Hand: Carpal Tunnel Syndrome

Diagnosis of Cubital Tunnel Syndrome

Hutchison RL, Rayan G (INTEGRIS Baptist Med Ctr, Oklahoma City, OK) J Hand Surg 36A:1519-1521, 2011^§

Abstract

Background

The diagnosis of cubital tunnel syndrome (CubTS) has depended on a combination of patient history, physical findings, specific provocative maneuvers, and electrophysiologic tests, although some clinicians choose to consider the clinical examination only and others wait for confirmation through electrodiagnostic testing. The most reliable way to confirm the diagnosis of CubTS was evaluated.

Case Study

Man, 51, complained of intermittent numbness or tingling of the ring and small fingers of the nondominant hand lasting 1   year. Occasionally this anesthesiologist also suffered medial elbow pain radiating to the ulnar side of the hand. Symptoms worsen with activity and have been increasing gradually in frequency and severity, but he has no upper extremity injury or systemic disease. Physical examination shows tenderness in the retrocondylar groove with no ulnar nerve instability, diminished light touch in the ulnar two digits, and weakness of the ulnar innervated intrinsic muscles without atrophy. The clinician believes the symptoms are characteristic of CubTS.

Analysis of Evidence

Risk factors for ulnar neuropathy at the cubital tunnel may include remote history of elbow fractures, fall with direct trauma to the medial elbow, habitually placing the elbow on a hard surface, repetitive elbow flexion, and systemic disease. Symptoms ascribed to CubTS include activity-induced and nocturnal paresthesias, constant sensory dysfunction in the small and ring fingers, pain in the medial elbow that radiates to the hand, handgrip weakness, and clumsiness. Neither the risk factors nor the symptoms are supported by evidence.

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