Cubital and Radial Tunnel Syndrome: What Does That Mean?

Article featured on WebMD

Cubital tunnel syndrome and radial tunnel syndrome aren’t as familiar as their better-known relative — carpal tunnel syndrome — but they also can cause severe pain, numbness, tingling, and muscle weakness in the hands and arms.The common cause of all these nerve compression syndromes is increased pressure — usually from bone or connective tissue — on a nerve in the wrist, arm, or elbow. In most cases, cubital tunnel syndrome and radial tunnel syndrome can be managed with conservative treatments. But more severe cases may require surgery to reduce pressure on the affected nerve.

Cubital Tunnel Syndrome: Causes and Symptoms

Cubital tunnel syndrome — also known as ulnar neuropathy — is caused by increased pressure on the ulnar nerve, which passes close to the skin’s surface in the area of the elbow commonly known as the “funny bone.” You’re more likely to develop cubital tunnel syndrome if you:

  • Repeatedly lean on your elbow, especially on a hard surface
  • Bend your elbow for sustained periods, such as while talking on a cell phone or sleeping with your hand crooked under your pillow
Sometimes, cubital tunnel syndrome results from abnormal bone growth in the elbow or from intense physical activity that increases pressure on the ulnar nerve. Baseball pitchers, for example, have an increased risk of cubital tunnel syndrome, because the twisting motion required to throw a slider can damage delicate ligaments in the elbow.Early symptoms of cubital tunnel syndrome include:

  • Pain and numbness in the elbow
  • Tingling, especially in the ring and little fingers

More severe symptoms of cubital tunnel syndrome include:

  • Weakness affecting the ring and little fingers
  • Decreased ability to pinch the thumb and little finger
  • Decreased overall hand grip
  • Muscle wasting in the hand
  • Claw-like deformity of the hand

If you have any of these symptoms, your doctor may be able to diagnose cubital tunnel syndrome by physical examination alone. They also may order a nerve conduction study and a test called electromyography. Electromyography is a procedure in which electrodes placed into muscles and on the skin measure the health of muscles and the nerve cells that control them, to confirm the diagnosis, identify the area of nerve damage, and determine the severity of the condition.

Radial Tunnel Syndrome: Causes and Symptoms

Radial tunnel syndrome is caused by increased pressure on the radial nerve, which runs by the bones and muscles of the forearm and elbow. Causes include:

  • Injury
  • Noncancerous fatty tumors (lipomas)
  • Bone tumors
  • Inflammation of surrounding tissue

Symptoms of radial tunnel syndrome include:

  • Cutting, piercing, or stabbing pain at the top of the forearm or back of the hand, especially when you try to straighten your wrist and fingers.

In contrast to cubital tunnel syndrome and carpal tunnel syndrome, radial tunnel syndrome rarely causes numbness or tingling, because the radial nerve principally affects the muscles.

Just as with cubital tunnel syndrome, if you have any of these symptoms, your doctor may be able to diagnose radial tunnel syndrome by physical examination alone. They also may order electromyography to confirm the diagnosis, identify the area of nerve damage, and stage the severity of the condition.

Treatments for Cubital Tunnel Syndrome and Radial Tunnel Syndrome

Cubital tunnel syndrome often can be managed conservatively, especially if electromyography reveals that there is minimal pressure on the ulnar nerve.

Mild cases of cubital tunnel syndrome often respond to physical therapies such as:

  • Avoidance of undue pressure on the elbow during daily activities
  • Wearing a protective elbow pad over the “funny bone” during daily activities
  • Wearing a splint during sleep to prevent over-bending of the elbow

In cases where splinting doesn’t help or nerve compression is more severe, about 85% of patients respond to some form of surgery to release pressure on the ulnar nerve. These include surgeries that:

  • Result in simple decompression of the ulnar nerve
  • Shift the nerve to the front of the elbow
  • Move the nerve under a layer of fat, under the muscle, or within the muscle
  • Trim the bump of the inner portion of the elbow — the medial epicondyle — under which the ulnar nerve passes

If you undergo surgery for cubital tunnel syndrome, recovery may involve restrictions on lifting and elbow movement, and rehabilitation therapy. Although numbness and tingling may or may not quickly improve, recovery of hand and wrist strength may take several months.

