Carpal tunnel syndrome is the most common nerve compression disorder of the upper limb, affecting 3-6% of adults in Australia. Coming in at a close second is cubital tunnel syndrome, with a prevalence of 1.8-5.9%. Both these forms of compression neuropathy can interfere with your daily function by causing pain, numbness, and reduced grip strength. Treatment by an experienced cubital/carpal tunnel syndrome specialist alongside addressing modifiable risk factors can relieve your symptoms, restore function, and prevent permanent nerve damage.
Carpal tunnel syndrome is a condition arising from entrapment and compression of the median nerve in your wrist. It is most common in pregnant women, those living with obesity, or in people who perform repetitive hand/wrist movements, but can happen to anyone for no identifiable reason.
The carpal tunnel is a narrow channel in your wrist, which provides a passageway for tendons and nerves to reach your hand. One of these nerves is the median nerve, responsible for transmitting sensory information from your thumb, index and middle fingers, half of your ring finger, and the thumb-side half of your palm. The median nerve also controls some muscles in your forearm and hand.
Cubital tunnel syndrome also involves nerve compression, this time of the ulnar nerve that runs through the cubital tunnel in the elbow. Similar to carpal tunnel syndrome, cubital tunnel syndrome is associated with repetitive movements, and is more common in people living with obesity, among other risk factors.
The ulnar nerve is responsible for supplying sensation to your ring and pinkie fingers, as well as the area of your palm under these fingers. It also enables motor control in your forearm and hand, driving movements such as flexing your wrist or spreading and closing your fingers.
Due to their similar nature, both cubital and carpal tunnel syndromes share similar symptoms, though affecting different parts of your hand.
Carpal tunnel syndrome symptoms may include:
Cubital tunnel syndrome symptoms may present as:
Treatment for cubital tunnel syndrome and carpal tunnel syndrome are aimed at relieving your symptoms, improving pain-free function of your hand and wrist, and avoiding progression of the condition into permanent nerve damage or muscle wasting.
Diagnosis of carpal tunnel syndrome or cubital tunnel syndrome is based on your medical history, symptoms, and a physical examination. Additional tests such as nerve conduction studies to measure the ability of the nerve to transmit its signals, or imaging such as ultrasound, X-ray, and MRI, can be useful to exclude other causes of your symptoms and guide informed treatment decisions.
The ideal situation is to come under the care of an orthopaedic specialist when you first start noticing symptoms to confirm the diagnosis and receive timely treatment. In most cases, the first approach would be for non-surgical interventions, which include:
Surgery may be recommended if your nerve compression is severe and has already resulted in considerable loss of function, nerve damage, or muscle wasting. Surgical treatment may also be the next step if more conservative, non-surgical treatments have not provided sufficient relief of your symptoms.
Carpal tunnel syndrome may be treated with a surgical procedure known as a carpal tunnel release. This aims to widen the space in the carpal tunnel and alleviate the pressure on the median nerve by dividing the ligament that shares this space.
A carpal tunnel release can be performed as:
Surgical treatment for cubital tunnel syndrome may be achieved with:
