cubital tunnel syndrome

Cubital tunnel syndrome: how you’re unknowingly damaging your nerves

A condition quite common in console gamers, cubital tunnel syndrome—like carpal tunnel syndrome—is a nerve condition that can affect the hand.

What is cubital tunnel syndrome?

Cubital tunnel syndrome is impingement or irritation of the ulnar nerve within the cubital tunnel at the elbow. This is the area commonly referred to as the funny bone. If the ulnar nerve becomes irritated in this region due to pressure, inflammation, and/or stretching, symptoms will occur.

Cubital tunnel syndrome is more prevalent in console gamers due to the position of the hands and arms while gripping a controller. If you’re a console gamer, you’re more likely to develop cubital tunnel syndrome if you lean your elbows on your knees or on the armrests of your chair.

Note: although more common in console gamers, PC gamers are not completely excluded from experiencing cubital tunnel syndrome. If you’re a PC gamer, you may still rest your elbows on the armrests, and this may lead to symptoms.

Pertinent anatomy

It’s important to know some basic anatomy of the elbow to understand cubital tunnel syndrome.

To begin, the word “cubital” in cubital tunnel syndrome is in reference to your elbow. The cubital tunnel is an anatomical passageway around the back of your elbow comprised of bones and fascia.

The only structure to pass through this passageway is your ulnar nerve. The boundaries of the cubital tunnel are:

  • Floor: elbow joint capsule & medial collateral ligament (fascia)
  • Medial: medial epicondyle of the humerus (bone)
  • Lateral: olecranon process of the ulna (bone)
  • Roof: Osborne’s ligament (a band of fascia connecting the two bellies of the flexor carpi ulnaris muscle)
boundaries of the cubital tunnel
Depiction of a right, medial elbow

Ulnar nerve

The ulnar nerve innervates many muscles below your elbow:

  • Muscles in the forearm
    • Flexor carpi ulnaris: flexion and ulnar deviation of your wrist
    • Flexor digitorum profundus (medial half): flexion (closing) of your pinky and ring finger, including the finger tips
  • Muscles in the hand
    • Opponens digiti minimi: opposition of the pinky finger to the thumb
    • Abductor digiti minimi: abduction (separation) of your pinky finger away from the ring finger
    • Flexor digiti minimi brevis: flexion of your pinky finger
    • The third and fourth lumbrical muscles: flexion of the knuckles of your ring and pinky finger
    • Dorsal interossei: abduction (separation) of your fingers
    • Palmar interossei: adduction (bringing back together) of your fingers
    • Adductor Pollicis: adduction of  your thumb (bringing the thumb back to your palm)
    • Flexor pollicis brevis (deep head): flexion of your thumb
    • Palmaris brevis: squeezes the base of your hand

The ulnar nerve is also responsible for touch sensation for a large portion of your hand. The cutaneous innervation (touch sensation) includes:

  • Your pinky finger and medial half of your ring finger
  • The pinky side of your hand, both front and back

The median nerve DOES NOT provide touch sensation to your thumb, index, middle finger, or the corresponding portion of your hand!

Pathophysiology

compression or irritation of the ulnar nerve within the cubital tunnel
Cubital tunnel syndrome is compression or irritation of the ulnar nerve at the elbow

Cubital tunnel syndrome occurs when there is compression or irritation of the ulnar nerve within the cubital tunnel. The compression or irritation may be caused by:

  • Inflammation
    • Injury: elbow injuries (sprains, strains, trauma, etc.) may cause inflammation which may narrow the space within the cubital tunnel
    • Overuse: overuse syndromes may lead to chronic muscle tightness which can compress the cubital tunnel and the ulnar nerve
  • Tension on the ulnar nerve
    • Prolonged, static position: if the elbow is flexed for a long period of time, the ulnar nerve is pulled taut and will begin to cause symptoms
  • Direct compression of the ulnar nerve
    • Leaning on the elbows: resting the inner portion of the elbows on another surface may cause direct pressure over the cubital tunnel and the ulnar nerve

Signs & symptoms

If you’re affected by cubital tunnel syndrome, you may experience one or more of the following symptoms:

  • Numbness & tingling
    • The first sign is usually a change in sensation of your pinky, ring finger, and the pinky side of your hand
    • You may notice pins & needles, tingling, or numbness in these areas
  • Weakness
    • The weakness will be most prevalent in flexion of your pinky and ring finger

Note: cubital tunnel syndrome does not cause any of the above listed symptoms in the thumb, index, middle finger, or corresponding portion of your hand. Those symptoms are more consistent with carpal tunnel syndrome.

locations of cubital tunnel syndrome symptoms
Cubital tunnel syndrome causes symptoms in the pinky, ring finger, and the corresponding side of the hand

Other common findings may include:

  • More pronounced symptoms with flexion of your elbow (i.e. talking on the phone) or leaning of your elbows/forearms on any surface
  • Relief or improvement of symptoms with straightening of your elbow

Note: paleness or blue color and/or cool or cold sensation along with tingling and numbness are indicative of blood flow occlusion. This may be a more serious condition, and you should consult your doctor or visit the emergency room if you are concerned about these symptoms.

Common mechanism(s) of injury

Cubital tunnel syndrome is more common for console gamers due to the handling of a controller and resting of the elbows/forearms. Common risks for console gamers include:

  • Direct compression
    • Leaning on your forearms or elbows may cause direct compression of the ulnar nerve
    • If you rest your elbows on armrests or their thighs, the pressure may lead to symptoms
  • Prolonged elbow flexion
    • Bending your elbows puts tension on the ulnar nerve; allowing prolonged flexion of your elbows will eventually lead to symptoms
  • Overuse & chronic muscle tightness
    • Overuse of your flexor muscles—such as pressing buttons and triggers—may eventually lead to muscle tightness in your forearms
Cubital tunnel syndrome in gamers
A common mechanism of injury is resting the inner portion of your elbows on your thighs or the arms of a chair

Prevention

For all common gaming injuries, we’ve created a comprehensive injury prevention program. Performing this exercise routine may help reduce your risk for cubital tunnel syndrome.

The most common mechanisms of injury for cubital tunnel syndrome are direct compression of the ulnar nerve and poor and/or prolonged static position.

Elbow position: it is important to keep your elbows relatively neutral:

  • For console gamers, allow your elbows to relax so you’re not causing tension in the ulnar nerve
  • For both console & PC gamers, be sure you’re not resting the inside of your elbows on your armrests or thighs
    • If you’re resting your elbows, rest on the bony portion on the back of your elbow
  • For both PC and console gamers, between games/matches:
    • Flex and extend your elbows a few times
    • Turn your palms upward and downward a few times

Use & overuse: overuse may cause chronic muscle tightness or other injury which can cause crowding of the ulnar nerve:

Ulnar nerve glide
Ulnar nerve glide; see our Injury Prevention Program for more

Rehabilitation

Correcting ergonomics is often enough to relieve symptoms of cubital tunnel syndrome. Avoiding compression and tension will usually begin the healing process.

In practice, the following treatments are effective for improving the rate of recovery for cubital tunnel syndrome:

  • Massage of the wrist and finger flexors at the medial forearm
  • Contrast therapy: heat therapy followed by cold therapy
  • Therapeutic exercises
    • Functional Range Conditioning (FRC®): wrist PAILs/RAILs
    • Wrist & hand mobility exercises (FRC®: wrist CARs)
    • Ulnar nerve glide
  • Education in proper ergonomics

It is also important to eat an anti-inflammatory diet and/or include anti-inflammatory supplements in your diet to prevent chronic, systemic inflammation that may worsen nerve compression at your elbow.

Following resolution, continuation of these protocols allows for prevention of this condition from reoccurring.

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Disclaimer

This information is for educational purposes only and is not intended to replace the advice of your doctor. Esports Healthcare disclaims any liability for the decisions you make based on this information.

The information contained on this website does not establish, nor does it imply, doctor-patient relationship. Esports Healthcare does not offer this information for diagnostic purposes. A diagnosis must not be assumed based on the information provided.

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