Not all hand pain and tingling are carpal tunnel. Most people have heard of carpal tunnel, but another very common condition that causes hand pain, tingling, and numbness is called “cubital tunnel.”
Similar to carpal tunnel, cubital tunnel is a compression of a nerve in your arm (a peripheral nerve). There are three main nerves that provide function to the hand: median, ulnar, and radial. Carpal tunnel is the compression of the median nerve at the wrist, while the cubital tunnel is the compression of the ulnar nerve at the elbow.
Both conditions can cause pain, numbness, and tingling. Typically, carpal tunnel syndrome causes symptoms in the thumb, index, and long fingers. In contrast, cubital tunnel syndrome causes symptoms in the small and ring fingers.
Other common complaints with cubital tunnel include grip weakness and loss of dexterity, which can cause difficulty in tasks such as buttoning a shirt. Both conditions, if ignored, can sometimes lead to permanent nerve damage and loss of function.
In the vast majority of cases, doctors don’t know what causes a cubital tunnel. We do know certain activities and postures are risk factors. These include any activity where there is direct compression on the inside of the elbow along the nerve, such as driving or placing the elbows on a desk or armchair while working.
Additionally, extreme flexion of the elbow causes the nerve to stretch across the backside of the elbow; holding this position too long will cause symptoms. This is most common at night, when it is human nature to sleep with the arms and wrists in a flexed position, resulting in symptoms at night or upon waking.
Initial treatment focuses on avoiding these aggravating positions. Patients are encouraged to be aware of their elbows and avoid any direct contact, including armrests while driving, sofas, armchairs, desks, and tabletops. At night, to keep the elbow mostly straight, two over-the-counter tricks are recommended. A bath towel can be fashioned into a soft tube using tape to secure the outside and place the arm inside.
Alternatively, an elbow pad can be purchased and worn backward, such that the padding is in the front. Finally, if neither of these is successful, there is a lightweight spring brace that can be fitted in the office.
If after approximately three months, symptoms continue, often a nerve conduction test is
performed. If the diagnosis of cubital tunnel is confirmed, surgery may be offered. There are several surgical options with pros and cons to each. They fall into two general categories: releasing the tissue that is compressing the nerve versus moving the nerve to the front of the elbow along with the release. Most often, I recommend releasing the nerve but leaving the nerve in its natural bed. This allows much faster recovery after surgery while minimizing disruption to the nerve.
Additionally, using a new surgical technique, a scope can be used to visualize the nerve and perform the outpatient operation through a less than one-inch incision. This allows an even faster recovery. Patients often return to normal activities, including work, within a few short days.
Dr. Baker specializes in hand, wrist, and elbow surgery.
