Cubital tunnel syndrome
Updates to Article Attributes
Cubital tunnel syndrome is a type of ulnar nerve compression neuropathy due to pathological compression of the ulnar nerve along its course within the cubital tunnel.
Epidemiology
It is the second most common peripheral neuropathy of the upper extremity 1,3.
Clinical presentation
Ulnar nerve compression can result in altered sensation in the little and ring fingers. In many patients, sensory loss is often the first symptom to be reported. As the condition progresses, they may be clumsiness in the hand, as the ulnar nerve is the principal motor supply to the intrinsic muscles of the hand. In well‐established cases, there may be marked wasting of the small muscles of the hand and the ulnar‐sided muscles of the forearm 4.
Pathology
Aetiology
It can arise from varying causes which include:
- overuse
- subluxation/dislocation of the ulnar nerve from congenital laxity in fibrous tissue
- extrinsic compression
- humeral fracture with loose bodies or callus formation
- osteophytic bony spur arising from the epicondyle or olecranon
- compression from an accessory muscle, namely anconeus epitrochlearis muscle
- soft-tissue mass/tumour
- ganglion
- osteochondroma
- synovitis secondary to rheumatoid arthritis
- infective process (e.g. tuberculosis)
- haematoma
- thickened cubital tunnel retinaculum (or arcuate ligament) of the flexor carpi ulnaris muscle
Radiographic features
Exact imaging features may vary dependent on the underlying cause. Thickening of the ulnar nerve can be a commonly observed feature.
Plain radiograph
Osseous spurring within the ulnar groove can be seen in patients with chronic nerve irritation due to overuse or posteromedial elbow impingement as in throwers.
Ultrasound
Ulnar nerve thickening and edematousoedematous changes are suggestive features.
MRI
-
Ulnarulnar nerve thickening and increased T2signalssignal are typical MRI features. -
Oedemaoedema-like signal changes or atrophy of the flexor carpi ulnaris and flexor digitorum profundus muscles may be seen secondary to ulnar neuropathy.
-</ul><h4>Radiographic features</h4><p>Exact imaging features may vary dependent on underlying cause. Thickening of the ulnar nerve can be a commonly observed feature. </p><h5>Plain radiograph</h5><p>Osseous spurring within the ulnar groove can be seen in patients with chronic nerve irritation due to overuse or posteromedial impingement as in throwers. </p><h5>Ultrasound</h5><p>Ulnar nerve thickening and edematous changes are suggestive features.</p><h5>MRI</h5><ul>-<li>Ulnar nerve thickening and increased T2 signals are typical MRI features.</li>-<li>Oedema-like signal changes or atrophy of the flexor carpi ulnaris and flexor digitorum profundus muscles may be seen secondary to ulnar neuropathy.</li>-</ul><p> </p>- +</ul><h4>Radiographic features</h4><p>Exact imaging features may vary dependent on the underlying cause. Thickening of the ulnar nerve can be a commonly observed feature. </p><h5>Plain radiograph</h5><p>Osseous spurring within the ulnar groove can be seen in patients with chronic nerve irritation due to overuse or <a title="Posteromedial impingement of elbow" href="/articles/posteromedial-elbow-impingement">posteromedial elbow impingement</a>. </p><h5>Ultrasound</h5><p>Ulnar nerve thickening and oedematous changes are suggestive features.</p><h5>MRI</h5><ul>
- +<li>ulnar nerve thickening and increased T2 signal are typical MRI features</li>
- +<li>oedema-like signal changes or atrophy of the <a title="Flexor carpi ulnaris" href="/articles/flexor-carpi-ulnaris">flexor carpi ulnaris</a> and <a title="Flexor digitorum profundus" href="/articles/flexor-digitorum-profundus-1">flexor digitorum profundus</a> muscles may be seen secondary to ulnar neuropathy</li>
- +</ul>
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