Conservative treatments for radial tunnel syndrome include medications such as nonsteroidal anti-inflammatory drugs to reduce soft tissue swelling, corticosteroid injections to relieve inflammation and pressure on the radial nerve, and wrist and/or elbow splints to reduce irritation of the radial nerve.Some patients also may benefit from ergonomic education to reduce the effects of repetitive stress, nerve-gliding exercises, stretching/strengthening exercises, and other interventions such as heat, cold, and ultrasound.If these conservative measures fail to provide relief after three months, your doctor may consider surgery to reduce pressure on the radial nerve. Surgery is often recommended in severe cases, particularly those in which the wrist becomes weak or droopy or it becomes difficult to extend the fingers.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

Causes of Elbow or Arm Pain

Article features on News Medical Life Sciences

There are various possible causes of elbow pain or arm pain. These include injury to the arm, compression of the nerves that serve the arm, arthritis, and various other health conditions.

elbow pain

Injury

A sprain can occur when a movement of the arm has caused damage to the connective tissues in the area. This can present as arm or elbow pain. This damage is usually acute and temporary, and the pain will improve with time as the tissues are repaired.

A fracture or dislocation of a bone in the arm or elbow may also be responsible for causing elbow pain. Most patients are able to pinpoint the cause of the pain or trace it to a certain incident that caused the damage.

Repetitive strain injury (RSI) can also cause elbow pain. It is due to the performance of repetitive tasks that involve movements of the elbows. As such, it commonly affects office workers who use computers frequently throughout the day, and other individuals whose job comprises repetitive manual work.

Tennis elbow or golfer’s elbow can cause elbow pain, and occurs due to the overuse of the muscles and tendons in the joint. It is so named because it is most common in individuals who plan tennis or golf, due to the arm movements that are involved in these sports.

Nerve compression

The joints and bones of an individual show wear and tear as part of the natural aging process. This can lead to the squashing or trapping of nerves, which in turn can cause pain in various areas of the body. In this case, the nerves around the elbow may be pinched, causing pain. Other sensations, such as numbness or tingling, may also be experienced.

cubital tunnel syndrome

Cervical spondylosis is a condition that involves compression of the spinal nerves in the neck region. Some of these nerves are responsible for the sensory messages of pain carried to and from the arm. Damage to them can hence lead to arm pain. Sometimes the compressed nerve may be located in the arm.

A cervical rib is a musculoskeletal abnormality that involves the presence of an additional rib above the normal first rib. This extra bone can interfere with the free passage of nerves in the region, which may lead to elbow pain.

Arthritis

Osteoarthritis or rheumatoid arthritis that affects the elbow joint can lead to stiffness, pain and inflammation of the elbow and arm.

Osteoarthritis involves damage to the cartilage at the ends of the bones that help to prevent friction between the bones that take part in the joint, often due to overuse of or injury to the joint. This leads to rubbing of the bones against each other, which provokes the symptoms of arthritis.

Rheumatoid arthritis involves an autoimmune response of the body that leads to damage to the synovial membrane that lines the joints in the body, including the elbow. In this condition, both elbows are usually affected.

Other health conditions that cause elbow pain

Angina is a health condition that involves reduced blood flow to the heart muscles as a result of narrowing of the blood vessels. Individuals with angina may experience a dull, throbbing pain in the chest, neck, and left arm as a symptom of the condition, particularly during physical activity or when they undergo stress.

Gout is another health condition characterized by the formation of sharp crystals at various locations around the body, including inside the elbow joints. This is due to a high concentration of uric acid in the body. This can cause severe elbow pain during a gout attack.

Olecranon bursitis is the build up of fluid inside the fold of smooth synovial membrane that cushions the olecranon (the bony tip of the elbow joint). This can cause pain and inflammation.


