1. Cubital Tunnel Syndrome
INDH 5335-Ergonomic Methods & Analysis Techniques
HW3: CTD’s

2. Synonyms Cubital tunnel syndrome is used to describe
ulnar nerve entrapment/impingement
along the cubital tunnel at the
medial edge of the elbow.

3. Body Part Affected
Cubital tunnel syndrome can cause pain and numbness in the elbow as well as also cause severe pain, numbness, tingling, and muscle weakness in the hands and arms.

4. Description
Cubital tunnel syndrome is a form of mononeuropathy due to compression or other injury of the ulnar nerve at the elbow.
Mononeuropathy is a disorder of a single nerve or nerve trunk. 

5. Causes Keeping the arm bent for long periods of time
Leaning on the elbow for long periods of time
Fluid buildup in the elbow that can cause swelling which will compress the nerve
A direct hit to the elbow

6. Risk Factors
Some factors that put a person more at risk for developing cubital tunnel syndrome include:
Prior fracture or dislocations of the elbow
Bone spurs/ arthritis of the elbow
Swelling of the elbow joint
Cysts near the elbow joint
Repetitive or prolonged activities that require the elbow to be bent or flexed

7. Symptoms Early symptoms of cubital tunnel syndrome include:
Pain and numbness in the elbow
Tingling, especially in the ring and little fingers

8. Symptoms Continued
More severe symptoms of cubital tunnel syndrome include:
Weakness affecting the ring and little fingers
Decreased ability to pinch the thumb and little finger
Decreased overall hand grip
Muscle wasting in the hand
Claw-like deformity of the hand

9. Diagnosis
A physician assesses the pattern and distribution of symptoms, and examines for muscle weakness, irritability of the nerve to tapping and/or bending of the elbow, and changes in sensation.
A test called electromyography (EMG) and/or nerve conduction study (NCS) may be done to confirm the diagnosis of cubital tunnel syndrome and stage its severity. This test also checks for other possible nerve problems, such as a pinched nerve in the neck, which may cause similar symptoms.

10. Limitations Some limitations include:
difficulty using the affected hand to manipulate objects
difficulty using your affected hand to feel objects
difficulty reaching overhead
the inability to concentrate and focus (due to pain), and
the inability to follow and remember instructions (due to pain).

11. Occupational Causes
Repetitive motions that can cause cubital tunnel syndrome – Motions like these naturally occur during pulling, reaching or lifting. That's why cubital tunnel syndrome is more common in occupations such as:  
Assembly line workers
Checkout line workers
Data entry specialists or any job that requires extensive amounts of typing
Factory workers
Mechanics and others who operate vibrating tools

12. Occupational Causes Continued
Putting pressure on your elbow bone for too long – The bone the nerve sits next to has very little padding over it, so pressure on the bone will put pressure on the nerve.
Ex: If you make a habit of putting pressure on your elbow in this way (such as resting elbows on the desk while working on the computer).
Holding your elbow in a bent position for too long – This stretches the nerve over the bony bump and can create an increased amount of irritation.
Ex: Talking on the phone for long periods of time.

13. Treatment
Mild cases of cubital tunnel syndrome often respond to physical therapies such as:
Non-steroidal anti-inflammatory medicines
Steroid injections
Bracing or splinting
Nerve gliding exercises

14. Treatment Continued
In cases where nonsurgical methods have not improved the condition, if the ulnar nerve is very compressed or if muscles have started to atrophy then surgery is recommended. These include surgeries that:
Result in simple decompression of the ulnar nerve
Shift the nerve to the front of the elbow
Move the nerve under a layer of fat, under the muscle, or within the muscle
Trim the bump of the inner portion of the elbow -- the medial epicondyle -- under which the ulnar nerve passes

15. Short and Long Term Effects of Cubital Tunnel Syndrome
Short term effects of cubital tunnel syndrome include numbness, tingling, pain and trouble grasping things. Long term effects include muscles in the hand wasting away and hand deformities.

16. Short Term and Long Term Effects After Treatment
Depending on several factors, conservative treatment (no surgery) may provide provide long-term relief in as many as four out of five people. Conservative treatment is usually not recommended for patients who have evidence of nerve damage.

17. Short Term and Long Term Effects After Treatment Continued
For people who don't get better with conservative treatment, surgery is recommended.
The results of surgery are generally good. If the nerve is very badly compressed or if there is muscle wasting, the nerve may not be able to return to normal and some symptoms may remain even after the surgery. Nerves recover slowly, and it may take a long time to know how well the nerve will do after surgery.

18. Statistical Prevalence
The incidence of cubital tunnel syndrome in the general population has been reported at 24.7 per 100,000.4
The prevalence ranges from 2.8% among workers whose occupations require repetitive work (e.g., assembly line workers, packagers and cashiers) to 6.8% in floor cleaners to 42.5% among vibrating tool operators.4

19. Costs Associated with Cubital Tunnel Syndrome
Costs of Cubital Tunnel Syndrome to the EMPLOYEE
Indirect costs: lost wages, loss of fringe benefits at your current position, work and life disruption (hospital visits, rehab, pain, etc.), and loss of productivity outside of work (child care, home repairs, etc.) while injured or during the recovery phase
Direct costs: medical expenses and medications/rehab not covered by insurance
Costs of Cubital Tunnel Syndrome to the EMPLOYER
Indirect costs: time spent on replacing employees and employee retraining, accident/injury investigation, workplace disruption, lost productivity, absenteeism
Direct costs: higher insurance premiums, costs for legal services, medical expenses

20. Prevention Methods
Cubital tunnel syndrome may be prevented or reduced by maintaining good posture and proper use of the elbow and arms. People in occupations that require holding the elbow in a bent position should be encouraged to perform consistent positional changes to take stress off of the ulnar nerve. Recommendations for activity modification can sometimes be disruptive to employment, but they have been shown to have the most significant positive response when treating cubital tunnel syndrome non-surgically.

21. References