What does it feel like?
Most patients describe numbness and tingling that involves the little finger and a side of the ring finger. Patients also complain of clumsiness or weakness, dropping objects or struggling to manage activities that require fine motor control (for example, doing up buttons, sewing, writing). Occasionally patients notice a change in the appearance and posture of the hand, with a slight and subtle curling of the little and ring fingers, and ‘dips’ between the fingers on the back of the hand (called ‘guttering’).
What is it?
It is a nerve compression syndrome. In this case, one of the three main nerves to the hand, the ulnar nerve, is compressed as it passes through a tunnel, known as the cubital tunnel, located around the inside of your elbow. It is typically the same location where you strike your ‘funny bone’ – the ulnar nerve is particularly vulnerable at this point and hitting this spot brings on shooting discomfort down the inner half of your forearm and part of your hand.
What causes it?
Many things can cause compression of the ulnar nerve within the cubital tunnel. Some people have an increased carrying angle, where the ulnar nerve is placed under stretch around the bend of the elbow. Sometimes, the nerve subluxes forwards, flicking over a bony prominence, with flexion and extension of the elbow. Arthritic spurs or joint swellings can also encroach on the available space around the bend of the elbow and compress the nerve.
What are my treatment options?
Cubital tunnel syndrome affects the intrinsic muscles of the hand; these muscles help you do fine motor tasks and lend strength and power to your grip. It is important to ensure that this does not continue for a long time, because recovery of strength is variable in this condition, with better results experienced with earlier treatment. Delayed presentations may lead to irreversible weakness in the hand, despite surgery.
Splintage, particularly at night, will help to prevent elbow flexion that puts the ulnar nerve on stretch. A hand therapist may be able to assist with maintaining hand strength and with a night-time splint.
Ultimately, however, surgery is an option that is best discussed early, rather than later. Discuss this with your general practitioner, who may organise some tests, such as an elbow ultrasound, and nerve conduction studies, prior to referral to a hand surgeon.