Ulnar neurothathy (Cubital tunnel syndrome)

Characterised by the ulnar nerve pressure at the level of the elbow. It is the second most common compression neuropathy syndrome after carpal tunnel syndrome.

The ulnar nerve is one of the major nerves of the hand, providing the sensation in the little finger and half the ring finger.

But the most important feature is the small muscles of the hand. These small muscles control fine movements of the hand and fingers.

Ulnar neuritis is caused by compression of the ulnar nerve on the physical tunnel that is behind the medial condyle of humerus. Usually pressure coexists with traction in the nerve.


Symptoms may vary, but usually include

  • numbness along the forearm, of the little finger and half of the ring finger,
  • reduction of the grip force (fist), difficulty in opening jars or turning doorknobs,
  • sense of "clumsy" hand operation
  • causalgia (burning pain sensation) at the elbow and hand


The most common causes are overuse (repetitive flexion-extension movements of the elbow) and the immediate pressure over the elbow for long periods.

Other problems may be implicated in ulnar neuritis as elbow injuries (fractures or ligamentous damage), local tumours (ganglions) or exostoses.


A percentage of cases respond positively to conservative treatment .This treatment involves modification of daily activities to avoid consecutive - repeated flexion of the elbow and avoid applying direct pressure to the area.

Surgery can be done in the daily treatment department or one day stay in hospital, under general or regional anaesthesia.

There are two basic methods

Decompression of the ulnar nerve by simple release of the cubital canal

Forward transfer of the ulnar nerve either subcutaneously or below the common tendon of the flexor muscles.

In our clinic, the method of choice is the transfer of the nerve below the common flexor tendon, with excellent results.

After surgery the upper limb is immobilised in a long splint for 2 weeks. After removing the splint, a physiotherapy program is required that includes stretching exercises to restore the full range of flexion - extension of the elbow.

The physiotherapy program will gradually be intensified until fully restore motion and strength.


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Carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is a common condition that causes a tingling sensation, numbness and sometimes pain in the hand and fingers.

These sensations usually develop gradually and start off being worse during the night. They tend to affect the thumb, index finger and middle finger.

It is estimated that 3% of the population is affected by the syndrome, which is more common among women.

Pain is often reflected up to the arm. By night symptoms in the hand and fingers worsen with feelings of burning, itching and tingling that disrupt sleep. In very severe cases there is a risk of loss of sensation or partial paralysis of the hand (thumb). The condition is caused by compression of the median nerve in the wrist.

The carpal tunnel is a narrow passage in your wrist made up of small bones and a tough band of tissue that acts as a pulley for the tendons that bend the fingers.

In most cases, it isn't known why the median nerve becomes compressed.

However, some things do increase the risk of CTS.

This includes

  • a family history of CTS
  • pregnancy – up to about 50% of pregnant women develop CTS
  • injuries to the wrist
  • other health conditions, such as diabetes and rheumatoid arthritis
  • strenuous, repetitive work with the hand

CTS is more common in women and becomes more likely as you get older.


The symptomatology begins with numbness in the first three fingers of the hand. It mainly occurs during the evening hours.

Later there is pain which may be reflected in the entire upper extremity. In more severe cases weakness occurs during bending of the fingers and especially during abduction and opposition of the thumb.


The differential diagnosis is mainly made with conditions characterised by damage of the median nerve at a level other than that of the wrist. Such conditions are pronator syndrome, brachial plexus lesions and cervical diseases (compression injuries of spinal nerve roots).

Other diseases or conditions can also cause the appearance of the syndrome such as gout, rheumatoid arthritis, obesity, diabetes mellitus, pregnancy.


Treatment should begin as soon as possible, according to medical guidelines. Initial treatment includes resting of the hand for at least two weeks by applying simple wrist brace immobilization.

Applying cold patches can reduce swelling and burning pain. The administration of drugs such as non-steroidal anti-inflammatories, diuretics, or even topical cortisone injection may, in the initial stages, relieve swelling and pain.

Surgical opening of the carpal tunnel is the radical solution of the syndrome. It is  recommended in cases where of symptoms persist for at least six months.

The operation is performed under local or regional anaesthesia and substantially consists in the opening of the transverse carpal ligament.



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