Diseases

Ulnar sulcus or cubital tunnel syndrome


Sulcus-Ulnaris syndrome, cubital tunnel syndrome, Ulnaris gutter syndrome

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

Definition

The cubital tunnel syndrome describes a compression of the ulnar nerve in the cubital tunnel on the elbow, which is accompanied by corresponding impairments in the area of ​​the ulnar nerve. In the past, the symptoms were mostly referred to as "sulcus nervi ulnaris syndrome" or "sulcus ulnaris syndrome", which, however, does not adequately reflect the localization of nerve compression. Other names include ulnar neuropathy on the elbow and ulnar groove syndrome. In addition, a distinction is sometimes made between a primary form and a secondary form, the latter being, for example, the side effect of an elbow joint arthrosis.

Symptoms and spread

Cubital tunnel syndrome is considered the second most common compression syndrome of a peripheral nerve. According to a study published in the “Deutsches Ärzteblatt”, the incidence is 24.7 per 100,000 inhabitants, with men being affected about twice as often as women. The complaints in the left arm also occur significantly more frequently than in the right.

The syndrome is characterized by recurrent emotional disorders in the supply area of ​​the ulnar nerve. So there are often sensations (tingling, numbness) in the little finger and the ring finger. With increasing damage to the nerve, there are permanent sensitivity disorders and pain, which can extend from the hand to the forearm and elbow. In addition, increasing muscle weakness and atrophy of the supplied muscles are not uncommon. The strength decreases significantly in some hand muscles. Even simple tasks, such as holding a pen while writing, may become a problem.

Causes

The elbow nerve (ulnar nerve), which primarily supplies the outside of the hand, runs in a groove, the so-called cubital tunnel, on the elbow. When we bend our arm, the nerve is automatically drawn against the middle wall of the tunnel. In addition, the middle head of the triceps muscle, which starts here, is also pulled to the nerve canal. A ligament (Lig. Collaterale ulnare), which runs over and along the canal, prevents the nerve from escaping and therefore also exerts pressure on it. Under these initial conditions, the nerve can easily be compressed if, for example, external loads or overloads are added.

For example, many people who work on the PC suffer from the syndrome because they rest on their elbows for long periods of time, creating a situation in which the nerve is permanently depressed using the mechanisms described above. A bruise on the elbow can also increase the pressure on the ulnar nerve. Changes in the tissue such as bone protrusions or tumors are other 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 susceptible to external pressure. Overweight and diseases of the rheumatic type also belong to the risk factor. Last but not least, previous injuries can increase the risk of cubital tunnel syndrome.

Diagnosis

As a rule, the complaints that emerge quickly lead to suspicion of nerve compression, but it remains to be checked which nerve is affected and where the compression is present. An electrophysiological examination of the nerve, for example with the help of electroneurography, remains essential in order to objectively determine the damage. However, the localization of nerve compression along its course sometimes creates difficulties. Ultrasound examinations and the process of so-called MR neurography can provide information here. MR neurography also allows the cubital tunnel syndrome to be divided into different degrees of severity.

In addition to the constriction at the elbow, the lodge of Guyon with its symptoms (Loge-de-Guyon syndrome) should also be taken into account when making the diagnosis. The same applies to possible narrowing of the nerve above the elbow.

Treatment of cubital tunnel syndrome

In principle, it makes sense in terms of prevention - but also during therapy - to change the position of the arm and move the arm more frequently in order to avoid one-sided stresses that can favor nerve compression. Upholstery of the elbow can also be helpful here. Otherwise, care should be taken when the symptoms appear. Physiotherapeutic treatments can also be used as a support.

If the symptoms do not go back, the recommendation of the University Medical Center Schleswig-Holstein (USH) should be taken as soon as possible to determine whether an operation is necessary. Waiting too long can significantly reduce the chances of successful treatment. A surgical intervention primarily aims at decompression of the nerve, which can, however, require different measures. A distinction is made between endoscopic decompression and open procedures.

According to the USH, an endoscopic decompression is usually possible, in which a special endoscope can be pushed along the nerve path using a small incision on the elbow. This allows the nerve to be checked visually and, if necessary, smaller bottlenecks can be eliminated. The intervention can usually be carried out on an outpatient basis and those affected can return home the same day.

Open decompression, on the other hand, is somewhat more complex. Here, the covering tape over the cubital tunnel is cut from the outside, the course of the nerve is checked and, if necessary, the constricting tissue is removed. If necessary, the ulnar nerve can also be relocated here. (tf, fp)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Geogr. Fabian Peters, Barbara Schindewolf-Lensch

Swell:

  • Merck and Co., Inc .: Cubital Tunnel Syndrome (Ulnar Neuropathy) (accessed: August 12, 2019), msdmanuals.com
  • German Society for Hand Surgery (DGH) / German Society for Neurosurgery eV (DGNC) / German Society for Neurology (DGN) / German Society for Orthopedics and Orthopedic Surgery eV (DGOOC): S3 guideline for diagnosis and therapy of cubital tunnel syndrome, as of November 2017, Guideline detailed view
  • Assmus, Hans / Antoniadis, Gregor / Bischoff, Christian: Carpal tunnel, cubital tunnel and rare nerve compression syndromes, Dtsch Arztebl Int, 2015, aerzteblatt.de
  • American Society for Surgery of the Hand: Cubital Tunnel Syndrome (accessed: August 12, 2019), assh.org
  • Columbia University, Department of Neurology: Cubital Tunnel Syndrome (accessed: August 12, 2019), columbianeurology.org
  • University of Rochester Medical Center Rochester: Cubital Tunnel Syndrome (accessed: August 12, 2019), urmc.rochester.edu

ICD codes for this disease: G56ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.


Video: Anatomy and Surgery of Ulnar Nerve Decompression. Transposition at Elbow Cubital Tunnel (October 2021).