Ulnar(Cubital)Tunnel
By : Banan AlzubaidiDefinition:
It is a fibro osseous space,oval in the shape .
In the dorsomedials(posteromedials)of the elbow joint .
Allow passage the ulnar nerve from arm to the forearm.
In the dorsomedials(posteromedials)of the elbow joint .
Allow passage the ulnar nerve from arm to the forearm
Note
(the ulnar nerve passes posterior to the medial epicondyl of the humerus)
Borders :
Medially :
1 )medial epicondyl of humerus
Laterally :
1 )olecranon process of the ulna
2 )tendinous arch joining the humeral
3 )ulnar head of the flexor carpi ulnaris m.
Roof :
1 )arcuate ligament of the osborneś (also known cubital tunnel retinaculum).
Floor :
1 )elbow joint capsule
2 )posterior band of the medial collateral ligament of the elbow joint
Contents :
1 )ulnar nerve
2 )fat
3 )anconeus epitrochlearis muscle (when present)
1 )medial epicondyl of humerus
Laterally :
1 )olecranon process of the ulna
2 )tendinous arch joining the humeral
3 )ulnar head of the flexor carpi ulnaris m.
Roof :
1 )arcuate ligament of the osborneś (also known cubital tunnel retinaculum
Note
it is a band of the fibrous tissue connect the humeral and ulnar head of the flexor carpi ulnaris the ligament spans between the olecranon process of the ulna and medial epicondyl of the humerus.Floor :
1 )elbow joint capsule
2 )posterior band of the medial collateral ligament of the elbow joint
Contents :
1 )ulnar nerve
2 )fat
3 )anconeus epitrochlearis muscle (when present)
Clinical Note:
Ulnar(cubital)tunnel syndrome :refer to the compression the ulnar nerve in the cubital tunnel .
It is the most second common peripheral neuropathy of the upper limib in the human body (after carpal tunnel syndrome ).
It is the most second common peripheral neuropathy of the upper limib in the human body (after carpal tunnel syndrome ).
The Symptoms:
1 )patients may experience altered sensation in the sensory distribution of the ulnar nerve in the dorsal and palmar aspect of the hand
2 ) The motor function of the ulnar nerve can also affected in the severe disease causing weakness and wasting of intrinsic hand muscles
3 ) Numbness and tingling in the hand and/or ring and little fingers especially when the elbow bend
4 )Hand pain
5 ) Weak grip and clumsiness due to muscles weakness in the effected arm and hand
6 ) Arching pain on the inside of the elbow
Note
(the medial one and half fingers and the medial one third of the hand )2 ) The motor function of the ulnar nerve can also affected in the severe disease causing weakness and wasting of intrinsic hand muscles
Note
(lumbricals..interossei..hypothenar eminence..adductor pollicis)3 ) Numbness and tingling in the hand and/or ring and little fingers especially when the elbow bend
4 )Hand pain
5 ) Weak grip and clumsiness due to muscles weakness in the effected arm and hand
6 ) Arching pain on the inside of the elbow
Cubital tunnel syndrome (compression of the ulnar nerve)
The Causes:
Although the cause of the ulnar (cubital) tunnel syndrome is not always known when the ulnar nerve in the tunnel is injured and become inflamed ..swollen and irritated by :
1 )It may be due repetitive movement or putting too much pressure or tension on the nerve ...when the person bends the elbow often (when pulling...reaching …lifting ...leans on their elbow a lot )or has an injury to the area .
2 ) Pervious fractures or dislocation of elbow …or adhesions within the cubital tunnel ………hypertrophy of surrounding musculature .
3 ) Elbow arthritis :it is refer to inflammation ...swelling… tenderness in the joint ...the major symptoms of the arthritis stiffness and pain in the joint …most common inflammations that occur in the elbow joint ( osteoarthritis …rheumatoid arthritis ...Post Traumatic Arthritis (PTA) and other Gout .. psoriatic .. lupus .. bursitis ..and tendinitis .
4 ) Bone spurs :are tiny ..hard bumps of the extra bone that form on the ends of bones(forms when bone meets with bone )they often appears in the joint
5 )the epitrochlearis anconeus muscle can cause the cubital tunnel syndrome
6 )or by external factors such as shooting ..shrapnel ..
