Sulcus ulnar or cubital tunnel syndrome

Sulcus Ulnaris syndrome, cubital tunnel syndrome, ulnar trough syndrome

Numbness and tingling in the fingers are often caused by nerve compression higher up in the arm. So also in the so-called cubital tunnel syndrome, which is due to a compression of the ulnar nerve in the cubital tunnel at the elbow. Often this is triggered by long or frequent support of the elbow (elbow pain).

contents

• Sulcus Ulnaris syndrome, cubital tunnel syndrome, ulnar trough syndrome
• definition
• Symptoms and distribution
• causes
• diagnosis
• Treatment of the cubital tunnel syndrome

definition

The cubital tunnel syndrome describes a compression of the ulnar nerve in the cubital tunnel at the elbow, which is associated with corresponding impairments in the supply of the ulnar nerve. In the past, the symptoms were usually referred to as "sulcus nervi ulnaris syndrome" or "sulcus ulnar syndrome", which, however, the localization of nerve compression is insufficient. Other names include ulnar neuropathy on the elbow and Ulnarisrinnen syndrome. In addition, a distinction is sometimes made between a primary form and a secondary form, the latter, for example, may be the concomitant of an elbow joint arthrosis.

The cubital tunnel syndrome is caused by a compression of the ulnar nerve and is associated with discomfort in the supply area of ​​the nerve. (Image: bilderzwerg / otolia.com)

Symptoms and distribution

Cubital tunnel syndrome is considered the second most common compression syndrome of a peripheral nerve. According to a study published in the "Deutscher Ärztblatt", the incidence amounts to 24.7 per 100,000 inhabitants, whereby men are affected about twice as often as women. Also, the complaints in the left arm occur much more frequently than in the right.

The syndrome is characterized by recurring emotional disturbances in the supply area of ​​the ulnar nerve. This often shows discomfort (tingling, numbness) in the little finger and the ring finger. With increasing damage to the nerve, persistent sensory disturbances and pain are added, which can range from the hand to the forearm and elbow. In addition, muscle weakness and atrophy of the supplied musculature are not uncommon. The strength decreases significantly in some hand muscles. Even simple tasks, such as holding a pen while writing, may be a problem.

The complaints in the cubital tunnel syndrome occur mainly in the area of ​​the ring finger and the little finger. (Image: fosupaksorn / fotolia.com)

causes

At the elbow, the ulnar nerve (nervus ulnaris), which mainly supplies the outside of the hand, runs in a groove, the so-called cubital tunnel. As we bend our arm, the nerve is automatically pulled against the middle wall of the tunnel. In addition, the middle head of the triceps muscle, which attaches here, is pulled to the nerve canal. A ligament (collateral ulnar ligament) that runs across the canal and laterally prevents the nerve from dodging and thus puts pressure on it. Under these initial conditions, compression of the nerve can easily occur, for example when external loads or overloads are added.

For example, many people who work on the PC suffer from the syndrome because they support themselves with the elbow for long periods of time, creating a situation where the nerve is permanently pulled off with the mechanisms described above. A bruised elbow can also increase the pressure on the ulnar nerve. Changes in the tissue such as bony prominences or tumors form further possible causes. Last but not least, in people with a so-called polyneuropathy, as can occur, for example, in diabetes, the nerves are often particularly vulnerable to external pressure. Obesity and diseases of the rheumatic type also belong to the risk factor. Last but not least, injuries can increase the risk of the cubital tunnel syndrome.

If the elbows are regularly supported while working on a PC or notebook, this can trigger the symptoms of a cubital tunnel syndrome. (Image: undrey / fotolia.com)

diagnosis

As a rule, the incidence of the symptoms causes suspicion of nerve compression, but it remains to be determined which nerve is affected and at which point the compression is present. An electrophysiological examination of the nerve, for example with the help of an electroneurography, remains indispensable in order to determine the damage objectively. However, the localization of nerve compression sometimes causes difficulties along the way. Ultrasound examinations and the procedure of so-called MR neurography can provide information here. The MR neurography also allows a classification of the cubital tunnel syndrome in different degrees of severity.

In addition to the constriction at the elbow should be taken into account in the diagnosis of the lodge of Guyon with their symptoms (Loge-de-Guyon syndrome). The same applies to possible bottlenecks of the nerve above the elbow.

Treatment of the cubital tunnel syndrome

Basically, it makes sense in terms of prevention - but also during therapy - to change the position of the arm more often and to move the arm to avoid unilateral stress, which may favor a nerve compression. A padding of the Ellenbiogens can be helpful here. Otherwise, when the symptoms occur first of all protection is required. Also physiotherapeutic treatments can be used to support.

If the complaints do not go away, according to the recommendation of the University Hospital Schleswig-Holstein (USH), it should be decided as soon as possible to what extent an operation is necessary. To wait too long could significantly worsen the chances of a successful treatment. An operative procedure aims primarily at the decompression of the nerve, but this may require different measures. A distinction is made between endoscopic decompression and open surgery.

Not infrequently, surgery remains the only option to relieve the ulnar nerve. (Image: Ratthaphon Bunmi / fotolia.com)

According to the USH, endoscopic decompression is usually possible, in which a small endoscopic elbow can be used to push a special endoscope along the course of the nerve. This allows the nerve to visually check and, if necessary, smaller bottlenecks can be corrected. Usually, the procedure can be performed on an outpatient basis and those affected can return home the same day.

The open decompression, however, is a little more elaborate. Here, the covering band over the cubital tunnel is severed from the outside, controls the course of the nerve and it takes place if necessary, an elimination of the constricting tissue. Optionally, a shift of the ulnar nerve can also be made here. (tf, fp; last updated 24.01.2017)
Specialist supervision: Barbara Schindewolf-Lensch (doctor)