Cubital tunnel syndrome: Anatomy, clinical presentation, and management

Abstract

Cubital tunnel syndrome is the second most common peripheral nerve compression seen by hand surgeons. A thorough understanding of the ulnar nerve anatomy and common sites of compression are required to determine the cause of the neuropathy and proper treatment. Recognizing the various clinical presentations of ulnar nerve compression can guide the surgeon to choose examination tests that aid in localizing the site of compression. Diagnostic studies such as radiographs and electromyography can aid in diagnosis. Conservative management with bracing is typically trialed first. Surgical decompression with or without ulnar nerve transposition is the mainstay of surgical treatment. This article provides a review of the ulnar nerve anatomy, clinical presentation, diagnostic studies, and treatment options for management of cubital tunnel syndrome.

Keywords: Brachial plexus compression; Cubital tunnel syndrome; Medial epicondylectomy; Thoracic outlet syndrome; Ulnar nerve decompression.

Figures

Fig. 1

Schematic of the major structures the ulnar nerve traverses through the arm.

Fig. 2

Major sites of compression are the (a) arcade of Struthers, (b) the Osborne ligament (cubital retinaculum), and (c) the arcade of Osborne between the two heads of the flexor carpi ulnaris.

Fig. 3

Claw hand deformity resulted from ulnar nerve damage.

Fig. 4

Froment's sign is positive when the adductor pollicis muscle fails, resulting in thumb interphalangeal (IP) joint flexion.

Fig. 5

In situ ulnar nerve decompression.