Questions to Ask Your Doctor About Cubital Tunnel Syndrome
Cubital tunnel syndrome (CuTS) is a serious medical affliction that can result in severe pain and discomfort. Untreated, CuTS can cause your fingers to curl into your palm, your arm to weaken and atrophy, and eventually you can lose the use of your fingers. Therefore, if you experience CuTS symptoms for more than a couple weeks, you should see a doctor, preferably one that specializes in arm and nerve surgery. Given the state of medicine these days, with busy doctors, bureaucratic HMOs and complex injuries, it’s important that you affect your own medical care. You should conduct your own research about CuTS on the Web, be open and honest and explicit with the doctor about your symptoms and concerns, and be sure to ask lots of questions. Inspired by posts in our Cubital Tunnel Forums (here and here), following are 10 questions you should ask your doctor about your cubital tunnel syndrome:
Remember that it’s your responsibility to ensure that you have an experienced, attentive doctor who has all the information he or she needs to treat your cubital tunnel syndrome. Good luck, and if you have any questions, you are welcome to ask them in our forums.
CuTS is less common than carpal tunnel syndrome, and therefore many doctors lack experience with CuTS. However, CuTS is a serious affliction that requires a specialist who has significant experience and success treating CuTS and who is familiar with the latest CuTS studies and surgery techniques.
There are many tests for CuTS. Studies show that MCV tests (motor nerve conduction velocity) that indicate "decreased velocity" across the ulnar nerve are quite effective in diagnosing cubital tunnel syndrome. Other tests include 2-point discrimination (testing whether you can distinguish between one or two pin pricks on your finger), ability to cross index and middle fingers, grip and pinch strength, and EMG (electromyograph) tests.
There are numerous medical scales to describe the severity of CuTS. My favorite scale is also the simplest: mild, moderate or severe. With severe CuTS, you can no longer do your job, your fingers may bend in toward your palm, and you may lose all sensation in your ring and little fingers.
CuTS pain can appear in both the elbow and ring & little fingers. The problem is caused by a pinching of the ulnar nerve, which starts in your neck, runs along your shoulder, around your elbow, through your wrist and into your hand. Pinching or compression of that nerve anywhere along its path can result in pain and discomfort. It’s important your doctor knows where the problem originates in order to treat you properly.
There are many causes of cubital tunnel syndrome: direct injury, sports, sleeping on bent elbows, computer use, repetitive motion, cysts and bone spurs. Be sure to share with your doctor the activities you do that cause you pain. Remember that even with treatment or surgery, your CuTS may not go away completely if you continue the activities that caused your CuTS in the first place.
Conservative treatment is recommended first for mild to moderate CuTS. This include splints to keep your elbow straight while sleeping, a change in your work or play habits that caused your CuTS, Advil or prescription NSAIDs to help relieve pain, and special exercises or physical therapy to help relieve pressure on your ulnar nerve. Patients with severe CuTS typically require surgery immediately.
Based on anecdotal evidence on the Web, it appears that conservative treatment works only about half the time, and the other half eventually requires surgery. This is true especially for CuTS caused by long-term repetitive motion at work or in sports. Be sure to give conservative treatment time to work, but don’t wait to long or allow your symptoms to become severe. The more severe your symptoms before surgery, the less likely that surgery will be completely successful.
There are three main types of cubital tunnel surgery: decompression, transposition, and medial epicondylectomy. The success rate is roughly the same for all three types: about 70% of patients see improvement, 20% see little or no improvement, and 10% may get worse. But there are big differences in the severity of the procedures. With decompression, you can typically return to work in about a week and see full recovery in two months. With transposition, your arm is immobilized for 2-4 weeks, and full recovery can take 6 months or more. Many doctors are unaware of recent studies that show decompression is the preferred method for mild-to-moderate CuTS. If your symptoms are not severe but your doctor is recommending transposition, be sure to question why.
Although not life threatening, CuTS can certainly have a significant negative impact on your job and overall well-being. But CuTS surgery is no walk in the park either. Although CuTS surgery helps many people, it is not 100% effective, and as with any surgery that puts you to sleep with a general anestetic, CuTS surgery carries some risks.
As mentioned in #8, the type of CuTS surgery you have has a significant effect on your downtime. Be sure you understand how long your arm will be immobilized, when you can start using your arm for light-duty work, and when you can expect to return to work or play at full force. Note that complete recovery from CuTS surgery may take as long as 6 months.
One Response to “Questions to Ask Your Doctor About Cubital Tunnel Syndrome”
November 10th, 2008 at 9:26 pm
[...] few days, be sure to see a hand doctor or surgeon as soon as possible. Be sure to ask lots of questions. If you find that your doctor is not a CuTS expert or you have any doubts about his/her [...]