Topic: Cubital Tunnel Syndrome

Ulnar nerve entrapment between the humerus and ulna was first described in 1958. This painful and often debilitating condition hereafter referred to CUTS, is known as the second most common entrapment neuropathy in the upper extremity, next to Carpal Tunnel Syndrome.

Characterized by numbness and/or tingling in the ulnar nerve distribution (ring and small finger), CUTS often results in a routine surgical procedure, known as “Ulnar Nerve Transposition”. During this procedure the surgeon cuts a healthy ligament to release and relocate the entrapped ulnar nerve located between the triangular shaped arcuate ligament and the transverse epicondylo-olecranon (TEO) ligament.

In my 40+years of practice and having treated countless upper and lower extremity entrapment neuropathies, this is one that baffles me endlessly when listening to the patient express the opinions of their health care provider, namely the orthopedic surgeon. The anatomic location of the ulnar nerve in the olecranon groove just distal to the sulcus cubitalis humeri is a common site for compression. That is, if the humerus and/or ulna are not juxtaposed and one or both are subluxated, then there is elevation of the ulnar nerve sandwiched between the ligamentous anatomy previously explained.

Examination of the possibly involved wrist, elbow and shoulder for accurate assessment and appropriate treatment is critical. Decompression of the medially (valgus) subluxed ulna utilizing the Mally Method ( in most instances yields immediate humero-ulnar joint function and improved sensation in the ulnar nerve with commensurate rehabilitation exercises to enhance strength and stability. Rarely, however and if necessary depending on the tasks, job duties, etc., a flexible neoprene strap is recommended for temporary support affording time for adequate ligamentous and joint recovery.

Overall, positive outcomes result from understanding and treating the underlying root source of the entrapment neuropathy. We were not designed as human bodies often requiring surgical re-wiring and relocating of our normal anatomy. Therefore, it is prudent to learn the near 30 upper extremity and almost 20 lower extremity entrapment neuropathies to educate and inform the public with your expertise in expanded services as an extremity expert.

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