Cubital Tunnel Syndrome

Question 1

What is cubital tunnel syndrome?

Answer 1

It is defined as a condition in which there is compression of the ulnar nerve in the cubital tunnel of the elbow

Question 2

What is the pathophysiological cause of cubital tunnel syndrome?

Answer 2

The compression is related to either a reduced volume or increased pressure within the cubital tunnel

Question 3

What eight risk factors are associated with cubital tunnel syndrome?

Answer 3

Middle Aged, 45 – 64 Years Old

Female Gender

Elbow Fractures

Repetitive Strain Injuries

Osteoarthritis

Rheumatoid Arthritis

Diabetes Mellitus

Obesity

Question 4

What are the four clincial features of cubital tunnel syndrome?

Answer 4

Paraesthesia of 4th & 5th Finger

Pain of 4th & 5th Finger

Hypothenar Eminence Wasting

Claw Hand

Question 5

Describe the pain associated with cubital tunnel syndrome

Answer 5

Gradual, which is initially intermittent then constant

Nocturnal

Worse when leaning on right elbow

Question 6

What is a claw hand?

Answer 6

It is hyperextension at the metacarpophalangeal joints and flexion at the interphalangeal joints

Question 7

What three investigations are used to diagnose cubital tunnel syndrome?

Answer 7

Tinel’s Test

Froment’s Test

Nerve Conduction Studies

Question 8

How is the Tinel’s test conducted?

Answer 8

It involves the examiner taping over the patient’s cubital tunnel with their finger

Question 9

What is a positive Tinel’s test?

Answer 9

It is indicated by pain or paraesthesia in the ulnar nerve distribution during this manoeuvr

Question 10

How is the Froment’s test conducted?

Answer 10

It involves asking the patient to make a strongly pinch a flat object between the thumb and index finger

The examiner attempts to pull the object out of the patient’s hand

Question 11

What is a positive Froment’s test? Explain

Answer 11

It is indicated by flexion of the interphalangeal joint of the thumb

This is due to the fact that there is weakness of the adductor pollicis, which is innervated by the ulnar nerve, and therefore the flexor pollicis longus muscle will compensate, which is innervated by the median nerve

Question 12

What are nerve conduction studies?

Answer 12

They measure how fast an electrical impulse is transmitted through the nerve

Question 13

What nerve conduction study result indicates cubital tunnel syndrome?

Answer 13

Reduced ulnar nerve conduction velocity

Question 14

When is conservative management option used to treat cubital tunnel syndrome?

Answer 14

It is the first line management option used to treat mild to moderate disease

Question 15

How long should conservative management be trialled for before surgical management is considered?

Answer 15

6 weeks

Question 16

What are the two conservative management options of cubital tunnel syndrome?

Answer 16

Elbow Rest

Physiotherpay

Question 17

When is pharmacological management used to treat cubital tunnel syndrome?

Answer 17

It is the second line management option used to treat mild to moderate disease

Question 18

What is the pharmacological management option of cubital tunnel syndrome?

Answer 18

Corticosteroid Injections

Question 19

How are corticosteroid injections used to manage cubital tunnel syndrome?

Answer 19

They can be used to provide symptomatic relief for a period of four weeks

Question 20

When is surgical management used to treat cubital tunnel syndrome?

Answer 20

It is used to treat severe disease, or when non-surgical management options are deemed ineffective

Question 21

What is the surgical management option of cubital tunnel syndrome?

Answer 21

Ulnar Nerve Release

Question 22

What is ulner nerve release?

Answer 22

It involves an incision to the medial collateral ligament, which is the roof of the cubital tunnel, in order to relieve pressure on the ulnar nerve