1 )It may be due repetitive movement or putting too much pressure or tension on the nerve ...when the person bends the elbow often (when pulling...reaching …lifting ...leans on their elbow a lot )or has an injury to the area .
2 ) Pervious fractures or dislocation of elbow …or adhesions within the cubital tunnel ………hypertrophy of surrounding musculature .
3 ) Elbow arthritis :it is refer to inflammation ...swelling… tenderness in the joint ...the major symptoms of the arthritis stiffness and pain in the joint …most common inflammations that occur in the elbow joint ( osteoarthritis …rheumatoid arthritis ...Post Traumatic Arthritis (PTA) and other Gout .. psoriatic .. lupus .. bursitis ..and tendinitis .
4 ) Bone spurs :are tiny ..hard bumps of the extra bone that form on the ends of bones(forms when bone meets with bone )they often appears in the joint
5 )the epitrochlearis anconeus muscle can cause the cubital tunnel syndrome
6 )or by external factors such as shooting ..shrapnel ..
The Diagnosis:
In addition to a complete medical history and physical exam ..a diagnostic tests for cubital tunnel syndrome may include :
1)Nerve conductor test : a test to find out how fast signals travel down a nerve to find a compression or constriction of the nerve.
2)Electromyography (EMG ):a test checks nerves and muscles and may be used to test the forearm muscles controlled by the ulnar nerve if the muscle do not work the way they should ,it may be a sign that there a problem with the ulnar nerve .
3)x-ray :this is done to look at the bone of the elbow and see if you have arthritis or bone spurs in your elbow .
1)Nerve conductor test : a test to find out how fast signals travel down a nerve to find a compression or constriction of the nerve.
2)Electromyography (EMG ):a test checks nerves and muscles and may be used to test the forearm muscles controlled by the ulnar nerve if the muscle do not work the way they should ,it may be a sign that there a problem with the ulnar nerve .
3)x-ray :this is done to look at the bone of the elbow and see if you have arthritis or bone spurs in your elbow .
Nerve conductor test
The Treatment :
Non-surgical Treatment :
The first choice for treatment is non surgical if the condition not severe..like :
1 ) resting and stopping an activity that aggravates the condition such as bending the elbow
2 )a splint or f oam elbow brace worn at night to limit movement and reduce irritation
3 )use an elbow pad to protect against chronic irritation especially during put the elbow on the hard surface for long time
4 ) nerve gliding exercise
5 ) anti-inflammatory medicines
6 ) ice or heat
1 ) resting and stopping an activity that aggravates the condition such as bending the elbow
2 )a splint or f oam elbow brace worn at night to limit movement and reduce irritation
3 )use an elbow pad to protect against chronic irritation especially during put the elbow on the hard surface for long time
4 ) nerve gliding exercise
5 ) anti-inflammatory medicines
6 ) ice or heat
Surgical Treatment :
If the non-surgical treatment dose not affect the condition .the doctor will perform a surgical operation . There are several options, including:
1)cubital tunnel release :the roof of the cubital tunnel is a ligament ..in this type of surgery ..cuts and divides the ligament making tunnel bigger and decreasing pressure on the ulnar nerve.
2)ulnar nerve anterior
transposition :in this surgery the surgeon moves ulnar nerve from behind the medial epicondyle to the front closest..this procedure stops nerve from getting caught on the bone.
3)medial epicondylectomy : this surgery removes part of the medial epicondyle to release the nerve.
1)cubital tunnel release :the roof of the cubital tunnel is a ligament ..in this type of surgery ..cuts and divides the ligament making tunnel bigger and decreasing pressure on the ulnar nerve.
2)ulnar nerve anterior
transposition :in this surgery the surgeon moves ulnar nerve from behind the medial epicondyle to the front closest..this procedure stops nerve from getting caught on the bone.
3)medial epicondylectomy : this surgery removes part of the medial epicondyle to release the nerve.
