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CUBITAL TUNNEL SYNDROME / ULNAR NERVE ENTRAPMENT AT THE ELBOW

A 42 year old computer programmer presented with on-and-off numbness and tingling in the ring finger and little finger of his right hand. This started three years ago, and he thought it was only because he spent a lot of time working on the computer. The numbness and tingling became worse six months ago, and was there all the time instead of occurring occasionally. He also noted that his right hand became weak and clumsy. He would have difficulty typing on the keyboard and controlling the computer mouse, and his handwriting became worse. He had trouble getting his keys out of his pants pocket because his little finger would stick out and be left behind instead of slipping inside the pocket. All these symptoms worried him and interfered with his work, so he consulted a doctor.

On examination, the ring and little fingers of the patient’s right hand were partially curled into a “claw.” The muscles on one side of the right hand were less bulky compared to the other side. There was some weakness of the finger muscles, and numbness in the ring and little fingers. When the doctor examined the patient’s right elbow, the patient felt a sensation like an “electric current” going down his forearm and hand. Additional tests called EMG-NCV were done, and they confirmed the diagnosis of a compressed ulnar nerve at the elbow.

Cubital tunnel syndrome or ulnar nerve entrapment at the elbow is the second most common entrapment neuropathy (pinched nerve or compressed nerve) in adults, after carpal tunnel syndrome. Symptoms include numbness and tingling in the ring and little fingers of the hand, and in more advanced cases, hand weakness, clumsiness, and loss of muscle mass may also be seen. Treatment is conservative for mild cases, but surgery for nerve decompression should be considered if the symptoms persist despite conservative treatment, or if there is already hand weakness at the time of diagnosis.

The patient underwent surgery for ulnar nerve decompression. The surgery was done as an outpatient procedure, with no need for hospital admission. During surgery, the ulnar nerve at the elbow was found to be compressed by thickened ligaments and fibrous bands. These were cut in order to free the nerve from compression.

After the operation, the patient noticed gradual improvement in the numbness and tingling over the next few weeks. The weakness and clumsiness have also improved a little bit, enough to allow the patient to go back to work. Some further improvement would be expected in the next few months.

 

 

 

 

 

     
 
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