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Is there any evidence linking Cubital Tunnel Syndrome to "chronic" (persistent, non-healing) tendonitis or any other long-term/chronic issues with connective tissue in the elbow region?

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    I guess I'm wondering if Cubital Tunnel somehow causes swelling/inflammation around certain nerves that either cause tendonitis or the sensation of tendonitis... – smeeb Sep 12 '17 at 14:35
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    +1 Great Question -- When I get some time I will answer this for you – Mike-DHSc Sep 15 '17 at 5:52
  • Just a gentle nudge @Mike-DHSc... bounty ends in 3 days, after that I can't assign it to you even if you answer! – smeeb Sep 18 '17 at 13:24
  • @Mike-DHSc Another ping. The only thing I came across was this article discussing causes of carpal tunnel syndrome and not mentioning tendonitis. It claimed that 15 cases of CTS out of those discussed were caused by tendon compression. Full source. That's not really a lot, but it might help. If no one answers this question, I might give it a shot, but I'm just a layperson in this area and don't want to rely on my google skills... – Narusan Sep 20 '17 at 16:42
  • @smeeb My apologizes, a busy couple of weeks coming up. Just a matter of putting together my thoughts and information I already have on this. If anyone else has anything to add in the mean time that would be great. Don't need a bounty to help you out. I'll gladly help out soon as I get some time! Really sorry to keep you waiting. – Mike-DHSc Sep 22 '17 at 9:22
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Sorry for the wait!


To orient ourselves first trace the Ulnar Nerve distally to the hand from the Brachial Plexus (BP) and then review how Cubital Tunnel Syndrome ties in (it's neurological relation).

Let me know if you have a more specific question (this is most commonly what is seen -- can go into other areas. Sorry for so many abbreviations - these are old ortho notes.


Nerve Entrapment - UE

Ulnar Nerve (C7, C8, T1)

1.) Arises from medial cord of BP
2.) Travels down medial arm (anterior compartment)
3.) Once it reaches the medial epicondyle run b/n brachalis and the medial head of the triceps.
4.) Crosses elbow on medial under ulnar groove.
5.) Right after it crosses the elbow It’s travels b/n the heads of the FCU (called the cubital tunnel) then it. Innervates FCU ulnar (humeral and ulnar) heads and FDP (Medial Part) (MOTOR)
6.) In the forearm it travels b/n FDS and FDP.
8.) Exits forearm medial to FDP tendons and just before it crosses wrist gives off a branch Dorsal Brach (SENSORY)
Dorsal side sensation to medial ½ 4th finger and 5th finger
9.) Travels through Guyon Tunnel (or Canal) at wrist above flexor retiaculum and gives off 2 branches:

enter image description here

Deep Branch Supplies (MOTOR)

  • Oppones Digiti Minimi
  • Adductor DM
  • 2 Lumbricals (on ulnar side)
  • Dorsal and Palmar Interossi
  • FPB

Superficial Branch (SENSORY)

  • Palmar side sensation to medial ½ 4th finger and 5th finger

Ulnar Nerve Compression Syndromes

Cubital Tunnel Syndrome: enter image description here


Compression Sites:

  • Ulnar groove
  • Cubital tunnel (where nerve passes b/n 2 heads of FCU)
  • Medial head of triceps – seen as a result of hypertrophy of that muscle
  • If nerve is unstable in ulnar groove and it starts subluxing, can result in neuritis, but overtime with scaring can lead to compression.

Etiology:
Syndrome associated with frequent elbow flexion (ulnar nerve on stretch).

  • Weight lifting
  • Constricting fascia bands (ligament of strutres)
  • Masses (bone abnormalities, swelling and ulnar nerve subluxation)

Clinical Picture:

  • Will be medial elbow discomfort (similar to medial epicondyltis)
  • Parastesis of the medial ½ of the ring finger and 5th finger
  • Repetieve flex/ext activites may excepabte these symptoms
  • Orthopedic Testing / (+) tinnel
  • Atrophy of hypothenear group
  • Decreased grip strength

enter image description here

  Treatment:

  • Night splints to help keep elbow extended (to avoid stretching of that nerve)

     


Surgically:

  • Decompression, medial epicondyleptimy or transposition ulnar nerve more anteriorly. (so flexion will not stretch nerve)
  • Ulnar Nerve Transposition

Images From: https://www.physio-pedia.com/

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  • Thanks so much for this @Mike-DHSc (+1) - so in layman's terms (I'm a software guy, so a lot of the above is greek to me!) when I do a bicep curl, it feels like someone is stabbing my cubital fossa (elbow "pit"?!). After a few sets + reps, the pain goes away entirely (but only temporarily). My theory is that my Cubital Tunnel Syndrome (I was diagnosed by a neurologist a few years back before I had symptoms) is causing the pain but that doing a few sets of curls somehow pumps blood into "the right places" and relieves whatever compression/pain might be going on. Any thoughts/insights there? – smeeb Oct 9 '17 at 9:15

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