Cubital Tunnel

Overview

This is the second most common nerve compression that leads to nocturnal numbness, tingling and shooting pains in the ulnar half of the ring finger and small finger. In addition, patients can have issues with dropping objects and grip as the muscles innervated by the ulnar nerve are weakened. The patient often describes the symptoms come on with the elbow flexed, particularly when driving a car or holding a phone.

After reviewing the patient’s symptoms and performing provocative maneuvers associated with cubital tunnel syndrome, the patient is generally sent to obtain nerve tests to determine the severity of cubital tunnel syndrome. Combining the patient’s history/physical exam with the nerve tests, we work with the patient to determine what options would be best for management.

The vast majority are treated conservatively with braces, activity modification, or a combination of the two. Those who meet surgical criteria are taken to surgery usually after failing conservative management. Our practice prides ourselves on not rushing all patients to surgery.

Dr. Anup Patel Advantage

Dr. Anup Patel performs decompression of nerve compressions including some of the rarest syndromes encountered in the upper extremity. Trained by Dr. David T.W. Chiu, a pioneer and leader in microsurgery and nerve disorders, and Dr. John Persing, a pioneer and leader in neurosurgery, Dr. Patel often employs microsurgical techniques with precise dissection to relieve pressure on the nerves.

Dr. Chiu and Dr. Patel were recognized on the Tonight Show for their work in treating the peripheral nerve compression of Jimmy Fallon. Dr. Patel routinely treats patients from around the world suffering from nerve issues causing pain, sensory disturbances, and motor function loss.

Dr. Anup Patel performs cubital tunnel surgery by performing a full release of the ulnar nerve under loupe magnification. The nerve then is transposed under a bed of muscle (anterior submusuclar transposition of the ulnar nerve) to protect the nerve and prevent the nerve from slipping (a common cause of failed surgery).

Finally, using plastic surgery techniques, he closes the skin to provide an almost imperceptible scar. Please see our YouTube channel for an intraoperative experience of how Dr. Anup Patel delivers some of the best cubital tunnel surgical outcomes. Do not take our word for it, but see our patient examples accompanied by testimonials.

Symptoms

  • Numbness, tingling, weakness, paresthesias and pain radiates from the elbow to the tips of the ring and small finger
  • Motor weakness leading to clawing of the ring and small fingers, loss of thumb pinch, and inability to bring the small finger to the hand
  • These symptoms may become worse at night and/or when the elbow is flexed (e.g., talking on a phone)


Causes

  • Compression of the ulnar nerve in the cubital tunnel (elbow) that can lead to ischemia of the nerve


Treatment: Non-Surgical

  • Elbow brace
  • NSAIDs


Treatment: Surgical

  • Release of the cubital tunnel with possible transposition of the nerve

Patient 1

29 year old financial advisor from Boston who saw two other surgeons before flying to our office for a tertiary opinion. She presents with numbness and tingling in the ring and small fingers, pain over the elbow with flexion, and loss of grip strength. After cubital tunnel release with anterior submuscular transposition of the ulnar nerve, the patient has resolution of all symptoms 6 months later.

Patient 2

32 year old business owner who saw two other surgeons before coming from Tampa to our office for a tertiary opinion. He presents with numbness and tingling in the ring and small fingers, pain over the elbow with flexion, loss of grip strength, and the nerve catching over the elbow. After cubital tunnel release with anterior submuscular transposition of the ulnar nerve, the patient has resolution of all symptoms 6 months later.

Patient 3

35 year old nurse comes as a secondary opinion for cubital tunnel syndrome. She presents with numbness and tingling in the ring and small fingers, pain over the elbow with flexion, and loss of grip strength. After cubital tunnel release with anterior sub-muscular transposition of the ulnar nerve, the patient has resolution of all symptoms 6 months later, treating patients in the emergency room without any issues.

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Dr. Anup Patel

Dr. Anup Patel is a board-certified plastic and reconstructive surgeon trained in aesthetic, hand/upper extremity and reconstructive surgery. He completed his plastic and reconstructive surgery training at the premier Yale University followed by a hand and microsurgery fellowship at the New York University Institute of Reconstructive Plastic Surgery and Mount Sinai Department of Orthopedics. Dr. Patel received his MD and MBA from the Yale University School of Medicine and Yale University School of Management, respectively. He graduated as the valedictorian of his class at the University of Florida majoring in economics, biochemistry and molecular genetics and valedictorian of his high-school class at Lake Highland.

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