The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

Care of Casts and Splints

Article Featured on AAOS

Casts and splints support and protect injured bones and soft tissue. When you break a bone, your doctor will put the pieces back together in the right position. Casts and splints hold the bones in place while they heal. They also reduce pain, swelling, and muscle spasm.

Read more

Can I drive in a sling?

Article Featured on AAOS

Patients seem to suffer from amnesia after shoulder surgery in one specific area: driving. I tell my patients before they undergo shoulder surgery that, if I perform a repair, they will be in a sling for a minimum of four weeks — and this means no driving. I realize how difficult this is, but there is no way around it.

Read more

Do You Have A Ganglion Cyst?

Description

Ganglion cysts are very common lumps within the hand and wrist that occur adjacent to joints or tendons.  The most common locations are the top of the wrist (see Figure 1), the palm side of the wrist, the base of the finger on the palm side, and the top of the end joint of the finger (see Figure 2). The ganglion cyst often resembles a water balloon on a stalk (see Figure 3), and is filled with clear fluid or gel.

CAUSES

The cause of these cysts is unknown although they may form in the presence of joint or tendon irritation or mechanical changes. They occur in patients of all ages.

These cysts may change in size or even disappear completely, and they may or may not be painful. These cysts are not cancerous and will not spread to other areas.

Treatment

Diagnosis

The diagnosis is usually based on the location of the lump and its appearance. Ganglion cysts are usually oval or round and may be soft or firm. Cysts at the base of the finger on the palm side are typically very firm, pea-sized nodules that are tender to applied pressure, such as when gripping. Light will often pass through these lumps (trans- illumination), and this can assist in the diagnosis. Your physician may request x-rays in order to look for evidence of problems in ad-jacent joints. Cysts at the far joint of the finger frequently have an arthritic bone spur—which is a small bony bump or projection—associated with them, the overlying skin may become thin, and there may be a lengthwise groove in the fingernail just beyond the cyst.

Ultrasound or other advanced imaging such as magnetic resonance imaging (MRI) may be helpful in confirming the diagnosis. There are different types of growths that can occur around the and wrist, and additional imaging is sometimes required.

Treatment

Treatment can often be non-surgical. In many cases, these cysts can simply be observed, especially if they are painless, as they frequently disappear spontaneously. If the cyst becomes painful, limits activity, or is otherwise unacceptable, several treatment options are available.

The use of splints and anti-inflammatory medication can be prescribed in order to decrease pain associated with activities.

An aspiration can be performed to remove the fluid from the cyst and decompress it. This requires placing a needle into the cyst, which can be performed in most office settings. Aspiration is a very simple procedure, but recurrence of the cyst is common. If non-surgical options fail to provide relief or if the cyst recurs, surgical alternatives are available.

Surgery involves removing the cyst along with a portion of the joint capsule or tendon sheath (see Figure 3). In the case of wrist ganglion cysts, both traditional open and arthroscopic techniques usually yield good results. Surgical treatment is generally successful although cysts may recur. Your surgeon will discuss the best treatment options for you.


Orthopedic Sports Medicine Center of Oregon is located in Downtown Portland Oregon. Dr. Dominic Patillo, one of our Board-Certified Orthopedic Surgeons, specializes in hand surgery. His practice focuses on the treatment of both simple and complex hand and upper extremity conditions as well as general orthopaedic trauma. He is experienced with modern microsurgical techniques including nerve and vessel reconstruction.

Common problems treated include:

  • carpal tunnel syndrome
  • tennis elbow
  • wrist pain
  • sports injuries of the hand and wrist
  • fractures of the hand, wrist, and forearm
  • trigger finger

Other problems treated can include arthritis, nerve and tendon injuries, and congenital limb differences (birth defects).

If you have pain in your fingers, hand, wrist or arm, or if you have other upper-extremity related concerns, please consult our hand specialist Dr. Dominic Patillo for a consultation.

Distal Biceps Tendon Problems

Description

The biceps muscle is in the front of your arm (see Figure 1). It bends your elbow and twists your forearm to turn your palm upward. The biceps tendon connects the biceps muscle to your radius bone, which is one of the forearm bones. Such maneuverability may lead to distal biceps tendon problems.

Causes

Over time, the biceps tendon can weaken.  This is called tendonosis.  Tendonosis of the biceps tendon can be painless or it can cause dull or sharp pain in the area of the tendon just past the elbow in the forearm.  Tendonosis can lead to tendon tears or tendon rupture. Not all pain in the area of the elbow is caused by biceps tendon problems.  There can be other causes for pain in this area.

Biceps tendon tear or rupture can also cause weakness. This can happen without any warning.  It often occurs when lifting heavy objects such as furniture.  Weightlifters are more likely to experience this injury when doing “negatives,” which is done while holding a weight and extending the arm at the elbow.

Signs & Symptoms

A biceps tendon rupture usually occurs when the tendon tears away from the forearm bones (See Figure 2).  This may be felt as a “pop” in the front of the elbow and can be painful.  Often, but not always, people feel continued pain, swelling, bruising and warmth in the elbow.  Sometimes, people feel a relief from pain that was present before. Muscle spasms in the biceps muscle are common when this happens.  Symptoms usually get better over a few weeks.  Also, sometimes the muscle can pull up in the arm toward the shoulder. This results in a muscle with a larger-than-normal appearance.

The elbow will usually continue to work after a biceps tendon rupture. This is because there are other muscles that can do part of the job of the biceps muscle.  You may experience weakness when flexing the elbow.  Most of the weakness after a biceps tendon rupture occurs when twisting your forearm to turn the palm upward, or in supination.  You may experience fatigue with repetitive motions if your tendon is not repaired.

There are many medical problems that can make people more likely to have tendon ruptures.  Chronic steroid use, whether for medical purposes or when used to gain muscle, is one of the most common reasons for this to happen.

Tendon rupture is most common in men over age 30, but can happen in women too.

Treatment

If the biceps tendon tears completely, it will not grow back to the bone.  You must seek care immediately if this occurs since surgery is an option and surgery is best done soon after the injury.  If too much time passes, the tendon may not be repairable.

Your surgeon may choose to use imaging, such as an MRI or ultrasound. This can help to diagnose your tear or to plan for surgery.   X-rays are often used at the initial visit.  X-rays do not show the tendon well, but can be helpful in looking for other causes of elbow pain.

Surgery is not absolutely required for a biceps tendon rupture, but your doctor may suggest it. If your arm is working well after the rupture, you may choose not to have surgery.  If you choose to avoid surgery then you should expect permanent weakness and an arm that becomes more easily fatigued.

Surgery is done to reattach the tendon to the bone or to a nearby muscle.  There are many different ways surgeons can reattach tendons to bone.  Figure 3 shows a repair of the biceps tendon. After surgery, you will require rehabilitation and time to heal.  Often, people are able to resume even heavy activities after surgery and rehabilitation.

Figure 1 - The biceps tendon

Figure 1 – The biceps tendon

Figure 2A - Illustration of an acute rupture of the biceps tendon

Figure 2A – Illustration of an acute rupture of the biceps tendon

Figure 2B - Image of an acute rupture of the biceps tendon

Figure 2B – Image of an acute rupture of the biceps tendon

Figure 3A - Repair of the biceps tendon

Figure 3A – Repair of the biceps tendon


Orthopedic Sports Medicine Center of Oregon is located in Downtown Portland Oregon. Dr. Dominic Patillo, one of our Board-Certified Orthopedic Surgeons, specializes in hand surgery. His practice focuses on the treatment of both simple and complex hand and upper extremity conditions as well as general orthopaedic trauma. He is experienced with modern microsurgical techniques including nerve and vessel reconstruction.

Common problems treated include:

  • carpal tunnel syndrome
  • tennis elbow
  • wrist pain
  • sports injuries of the hand and wrist
  • fractures of the hand, wrist, and forearm
  • trigger finger

Other problems treated can include arthritis, nerve and tendon injuries, and congenital limb differences (birth defects).

If you have pain in your fingers, hand, wrist or arm, or if you have other upper-extremity related concerns, please consult our hand specialist Dr. Dominic Patillo for a consultation.