Ep 30: Elbow Nerve Pain: Understanding and Treating Cubital Tunnel Syndrome with a Hand Therapist

Cubital Tunnel Syndrome creates numbness in the pinky and ring finger when the ulnar nerve becomes compressed at the elbow. The condition differs from Carpal Tunnel Syndrome, which affects the thumb side of the hand, and requires specific treatment approaches to prevent long-term muscle problems.

• Nerve pressure at the inside of elbow causes painful symptoms different from carpal tunnel
• Avoid leaning on elbows, especially on desks, door frames, or consoles to prevent pressure
• Use cold running water for 10-20 seconds instead of ice packs to avoid pressure on the nerve
• Custom night braces hold the elbow at 45 degrees to protect the nerve while sleeping
• Untreated cases can develop "claw hand" deformity from muscle imbalance
• Simple nerve "flossing" exercises help the nerve glide through the tunnel (3 seconds, 3 reps, 3 times daily)
• Early intervention prevents need for surgical treatment and speeds recovery

Always check with your doctor and see a hand therapist to get a proper diagnosis and treatment plan before your symptoms worsen.

Chapters

• 0:00 Introducing Cubital Tunnel Syndrome
• 1:26 Understanding Nerve Pressure Problems
• 3:29 Cold Therapy and Nighttime Solutions
• 6:11 Custom Elbow Braces for Relief
• 7:51 Nerve Flossing Techniques

Transcript

Speaker 1: 0:00

Welcome back to the Hand-to-Shoulder Solution Giving Pain the Middle Finger. I'm your host, carl Petito, occupational Therapist and Board Certified Hand Therapist. Today I want to talk to you about Cubital Tunnel Syndrome. We've all heard about Carpal Tunnel Syndrome. Now let's talk about the Cubital Tunnel. Cubital means elbow and of course tunnel is a tunnel.

Speaker 1: 0:18

So the nerves that connect to our skin for sensation and the nerves that connect to our muscles to send electrical signals to our muscles to make them contract and move, they travel through tunnels. So they come out of the spinal cord, go through the vertebrae down through the armpit. Bundle of nerves looks like a bundle of thick spaghetti and they branch out. And every nerve or wire of your body, every nerve, has a name. So the nerve that goes to your carpal tunnel is the median M-E-D-I-A-N nerve and it branches out and innervates or plugs into the thumb, index finger, long finger or, like we call it on the show, the middle finger and half of the ring finger. Now, if you're having numbness and tingling on the small finger side of your hand, the small finger and the small finger side of your ring finger. Now, if you're having numbness and tingling on the small finger side of your hand, the small finger and the small finger side of your ring finger. We know that that's the ulnar nerve. If you decompress that Guillain's canal, which is right next door to carpal tunnel, or at the cubital tunnel, which we're going to talk about in a moment, or anywhere further upstream, without getting into all those details, let's talk about cubital tunnel syndrome.

Speaker 1: 1:26

So the tunnel in the elbow when you hit your funny bone it's not the bone at all. You're actually hitting the ulnar nerve and the ulnar nerve on the model here it's actually shown a little bit too small. This is the left hand and here's the inside part of the elbow. That would be right here on me. And it's this yellow nerve, the yellow, the inside part of the elbow, that'd be. That would be right here on my on me, and it's this yellow yellow nerve, the yellow. The red, of course, is an artery, but this goes around the inside part of the elbow. So if you feel this bony knob in the inside part of your elbow then you feel the tip of your elbow. In between the two there's a soft trough, there's a little ditch right there and that's the nerve. So you never want to rub that if you, if you ever have to have surgery, a surgical release of pressure on the nerve and the cubital tunnel.

Speaker 1: 2:15

We talked on other episodes about why not to rub that. It's very simple. You just don't want pressure there. Any pressure on the nerve makes it numb and tingly and go to sleep and start to ache and hurt. When you cross your leg, your foot goes to sleep. That's because of pressure on the nerve. Okay, so you don't want to lean on the table, you don't want to lean on the armrest of your desk chair.

Speaker 1: 2:37

I treat a lot of. I live in an area where there's a lot of snow and I treat a lot of snowplow drivers. They're resting on the on the door and the door frame is right on the inside part of the elbow. They're resting on the center console. You know, if you just fold up a towel and put a towel or a cloth or something underneath the meaty part of the forearm, you can rest on that and then and then there's nothing but air. There's nothing touching the inside part of the forearm. You can rest on that and then and then there's nothing but air. There's nothing touching the inside part of the elbow. So okay, now we know the nerve comes out of the neck, goes down through the armpit and goes through the cubital tunnel, which is on the inside part of the elbow. Now, if you're having aching here and numbness and tingling and you just put that inside part of the elbow under cold running water only until it's deeply cold, that should take 10 to 20 seconds and that's a lot more effective than an ice pack for 10 minutes. What's really nice about that? And that's so important to use cold running water? Because, again, we can't have the pressure of anything on there. If you put an ice pack on there now, there's pressure on the nerve. Sure, the cold is reducing inflammation, but we cannot have pressure on the nerve and that pressure is just what continuously makes it worse.

