Common Tennis Injuries
Cubital Tunnel Syndrome
What is Cubital Tunnel Syndrome?
This is a compressive neuropathy of the ulna nerve as it travels along the inner aspect of your elbow or humerus (“funny bone”). Irritation of this nerve is due to repetitive traction, compression and valgus stress associated with racket sports such as tennis. The compression of the nerve is due to an overlying muscle (flexor carpi ulnaris). It is very rare to develop fractures around the elbow from tennis.
Tennis players with cubital tunnel syndrome may experience pain and numbness over the little finger and half of their ring finger. This unusual distribution of symptoms is due to the ulna nerve innervation of the fingers.
Your orthopaedic surgeon will assess your elbow and ensure your symptoms are due to cubital tunnel syndrome. Symptoms such as a sudden onset of pain accompanied by popping may be due to ulna collateral ligament injuries and are managed differently.
There are small tears over the extensor carpi radialis brevis (ECRB) muscle which helps to stabilise the wrist when the elbow is straight. Microscopic tears form in the tendon of the ECRB as it is attached to the lateral epicondyle.
Your orthopaedic surgeon will investigate the cause of your elbow pain before prescribing the appropriate treatment for you.
Standard X-rays will give an idea of the bone structure of your elbow and to exclude any arthritis of the elbow joint.
An ultrasound scan of the elbow will determine if the ulna nerve is stretched behind the medial epicondyle of the distal humerus as the elbow is extended and flexed. It can also look for compression of the nerve by the overlying Flexor Carpi Ulnaris (FCR) muscle.
What can happen if Cubital Tunnel Syndrome is left untreated?
Neglected cases may deteriorate into more serious injuries that require invasive and protracted treatment. It is best to seek professional help sooner and receive the appropriate care for your injuries.
Self-care with adequate rest, icing and anti-inflammatory medication are important measures to take while waiting for professional assessment for your elbow pain.
Splinting the elbow in an extended position at night helps to relieve the tension on the nerve and reduce symptoms.
If symptoms persist despite conservative treatment, surgery may be recommended by your orthopaedic surgeon.
A cubital tunnel decompression and ulna nerve transposition are procedures that are performed to reduce the compressive force on the nerve and to allow the nerve to take a shorter route towards the arm. In the transposition procedure, the nerve is brought forward to the front of the elbow to reduce the extent of its stretch as the elbow moves from extension to flexion. Lesser stretching of the ulnar nerves leads to lesser pain and numbness in the little and ring finger distribution.
It is important not to rush your recovery. Tendon healing takes time and rushing your return to sport may delay your recovery.
Allow some time for the injured tendons and strained forearm muscle to rest and recover. Physiotherapy is also important to stretch out those tense muscles and help in its healing.
What to do now while waiting for diagnosis/treatment?
Take a break from racket sports and other aggravating physical activities.
Make the necessary changes to your work and sports equipment to prevent further injuries.
Do indulge in self-care such as rest, icing and anti-inflammatories to help your inflamed tendons and stress muscles recover.