Avoid the cubital tunnel syndrome:
1 )By avoiding its causes
2 )Avoid leaning on the elbow
3 )Avoid putting pressure on the inside of the arm
4 )Sleep with the elbow straight
5 )Stay away from anything that makes bend the arm for along time
2 )Avoid leaning on the elbow
3 )Avoid putting pressure on the inside of the arm
4 )Sleep with the elbow straight
5 )Stay away from anything that makes bend the arm for along time
References:
1)The Ulnar tunnel/teachmeanatomy/https://www.google.com/url?sa=t&source=web&cd=&ved=2ahUKEwiGwOvU8pv6AhVhX_EDHXfvAfsQFnoECAsQAQ&url=https%3A%2F%2Fteachmeanatomy.info%2Fupper-limb%2Fareas%2Fulnar-tunnel%2F&usg=AOvVaw0CSY2ZWXEam9hM0SoanRQf
2)Cubital tunnel/Radiopaedia/https://www.google.com/url?sa=t&source=web&cd=&ved=2ahUKEwi1j_708pv6AhXmSfEDHQnlCaMQFnoECBAQAQ&url=https%3A%2F%2Fradiopaedia.org%2Farticles%2Fcubital-tunnel&usg=AOvVaw09QDEG87-CQ-_Oz484M6CO
3)Cubital tunnel syndrome/pmj.bmj/https://www.google.com/url?sa=t&source=web&cd=&ved=2ahUKEwi_rd6N85v6AhWDW_EDHUtMBYgQFnoECAkQAQ&url=https%3A%2F%2Fpmj.bmj.com%2Fcontent%2F83%2F975%2F28&usg=AOvVaw1sLFFoxHwa3yjFhbJuxMP_
4)Cubital tunnel syndrome/physiopedia/https://www.google.com/url?sa=t&source=web&cd=&ved=2ahUKEwjqo4-f9Jv6AhXLXvEDHedlAaoQtwJ6BAgQEAE&url=https%3A%2F%2Fwww.physio-pedia.com%2FCubital_Tunnel_Syndrome&usg=AOvVaw1-I35H4wfQerRFDMSIsWm
5)Cubital tunnel syndrome/medicalnewstoday/https://www.google.com/url?sa=t&source=web&cd=&ved=2ahUKEwiK5afl-pv6AhW8SfEDHVy5AxYQtwJ6BAgOEAE&url=https%3A%2F%2Fwww.medicalnewstoday.com%2Farticles%2F322593&usg=AOvVaw3zdWZTNjDxu-VdPiZFlqQ9
6)Cubital tunnel syndrome /hopkinsmedicine/https://www.google.com/url?sa=t&source=web&cd=&ved=2ahUKEwj6-oDf_pv6AhVuQfEDHV8MAF8QtwJ6BAgREAE&url=%2Famp%2Fs%2Fwww.hopkinsmedicine.org%2Fhealth%2Fconditions-and-diseases%2Fcubital-tunnel-syndrome%253Famp%253Dtrue&usg=AOvVaw0Zvx1JBzGBlF8VKa_o4rvm
7)Cubital Tunnel/ladanhajipour/https://www.google.com/url?sa=t&source=web&cd=&ved=2ahUKEwiMyOiQhJz6AhXESPEDHYRiBbwQFnoECAoQAQ&url=https%3A%2F%2Fladanhajipour.com%2Fconditions%2Fhand%2Fcubital-tunnel-syndrome%2F&usg=AOvVaw2F_phqfuk594V8WZfAvoe9
8)Bone spurs/Orthopedicone/ https://www.google.com/url?sa=t&source=web&cd=&ved=2ahUKEwi6ucet3Jz6AhW7SvEDHdJQD60QFnoECAQQAQ&url=https%3A%2F%2Fwww.orthopedicone.com%2Fconditions%2Felbow-spurs%2F&usg=AOvVaw0W8ax3A4zyu7Ypa6zFjUI4
9)Bone spurs/webmd/https://www.google.com/url?sa=t&source=web&cd=&ved=2ahUKEwi49pDL3Jz6AhXARPEDHaIGCysQFnoECCwQAQ&url=https%3A%2F%2Fwww.webmd.com%2Fpain-management%2Fwhat-are-bone-spurs&usg=AOvVaw3JWJQSoSfSyLqCVonMBd1l
10)Cubital tunnel syndrome/Clevelandclinic/
https://www.google.com/url?sa=t&source=web&cd=&ved=2ahUKEwi8yuno3Jz6AhVzQPEDHevyAHUQFnoECAQQBQ&url=https%3A%2F%2Fmy.clevelandclinic.org%2Fhealth%2Fdiseases%2F21997-cubital-tunnel-syndrome&usg=AOvVaw3b6x92Y6_fAcsNZ1aGnHlk
11)Cubital tunnel syndrome/Orthoinfo.asos/ https://www.google.com/url?sa=t&source=web&cd=&ved=2ahUKEwjdiL2t3Zz6AhXqSfEDHZk1CtsQFnoECA4QAQ&url=https%3A%2F%2Fmy.clevelandclinic.org%2Fhealth%2Fdiseases%2F21997-cubital-tunnel-syndrome&usg=AOvVaw3b6x92Y6_fAcsNZ1aGnHlk
12)Moore, Keith L. (2010). Clinically Oriented Anatomy 6th Ed. Baltimore, MD: Lippincott, Williams and Wilkins. p. 770. ISBN 978-07817-7525-0.
2)Cubital tunnel/Radiopaedia/https://www.google.com/url?sa=t&source=web&cd=&ved=2ahUKEwi1j_708pv6AhXmSfEDHQnlCaMQFnoECBAQAQ&url=https%3A%2F%2Fradiopaedia.org%2Farticles%2Fcubital-tunnel&usg=AOvVaw09QDEG87-CQ-_Oz484M6CO
3)Cubital tunnel syndrome/pmj.bmj/https://www.google.com/url?sa=t&source=web&cd=&ved=2ahUKEwi_rd6N85v6AhWDW_EDHUtMBYgQFnoECAkQAQ&url=https%3A%2F%2Fpmj.bmj.com%2Fcontent%2F83%2F975%2F28&usg=AOvVaw1sLFFoxHwa3yjFhbJuxMP_
4)Cubital tunnel syndrome/physiopedia/https://www.google.com/url?sa=t&source=web&cd=&ved=2ahUKEwjqo4-f9Jv6AhXLXvEDHedlAaoQtwJ6BAgQEAE&url=https%3A%2F%2Fwww.physio-pedia.com%2FCubital_Tunnel_Syndrome&usg=AOvVaw1-I35H4wfQerRFDMSIsWm
5)Cubital tunnel syndrome/medicalnewstoday/https://www.google.com/url?sa=t&source=web&cd=&ved=2ahUKEwiK5afl-pv6AhW8SfEDHVy5AxYQtwJ6BAgOEAE&url=https%3A%2F%2Fwww.medicalnewstoday.com%2Farticles%2F322593&usg=AOvVaw3zdWZTNjDxu-VdPiZFlqQ9
6)Cubital tunnel syndrome /hopkinsmedicine/https://www.google.com/url?sa=t&source=web&cd=&ved=2ahUKEwj6-oDf_pv6AhVuQfEDHV8MAF8QtwJ6BAgREAE&url=%2Famp%2Fs%2Fwww.hopkinsmedicine.org%2Fhealth%2Fconditions-and-diseases%2Fcubital-tunnel-syndrome%253Famp%253Dtrue&usg=AOvVaw0Zvx1JBzGBlF8VKa_o4rvm
7)Cubital Tunnel/ladanhajipour/https://www.google.com/url?sa=t&source=web&cd=&ved=2ahUKEwiMyOiQhJz6AhXESPEDHYRiBbwQFnoECAoQAQ&url=https%3A%2F%2Fladanhajipour.com%2Fconditions%2Fhand%2Fcubital-tunnel-syndrome%2F&usg=AOvVaw2F_phqfuk594V8WZfAvoe9
8)Bone spurs/Orthopedicone/ https://www.google.com/url?sa=t&source=web&cd=&ved=2ahUKEwi6ucet3Jz6AhW7SvEDHdJQD60QFnoECAQQAQ&url=https%3A%2F%2Fwww.orthopedicone.com%2Fconditions%2Felbow-spurs%2F&usg=AOvVaw0W8ax3A4zyu7Ypa6zFjUI4
9)Bone spurs/webmd/https://www.google.com/url?sa=t&source=web&cd=&ved=2ahUKEwi49pDL3Jz6AhXARPEDHaIGCysQFnoECCwQAQ&url=https%3A%2F%2Fwww.webmd.com%2Fpain-management%2Fwhat-are-bone-spurs&usg=AOvVaw3JWJQSoSfSyLqCVonMBd1l
10)Cubital tunnel syndrome/Clevelandclinic/
https://www.google.com/url?sa=t&source=web&cd=&ved=2ahUKEwi8yuno3Jz6AhVzQPEDHevyAHUQFnoECAQQBQ&url=https%3A%2F%2Fmy.clevelandclinic.org%2Fhealth%2Fdiseases%2F21997-cubital-tunnel-syndrome&usg=AOvVaw3b6x92Y6_fAcsNZ1aGnHlk
11)Cubital tunnel syndrome/Orthoinfo.asos/ https://www.google.com/url?sa=t&source=web&cd=&ved=2ahUKEwjdiL2t3Zz6AhXqSfEDHZk1CtsQFnoECA4QAQ&url=https%3A%2F%2Fmy.clevelandclinic.org%2Fhealth%2Fdiseases%2F21997-cubital-tunnel-syndrome&usg=AOvVaw3b6x92Y6_fAcsNZ1aGnHlk
12)Moore, Keith L. (2010). Clinically Oriented Anatomy 6th Ed. Baltimore, MD: Lippincott, Williams and Wilkins. p. 770. ISBN 978-07817-7525-0.
References of the images :
Cover image :cubital tunnel /Cedars-sinai/https://www.cedars-sinai.org/health-library/diseases-and-conditions/c/cubital-tunnel-syndrome.html
Fig.1)Cubital tunnel /cedars-sinai/https://www.cedars-sinai.org/health-library/diseases-and-conditions/c/cubital-tunnel-syndrome.html
Fig.2)cubital tunnel /teachmeanatomy/ https://teachmeanatomy.info/upper-limb/areas/ulnar-tunnel/
Fig.3)Osborneś fascia /orthobullets/https://www.orthobullets.com/hand/6021/cubital-tunnel-syndrome
Fig.4)anconeus epitrochlearis/ Jshoulderelbow.org/https://images.app.goo.gl/DFkqJwUvRcc1y74n8
Fig.5)anconeus epitrochlearis/semanticsholar/https://www.semanticscholar.org/paper/Acute-Cubital-Tunnel-Syndrome-Secondary-to-Anconeus-Law/97a5ac11331882f35105ba172a39eaab16a9aa83
Fig.6)
cubital tunnel syndrome/sport medicine.mayo clinic / https://sportsmedicine.mayoclinic.org/condition/ulnar-nerve-cubital-tunnel/
Fig.7)cubital tunnel syndrome/shutterstock.org/ https://www.shutterstock.com/search/ulnar-nerve-palsy
Fig.8)cubital tunnel syndrome/lmg.org/ https://www.lmh.org/get-care/orthokansas/hand-wrist/ulnar-nerve-transposition/
Fig.9)symptome of the cubital tunnel syndrome/my hand.com.au/Dr.stuart Myers/http://myhand.com.au/handouts/common-conditions/cubital-tunnel-syndrome
Fig.10)symptome of the cubital tunnel syndrome /orthobullets/ https://www.orthobullets.com/hand/6021/cubital-tunnel-syndrome
Fig.11)symptom of the cubital tunnel syndrome/my hand.com.au/Dr.stuart Myers/carpaltunnelrelief.net/ https://www.carpaltunnelrelief.net/elbow/cubital-tunnel-syndrome/amp/
Fig.12)Nerve conductor test/precisionhealth.com/ https://www.precisionhealth.com.au/nerve-conduction-studies/
Fig.13)Electromyography test/ os.mbed /https://os.mbed.com/teams/MyoWare-Sensor/wiki/Sparkfun-MyoWare-Muscle-Sensor
Fig.14)Electromyography test/verywellhealth/https://www.verywellhealth.com/understanding-emg-and-ncs-results-2488642
Fig.15)Electromyography test/instructables/ https://www.instructables.com/EMG-Sensing-Circuit/?amp_page=true
Fig.16)Bracing/splinting /medindia.net/ https://www.medindia.net/amp/patientinfo/diagnosis-treatment-and-prevention-of-cubital-tunnel-syndrome.htm
Fig.17)cubital tunnel syndrome/myhand.com.au/ http://myhand.com.au/handouts/common-conditions/cubital-tunnel-syndrome
Fig.18)Ulnar nerve entrapment at the elbow joint/orthoinfo.aaos.org/https://orthoinfo.aaos/en/diseases--conditions/ulnar-nerve-entrapment-at-the-elbow-cubital-tunnel-syndrome/
Fig.19)surgery of the cubital tunnel syndrome/myhand.com.au/ http://myhand.com.au/handouts/common-conditions/cubital-tunnel-syndrome
Fig.1)Cubital tunnel /cedars-sinai/https://www.cedars-sinai.org/health-library/diseases-and-conditions/c/cubital-tunnel-syndrome.html
