Skip to main content
SpringerLink
Log in

Clinical Presentation and Diagnosis of Cubital Tunnel Syndrome

  • Chapter
  • First Online:
Compressive Neuropathies of the Upper Extremity

  • 796 Accesses

Abstract

Cubital tunnel syndrome is the second most common peripheral neuropathy encountered by the upper extremity surgeon. Patients classically present with painful paresthesias radiating down the medial elbow into the ring and small finger. Symptoms are often exacerbated with activities that require repetitive elbow hyperflexion. The presence of intrinsic weakness, muscle atrophy, and clawing is often associated with advanced nerve compression and a more ominous prognosis. At times, the diagnosis can be elusive. Provocative examination maneuvers remain important tools in reaching the diagnosis. Modifications to the classic maneuvers may improve their sensitivity and specificity. Electrodiagnostic tests and advanced imaging continue to evolve in their technique and utility. Nerve conduction studies and electromyography can be used to supplement ones clinical diagnosis. Ultrasonography and magnetic resonance imaging allow for visualization of pathologic structural changes within and around the ulnar nerve as it courses through the Cubital tunnel. Continued advances in imaging may allow noninvasive objective means to assist in diagnosis and prognosis.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Palmer BA, Hughes TB. Cubital tunnel syndrome. J Hand Surg WB Saunders. 2010;35(1):153–63.

    Article  Google Scholar 

  2. Jarrett CD, Papatheodorou LK, Sotereanos DG. Cubital tunnel syndrome. Instr Course Lect. 2017;66:91–101.

    PubMed  Google Scholar 

  3. Novak CB, Lee GW, Mackinnon SE, Lay L. Provocative testing for cubital tunnel syndrome. J Hand Surg Elsevier. 1994;19(5):817–20.

    Article  CAS  Google Scholar 

  4. Ochi K, Horiuchi Y, Tanabe A, Morita K, Takeda K, Ninomiya K. Comparison of shoulder internal rotation test with the elbow flexion test in the diagnosis of cubital tunnel syndrome. J Hand Surg Am. 2011;36(5):782–7.

    Article  Google Scholar 

  5. Ochi K, Horiuchi Y, Tanabe A, Waseda M, Kaneko Y, Koyanagi T. Shoulder internal rotation elbow flexion test for diagnosing cubital tunnel syndrome. J Shoulder Elb Surg. 2012;21(6):777–81.

    Article  Google Scholar 

  6. Rayan GM, Jensen C, Duke J. Elbow flexion test in the normal population. J Hand Surg. 1992;17(1):86–9.

    Article  CAS  Google Scholar 

  7. Kuschner SH, Ebramzadeh E, Mitchell S. Evaluation of elbow flexion and linel tests for cubital tunnel syndrome in asymptomatic individuals. Orthopedics. 2006;29(4):305–8.

    Article  Google Scholar 

  8. Cheng CJ, Mackinnon-Patterson B, Beck JL, Mackinnon SE. Scratch collapse test for evaluation of carpal and cubital tunnel syndrome. J Hand Surg Am. 2008;33(9):1518–24.

    Article  Google Scholar 

  9. Beekman R, Schreuder AHCML, Rozeman CAM, Koehler PJ, Uitdehaag BMJ. The diagnostic value of provocative clinical tests in ulnar neuropathy at the elbow is marginal. J Neurol Neurosurg Psychiatry BMJ Publishing Group Ltd. 2009;80(12):1369–74.

    Article  CAS  Google Scholar 

  10. Childress HM. Recurrent ulnar-nerve dislocation at the elbow. Clin Orthop Relat Res. 1975;108:168–73.

    Article  Google Scholar 

  11. Calfee RP, Manske PR, Gelberman RH, Van Steyn MO, Steffen J, Goldfarb CA. Clinical assessment of the ulnar nerve at the elbow: reliability of instability testing and the association of hypermobility with clinical symptoms. J Bone Joint Surg Am Journal of Bone and Joint Surgery, Inc. 2010;92(17):2801–8.

    Article  Google Scholar 

  12. McGOWAN AJ. The results of transposition of the ulnar nerve for traumatic ulnar neuritis. J Bone Joint Surg Br. 1950;32-B(3):293–301.

    Article  CAS  Google Scholar 

  13. Dellon AL. Review of treatment results for ulnar nerve entrapment at the elbow. J Hand Surg. 1989;14(4):688–700.

    Article  CAS  Google Scholar 

  14. Cho C-H, Lee Y-H, Song K-S, Lee K-J, Lee S-W, Lee S-M. Accuracy of preoperative ultrasonography for cubital tunnel syndrome: a comparison with intraoperative findings. Clin Orthop Surg. 2018;10(3):352–7.

    Article  Google Scholar 

  15. Greenwald D, Blum LCI, Adams D, Mercantonio C, Moffit M, Cooper B. Effective surgical treatment of cubital tunnel syndrome based on provocative clinical testing without electrodiagnostics. Plast Reconstr Surg. 2006;117(5):87e–91e.

    Article  Google Scholar 

  16. Yoon JS, Walker FO, Cartwright MS. Ulnar neuropathy with normal electrodiagnosis and abnormal nerve ultrasound. Arch Phys Med Rehabil WB Saunders. 2010;91(2):318–20.

    Article  Google Scholar 

  17. Hutchison RL, Rayan G. Diagnosis of cubital tunnel syndrome. J Hand Surg Elsevier. 2011;36(9):1519–21.

    Article  Google Scholar 

  18. Tomaino MM, Brach PJ, Vansickle DP. The rationale for and efficacy of surgical intervention for electrodiagnostic-negative cubital tunnel syndrome. J Hand Surg W.B. Saunders. 2001;26(6):1077–81.

    Article  CAS  Google Scholar 

  19. Wiesler ER, Chloros GD, Cartwright MS, Shin HW, Walker FO. Ultrasound in the diagnosis of ulnar neuropathy at the cubital tunnel. J Hand Surg. 2006;31(7):1088–93.

    Article  Google Scholar 

  20. Beekman R, Visser LH, Verhagen WI. Ultrasonography in ulnar neuropathy at the elbow: a critical review. Muscle Nerve Wiley-Blackwell. 2011;43(5):627–35.

    Article  Google Scholar 

  21. Mondelli M, Filippou G, Frediani B, Aretini A. Ultrasonography in ulnar neuropathy at the elbow: relationships to clinical and electrophysiological findings. Neurophysiol Clin. 2008;38(4):217–26.

    Article  CAS  Google Scholar 

  22. Gruber H, Glodny B, Peer S. The validity of ultrasonographic assessment in cubital tunnel syndrome: the value of a cubital-to-humeral nerve area ratio (CHR) combined with morphologic features. Ultrasound Med Biol. 2010;36(3):376–82.

    Article  Google Scholar 

  23. Bayrak AO, Bayrak IK, Turker H, Elmali M, Nural MS. Ultrasonography in patients with ulnar neuropathy at the elbow: comparison of cross-sectional area and swelling ratio with electrophysiological severity. Muscle Nerve Wiley-Blackwell. 2010;41(5):661–6.

    Google Scholar 

  24. Ozturk E, Sonmez G, Çolak A, Sildiroglu HO, Mutlu H, Senol MG, et al. Sonographic appearances of the normal ulnar nerve in the cubital tunnel. J Clin Ultrasound. 2008;36(6):325–9.

    Article  Google Scholar 

  25. Yoon JS, Hong S-J, Kim B-J, Kim SJ, Kim JM, Walker FO, et al. Ulnar nerve and cubital tunnel ultrasound in ulnar neuropathy at the elbow. Arch Phys Med Rehabil. 2008;89(5):887–9.

    Article  Google Scholar 

  26. Zhong W, Zhang W, Zheng X, Li S, Shi J. The high-resolution ultrasonography and electrophysiological studies in nerve decompression for ulnar nerve entrapment at the elbow. J Reconstr Microsurg Thieme Medical Publishers. 2012;28(5):345–8.

    Article  Google Scholar 

  27. Volpe A, Rossato G, Bottanelli M, Marchetta A, Caramaschi P, Bambara LM, et al. Ultrasound evaluation of ulnar neuropathy at the elbow: correlation with electrophysiological studies. Rheumatology (Oxford) Oxford University Press. 2009;48(9):1098–101.

    Article  Google Scholar 

  28. Chappell KE, Robson MD, Stonebridge-Foster A, Glover A, Allsop JM, Williams AD, et al. Magic angle effects in MR neurography. AJNR Am J Neuroradiol. 2004;25(3):431–40.

    PubMed  Google Scholar 

  29. Kästel T, Heiland S, Bäumer P, Bartsch AJ, Bendszus M, Pham M. Magic angle effect: a relevant artifact in MR neurography at 3T? AJNR Am J Neuroradiol. 2011;32(5):821–7.

    Article  Google Scholar 

  30. Andreisek G, Crook DW, Burg D, Marincek B, Weishaupt D. Peripheral neuropathies of the median, radial, and ulnar nerves: MR imaging features. Radiographics. 2006;26(5):1267–87.

    Article  Google Scholar 

  31. Bäumer P, Dombert T, Staub F, Kaestel T, Bartsch AJ, Heiland S, et al. Ulnar neuropathy at the elbow: MR neurography—Nerve T2 signal increase and caliber. Radiology Radiological Society of North America, Inc. 2011;260(1):199–206.

    Google Scholar 

  32. Iba K, Wada T, Tamakawa M, Aoki M, Yamashita T. Diffusion-weighted magnetic resonance imaging of the ulnar nerve in cubital tunnel syndrome. Hand Surg World Scientific Publishing Company. 2010;15(1):11–5.

    CAS  Google Scholar 

  33. Altun Y, Aygun MS, Cevik MU, Acar A, Varol S, Arıkanoglu A, et al. Relation between electrophysiological findings and diffusion weighted magnetic resonance imaging in ulnar neuropathy at the elbow. J Neuroradiol Elsevier Masson. 2013;40(4):260–6.

    Article  Google Scholar 

  34. Breitenseher JB, Kranz G, Hold A, Berzaczy D, Nemec SF, Sycha T, et al. MR neurography of ulnar nerve entrapment at the cubital tunnel: a diffusion tensor imaging study. Eur Radiol Springer Berlin Heidelberg. 2015;25(7):1911–8.

    Google Scholar 

  35. Husarik DB, Saupe N, Pfirrmann CWA, Jost B, Hodler J, Zanetti M. Elbow nerves: MR findings in 60 asymptomatic subjects—Normal anatomy, variants, and pitfalls. Radiology Radiological Society of North America. 2009;252(1):148–56.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Orthopaedic Surgery, Wilmington Health Associates, Wilmington, NC, USA

    Claudius D. Jarrett

Authors
  1. Claudius D. Jarrett
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Orthopaedic Specialists - UPMC, University of Pittsburgh, Pittsburgh, PA, USA

    Dean G. Sotereanos

  2. Orthopaedic Specialists - UPMC, University of Pittsburgh, Pittsburgh, PA, USA

    Loukia K. Papatheodorou

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Jarrett, C.D. (2020). Clinical Presentation and Diagnosis of Cubital Tunnel Syndrome. In: Sotereanos, D., Papatheodorou, L. (eds) Compressive Neuropathies of the Upper Extremity. Springer, Cham. https://doi.org/10.1007/978-3-030-37289-7_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-37289-7_11

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-37288-0

  • Online ISBN: 978-3-030-37289-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation