Ulnar Nerve Neuritis (Cubital Tunnel Syndrome) in San Antonio, TX
What Is Ulnar Nerve Neuritis?
The ulnar nerve travels around the inside of the elbow — through a groove called the cubital tunnel — on its way from the neck to the hand. It is the nerve responsible for sensation in the ring and small fingers and motor control of the intrinsic muscles of the hand. When the nerve is compressed or stretched repeatedly at the elbow, it produces the familiar tingling in the small finger and ring finger that most patients describe as their hand 'falling asleep.'
Cubital tunnel syndrome is the second most common peripheral nerve compression in the upper extremity after carpal tunnel syndrome, and it is frequently overlooked or confused with cervical spine pathology. Accurate diagnosis requires identifying the level of compression and ruling out proximal causes.
Symptoms
- Tingling or numbness in the ring and small fingers, particularly with elbow flexion or prolonged gripping
- Weakness in grip or pinch, difficulty with fine motor tasks
- Pain on the inner elbow that radiates down the forearm
- In advanced cases, intrinsic muscle wasting visible in the hand
Non-Surgical Treatment
Mild cubital tunnel syndrome often responds to activity modification, elbow extension splinting at night and avoidance of sustained elbow flexion. I recommend a trial of conservative management for patients with mild to moderate symptoms and no significant motor deficit.
When Surgery Is Indicated
Surgical decompression is indicated when symptoms are severe, progressive or have failed a reasonable course of conservative treatment. I perform in-situ decompression for most patients — releasing the structures compressing the nerve at the cubital tunnel without moving the nerve from its groove. For patients with significant elbow flexion-related traction on the nerve or where anatomic variants make in-situ decompression inadequate, I perform anterior transposition of the ulnar nerve, repositioning it to the front of the elbow where it is no longer subjected to stretch.
Timing matters. The degree of motor recovery after surgical decompression depends on how long the nerve has been under compression. Advanced intrinsic muscle wasting may not fully recover even after successful decompression. If you have been experiencing symptoms for more than 6 to 12 months, earlier evaluation is better than waiting.
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