Fig.2)cubital tunnel /teachmeanatomy/ https://teachmeanatomy.info/upper-limb/areas/ulnar-tunnel/
Fig.3)Osborneś fascia /orthobullets/https://www.orthobullets.com/hand/6021/cubital-tunnel-syndrome
Fig.4)anconeus epitrochlearis/ Jshoulderelbow.org/https://images.app.goo.gl/DFkqJwUvRcc1y74n8
Fig.5)anconeus epitrochlearis/semanticsholar/https://www.semanticscholar.org/paper/Acute-Cubital-Tunnel-Syndrome-Secondary-to-Anconeus-Law/97a5ac11331882f35105ba172a39eaab16a9aa83
Fig.6)
cubital tunnel syndrome/sport medicine.mayo clinic / https://sportsmedicine.mayoclinic.org/condition/ulnar-nerve-cubital-tunnel/
Fig.7)cubital tunnel syndrome/shutterstock.org/ https://www.shutterstock.com/search/ulnar-nerve-palsy
Fig.8)cubital tunnel syndrome/lmg.org/ https://www.lmh.org/get-care/orthokansas/hand-wrist/ulnar-nerve-transposition/
Fig.9)symptome of the cubital tunnel syndrome/my hand.com.au/Dr.stuart Myers/http://myhand.com.au/handouts/common-conditions/cubital-tunnel-syndrome
Fig.10)symptome of the cubital tunnel syndrome /orthobullets/ https://www.orthobullets.com/hand/6021/cubital-tunnel-syndrome
Fig.11)symptom of the cubital tunnel syndrome/my hand.com.au/Dr.stuart Myers/carpaltunnelrelief.net/ https://www.carpaltunnelrelief.net/elbow/cubital-tunnel-syndrome/amp/
Fig.12)Nerve conductor test/precisionhealth.com/ https://www.precisionhealth.com.au/nerve-conduction-studies/
Fig.13)Electromyography test/ os.mbed /https://os.mbed.com/teams/MyoWare-Sensor/wiki/Sparkfun-MyoWare-Muscle-Sensor
Fig.14)Electromyography test/verywellhealth/https://www.verywellhealth.com/understanding-emg-and-ncs-results-2488642
Fig.15)Electromyography test/instructables/ https://www.instructables.com/EMG-Sensing-Circuit/?amp_page=true
Fig.16)Bracing/splinting /medindia.net/ https://www.medindia.net/amp/patientinfo/diagnosis-treatment-and-prevention-of-cubital-tunnel-syndrome.htm
Fig.17)cubital tunnel syndrome/myhand.com.au/ http://myhand.com.au/handouts/common-conditions/cubital-tunnel-syndrome
Fig.18)Ulnar nerve entrapment at the elbow joint/orthoinfo.aaos.org/https://orthoinfo.aaos/en/diseases--conditions/ulnar-nerve-entrapment-at-the-elbow-cubital-tunnel-syndrome/
Fig.19)surgery of the cubital tunnel syndrome/myhand.com.au/ http://myhand.com.au/handouts/common-conditions/cubital-tunnel-syndrome
References of the videos
1)Ulnar nerve decompression and subfascial transposition /ASUTOSH orthopedic channel /https://youtu.be/ECogoHAn1iI
2)live surgery cubital tunnel.. Ulnar nerve Transposition.. Decompression at the elbow/Dr. Thomas MCclellan/https://youtu.be/gIncgsuHr68
2)live surgery cubital tunnel.. Ulnar nerve Transposition.. Decompression at the elbow/Dr. Thomas MCclellan/https://youtu.be/gIncgsuHr68
