Cubital and Radial Tunnel Syndrome

Overview:

Pain, numbness or a tingling sensation in the elbow area could be the result of different conditions. Cubital tunnel syndrome and radial tunnel syndrome are two such conditions that affect the elbow. Read on to know their causes, symptoms and treatment.

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While both cubital and radial tunnel syndromes are nerve compression syndromes, i.e., they are caused as a result of pinching of the nerves and result in pain around the same area, their causes and treatment modalities are different. Let us take a look at both.

What Is Cubital Tunnel Syndrome?

The ulnar nerve passes via the cubital tunnel in the interior of the elbow. The cubital tunnel is a tunnel that is formed of muscles, bones and ligaments. Cubital tunnel syndrome is a condition in which the ulnar nerve is pinched or injured. Not as well-known as carpal tunnel syndrome, it is actually the second most common neuropathy to affect the arm, wrist and hand. It is also known by the terms ulnar neuropathy and ulnar nerve entrapment.

Causes of Cubital Tunnel Syndrome

The ulnar nerve is likely to get injured in the following cases:

• When we rest our elbow on a hard surface with our weight on the elbow.
• Bending the elbow for a long duration – for example, spending many hours on the phone bending the elbow to hold the phone to the ear or in some cases even resting with the hand bent under our head.
• Other causes include arthritis, bone spur formation and any previous injury to the elbow like a fracture.

Symptoms of Cubital Tunnel Syndrome

The pain due to this condition is best described as the pain that is felt when we strike the funny bone in our elbow. The funny bone is in fact the ulnar nerve which travels from the neck till the fingers.

• Pain originates in the inner elbow and then covers the outer elbow too.
• A numb sensation, in some cases a tingling, might be felt in the ring finger and the little finger and sometimes in the palm. This is more pronounced when the elbow is in a bent position.
• Patient might experience an inability to grip objects properly as the muscle is in a weakened state.

As the symptoms of cubital tunnel syndrome and golfer’s elbow are similar, it is best to consult an orthopedic doctor for accurate diagnosis.

Diagnosing Cubital Tunnel Syndrome

The doctor will start by asking about the patient’s medical history, occupation and activities. He will also do a physical examination to check for nerve compression.

For diagnosis, the following might be recommended:

• An x-ray to check for arthritis or bone spur.
• A nerve conduction test which will test how quickly a signal is transmitted by a particular nerve. If the desired output is not obtained, then it means that there is a problem with the nerve.
• An EMG or electromyogram, to check the muscle that is associated with the ulnar nerve. If the output is not normal, it could mean a problem with the ulnar nerve.

Treatment for Cubital Tunnel Syndrome

There are a number of non-surgical treatment options for cubital tunnel syndrome. These include:

• Anti-inflammatory medicines to handle the pain.
• Wearing a brace or splint around the elbow to minimize movement and hence nerve irritation.
• Nerve gliding exercises to facilitate the smooth movement of the ulnar nerve through the cubital tunnel.

Surgery will be suggested only if the nerve is badly damaged and muscle function is affected.

What Is Radial Tunnel Syndrome?

The radial nerve controls many arm movements including rotation of forearm, extending the elbow, wrist motion and finger maneuverability. Radial tunnel syndrome is a condition that occurs when the radial nerve is pinched as it makes its way through the radial tunnel at the elbow. The radial tunnel is a tunnel like space formed by muscles. The condition itself is quite rare unlike carpal and cubital tunnel syndrome.

Causes of Radial Tunnel Syndrome

When the muscles of the radial tunnel are inflamed, it constricts the radial nerve running through it. There are many reasons for muscle inflammation, some of which are given below.

• An injury to the elbow.
• Any kind of repetitive motion involving the elbow.
• Sports like baseball which require push and pull movement of arm.
• Tumors in the arm.

Symptoms of Radial Tunnel Syndrome

A nagging pain is what best describes the pain that is caused by radial tunnel syndrome. This pain starts at the elbow and is felt along the forearm. As the pain is persistent, the patient often feels fatigued.

• Pain is felt at the back of the hand too.
• Wrist rotation causes pain.
• Flexing fingers causes pain.
• The pain is worse at night.
• When untreated, it can cause forearm muscle weakness which will affect grip strength.
• Sometimes, it might result in wrist drop in which lifting the wrist is not possible.

Unlike cubital tunnel syndrome, radial tunnel syndrome does not cause numbness or tingling.

Diagnosis:

• The doctor will first ask about the patient’s medical history and which specific action causes pain.
• He will then do a physical exam by lightly pressing around the elbow to find out where exactly the radial nerve is pinched.
• The doctor may use the following methods during the physical examination to aid in diagnosis:
• He will ask the patient to keep the palm of the affected arm facing down and then apply resistance and ask the patient to change the palm position to face up. If pain is felt in the forearm, it is an indication of radial tunnel syndrome.
• He might also ask the patient to use the middle finger to oppose some form of force. Pain during this is another sign of radial tunnel syndrome.
• The rule of nine test might also be used for diagnosis. Here, the doctor will divide the elbow into 9 areas of 3 rows. He will apply pressure to these areas to find out where exactly pain is felt to arrive at a diagnosis.
• An x-ray could be advised to rule out other conditions.
• An EMG could be advised to assess the working of the muscles and nerves.

Treatment Options

The best option is to stop the activity that is causing the pain. Rest can relieve the pain though it might take around 3-6 weeks. However, if this does not work, the following can be tried:

• Pain medications and if they do not work then steroid injections to relieve the pain.
• Using a splint to minimize movement.
• The doctor may also recommend some exercises to help with stretching the muscle encircling the nerve.

In most cases, the above non-invasive measures will suffice. In rare cases, surgery may be required which will involve widening the radial tunnel to prevent radial nerve compression.