removed after one to two weeks to remove the stitches
- You should keep your elbow immobilized for at least three weeks based on the kind of repairs
- Apply ice packs to the affected area to prevent swelling. You should cover the surgical cut with a plastic wrap to keep it dry and clean as you do this.
- The surgeon will instruct physical therapy exercises involving strengthening and stretching to maximize the use of the arm.
Risks Associated with the Procedure
The outcome of a cubital tunnel surgery is often good. Each technique has proven successful in releasing pressure from the ulnar nerve. However, the following risks and difficulties are associated with the treatment:
- Bacterial infection
- Elbow instability
- Pain around the scar area
- Unresolved symptoms even after the operation
- Ulnar nerve damage results in total loss of sensation in the elbow and forearm
CBTS is rarely diagnosed if you are not experiencing any symptoms. As a result, there is scarce information on preventing the condition. However, you can take specific precautions to prevent the disease. The precautions include:
- Adopting a healthy lifestyle and weight reduction to prevent obesity, which is a disease highly linked to CBTS.
- Steady or constant positional changes for individuals in professions involving prolonged elbow bending like computer programmers to release stress from the ulnar nerve can help.
- Learning the various activities or positions that cause nerve irritation and avoiding them
Our physical therapists are dedicated to educating you on motions and lifestyle changes that will prevent the recurrence of the condition after a diagnosis.
Choosing the Right Physical Therapist
Finding the right PT is the right step toward reducing pain and regaining the mobility and function of your arm. All physical therapists have the necessary training and education to treat CBTS. Nonetheless, not everyone is right for you. Discussed below are factors you should consider when picking one:
1. The Physical Therapist’s Experience
Just because a PT can treat CBTS does not mean they have the experience you need to trust them with the treatment. Inquire how many patient with your condition the therapist has treated before. The more the patients with CBTS they have treated, the better the outcome of your treatment. Also, you can check whether the expert has advanced certification focusing on the wrist, elbow, and hand.
You need a physical therapist with board certification or who has completed a residency in orthopedic physical therapy. The accreditation is an indication that the therapist has the advanced knowledge, skills, and experience necessary to obtain the best outcome.
3. Pick a Convenient Location
With CBTS, you must see your physical therapist often. Therefore, location is a critical factor of consideration. Opt for a PT within your home or workplace to avoid missing appointments and reduce travel costs.
When starting your search for a therapist, obtain referrals from friends and family who had a condition like yours and were successfully treated. Once you have a few names, call them and arrange an appointment to learn more about the PT’s experience handling CBTS.
Find an Experienced Physical Therapist Near Me
After experiencing CBTS symptoms, your next stop should be the Suarez Physical Therapy. Do not wait for the symptoms to be severe to consult an expert. Our profound PTs are ready to conduct a physical examination and a diagnosis and offer the proper treatment to arrest the symptoms and prevent the condition from deteriorating. If you experience the symptoms in Las Vegas, NV, our bespoke physical therapy services will help you regain your normal hand function. Contact us today at 702-368-6778 to arrange a meeting with our profound PT.