Treating Cubital Tunnel Syndrome Through Physical Therapy
Cubital tunnel syndrome, characterized by entrapment of the ulnar nerve at the elbow, has been well reported and is characterized by pain and tingling in the hands along with pain along the course of the ulnar nerve behind the medial epicondyle. It is the second most common type of upper limb mononeuropathy after that of the median nerve seen in carpal tunnel syndrome.
The main aim of the treatment for patients with cubital tunnel syndrome is to reduce the pressure on the nerve and to reduce pain. In most cases, surgical treatments are offered where the ulnar nerve is transposed anteriorly from behind the medial epicondyle to a more superficial plane either under a muscle or under the skin. However, in some cases, physical therapy is also offered as a treatment option in patients in whom surgical treatment is not yet warranted.
Physical therapy maneuvers
In an acute case of cubital tunnel syndrome, the most important step to adopt is rest. Physical therapists can offer patients splints and orthoses that will maintain the arm in a neutral position making sure that the ulnar nerve is not compressed. This allows for the reduction of inflammation and can reduce pain. While it may be difficult to achieve this posture during the daytime, most certainly the splints can be applied by the patient at night. This form of treatment may be continued for a period of up to 3 months.
Physical therapists can also offer range of movement exercises to patients. These are usually offered after the period of rest is completed and helps maintain normal joint moment and places a degree of stress and stretch on the ulnar nerve, thus lengthening the nerve. Reports have suggested that range of movement exercises can improve symptoms in up to 90% of patients with mild cubital tunnel syndrome.
Balancing the strength between the flexors and extensor muscles around the elbow can also be of benefit to patients by normalizing the degree of strain the elbow undergoes during movements.
Physical therapy input is also vital post-operatively following anterior transposition of the ulnar nerve. In most cases, treatment is commenced two weeks after surgery, though it can be started sooner if required without any ill effect. Early mobilization is recommended and physical therapy can help improve hand function sooner.4
Physical therapy plays a vital role in managing patients with cubital tunnel syndrome. Treatments are primarily aimed at reducing pain and increasing range of motion at the elbow. Early physical therapy input post-operatively can ensure early return to activities of daily living.