Speaker 1: 3:52

If it keeps getting worse and goes on for a long time, the surgery is to go underneath the skin and cut a ligament that goes over the top and opens up the tunnel. It's called a release because it releases pressure off of the nerve. Now, when you're sleeping, I and I've had this condition on both sides and I like to lay on my stomach when I sleep and I'm like this and the inside part of my elbow is just jamming right straight down into the bed and I wake up all numb and tingly and then still on my stomach. I'll go like this and put my arm down by my side and the numbness and tingling goes right away, because now I'm not resting on the tunnel. So for nighttime what we used to do, we used to tell people to just, you know, wrap your arm in a bulky towel. That'll stop this full bending of the elbow which puts pressure in here. But still, even when you're wrapping with a bulky towel it's still in your and if you're laying and putting pressure there's still going to be pressure.

Speaker 1: 4:46

So what we always go to what studies have proven now is best practices is just making a custom brace and I made this on myself a few days ago so I could demonstrate it for you. I cut out a flat stock, molded onto the patient Very important you. I cut it out of flat stock, mold it onto the patient Very important. So the position of halfway between all the way palm up and all the way palm down, that's called the forearm neutral position and with the elbow bent at 45 degrees, that position studies have shown fully it most mostly reduces pressure inside the inside the cubital tunnel. So I'll have my patients put this on at night before they go to bed, there'd be a velcro strap, a velcro strap one here and one here, and then they could just totally relax. It's bubbled out right here so it's not hitting the tip of the elbow, and then it's pulled away from the inside part of the elbow. So now there's sort of like a protective cage, if you will, on the inside part of the elbow, so nothing is touching that elbow. This works wonders, puts a nice padding, you know, and it's only temporary. You know, wearing this every night for three or four weeks just makes a huge difference. And then during the day, making sure you're not leaning on the elbow.

Speaker 1: 6:00

Yeah, I'm actually treated a girl recently in high school who was resting on that wraparound desk that they use in high school and resting the elbow on there, and she's starting to develop a condition that people develop after. This has been going on for a long time, because now the muscles that are normally plugged into by that nerve are no longer firing or activating and it causes an imbalance in the hand and balance of the musculature of the fingers and they start getting this what we call a claw hand deformity. And she now we've made some changes to her positioning at school and she's actually resting on a on a folded up cloth, so she's not touching that side part of her elbow. She's wearing something like this at night. Um, I I haven't found anything good over the counter. You really really need to see your hand therapist and just have them mold something to you. Every elbow is different, every arm is different. Every person is different. Just just get what you need. Um, insurance covers it. So her condition is resolving. Numbness and tingling is going away. She's a lot more comfortable. And that put that claw and tingling is going away. She's a lot more comfortable. And that that claw hand position is going away very, very nicely. So I want you to have an awareness of of of these things so you know what to do when you start seeing these symptoms. You got to get in immediately because the longer you let this go, the more likely it is that you're going to need surgery. And then even with surgery, it's going to take longer for the symptoms to fully resolve because that nerve has been compressed and choked off for so long.

Speaker 1: 7:31

We also had people do what's called flossing. So if you bring your palm up toward the ceiling and your little finger toward the ear, I feel it pull right down through here. It doesn't hurt or or anything, it's just a light pull and I would hold that for three seconds. One and two and three. Put on slack. Again one and two and three. Put on slack one more time. One and two and three. Done three seconds, three repetitions, three times a day.

Speaker 1: 7:59

What does that do? That gets the nerve gliding or just flossing through the tunnel and sometimes some thick amount of fluid will form, will just build up in the tunnel. That chokes off the nerve as well. That gets all of that gunk out of there. And also it's healthy for the nerve not to really stretch the nerve but again just glide it. So you don't want a hard stretch. It's a lot tighter on my left. So one and two and three and so forth. Okay, so we have the nerve flossing. You got the cold running water midday and at the end of the day or more often, if necessary, not leaning on the elbow, wearing the elbow brace at night, and we'll get it to go away. Easy as that. So always check in with your doctor, go to your hand therapist, get it checked out, make sure it's not something else. And you just got to nip it in the bud like everything else. Thanks for watching.