Cubital tunnel syndrome is due to a pinched or compressed ulnar nerve at the elbow. Compression of this nerve causes pins and needles to be felt in the small finger and the ring finger and occasionally bending of the two fingers in the form of a claw. In moderate to severe cases, there can be weakness in the small muscles of the hand, clumsiness, and even decreased grip strength. In very severe cases of a compressed nerve at the elbow, there is atrophy or weakness in the muscles of the hand and/or forearm. This is sometimes obvious in the muscles on the back of the hand between the thumb and index finger.
The ulnar nerve at the elbow is most irritated when the elbow is bent, so keeping the elbow straight helps to relieve pressure on the nerve. This is most important when patients are sleeping. A splint is often prescribed, and the padded part of the splint is worn on the inside of the elbow to keep the arm straight.
In instances when patient fails to improve, develops weakness in the hand, and has nerve electrical studies that show slowing of the nerve at the elbow, peripheral nerve specialists frequently recommend a surgical release or decompression of the nerve. There are several techniques by which the nerve can be released. In cases where the muscles of the hand are very weak, Dr. Barbour occasionally recommends an additional procedure to increase the strength in the hand, called a supercharge nerve transfer. This nerve transfer increases the number of nerve fibers receiving the hand to prevent irreversible weakness.