Ultrasound-Guided Cortisone Injections for Cubital Tunnel Syndrome

 

Introduction

Cubital Tunnel Syndrome is a common nerve compression disorder affecting the upper limb. It occurs when the ulnar nerve becomes compressed or irritated as it passes through the cubital tunnel at the elbow. This condition can lead to pain, tingling, numbness, and weakness in the forearm and hand. Many individuals describe it as the “funny bone” problem, but unlike the temporary discomfort caused by bumping the elbow, cubital tunnel syndrome is a persistent condition that may interfere with daily activities.

At Joint Injections, we provide tailored care for nerve-related and joint conditions. One of the treatment options available is ultrasound-guided cortisone injections, which are performed with precision to aid in reducing inflammation around the affected nerve. This blog will explore cubital tunnel syndrome in detail, covering its anatomy, pathology, symptoms, diagnosis, management, and the role of cortisone injections guided by ultrasound.

Anatomy of the Elbow and Ulnar Nerve

The elbow is a complex hinge joint formed by the humerus (upper arm bone), radius, and ulna (forearm bones). The ulnar nerve originates from the brachial plexus in the neck and travels down the inner arm, passing behind the medial epicondyle of the humerus. At this point, it enters the cubital tunnel, a narrow space formed by bone, ligaments, and muscle.

Inside this tunnel, the ulnar nerve is relatively exposed and vulnerable to pressure and stretching. It supplies sensation to the little finger and part of the ring finger, and motor control to many small muscles in the hand, which are essential for grip and finger coordination.

Pathology of Cubital Tunnel Syndrome

Cubital tunnel syndrome develops when the ulnar nerve is compressed or irritated within the cubital tunnel. This can occur due to:

  • Repetitive elbow flexion: Activities involving frequent bending of the elbow can stretch and irritate the nerve.
  • Direct pressure: Leaning on the elbow for prolonged periods can cause compression.
  • Thickening of tissues: Ligaments or muscles around the nerve may become thickened, narrowing the tunnel.
  • Elbow arthritis or bone spurs: Bony changes can encroach upon the nerve.
  • Trauma or injury: Fractures or dislocations can alter the anatomy of the tunnel.

When compressed, the ulnar nerve experiences reduced blood supply and impaired conduction, leading to characteristic symptoms.

Symptoms

The symptoms of cubital tunnel syndrome often begin gradually and may worsen over time. Common features include:

  • Tingling and numbness in the ring and little fingers.
  • Pain on the inner side of the elbow, sometimes radiating down the forearm.
  • Weakness in hand grip and difficulty with fine motor tasks.
  • Muscle wasting in advanced cases, particularly in the small hand muscles.
  • Symptoms often worsen at night or when the elbow remains bent for long periods.

Causes and Risk Factors

Several factors increase the likelihood of developing cubital tunnel syndrome:

  • Repetitive arm movements (e.g., manual labour, sports).
  • Frequent leaning on the elbows (e.g., desk work, driving).
  • Prolonged elbow flexion (e.g., sleeping with the elbow bent.
  • Previous elbow injuries or surgery.
  • Medical conditions such as arthritis, diabetes, or thyroid disorders.

Diagnosis

Diagnosis of cubital tunnel syndrome is based on a combination of clinical evaluation and investigations:

  • Medical history: A clinician will review symptoms and activities that may contribute to nerve compression.
  • Physical examination: Tests may include tapping over the ulnar nerve (Tinel’s sign) or bending the elbow to reproduce symptoms.
  • Ultrasound imaging: Useful for visualising the nerve and identifying any structural causes of compression.

Management of Cubital Tunnel Syndrome

  • Activity modification: Avoiding prolonged elbow flexion and leaning on the elbow.

Role of Ultrasound-Guided Cortisone Injections

Cortisone injections are sometimes used as part of a management plan for cubital tunnel syndrome. These injections aim to reduce inflammation and irritation around the nerve.

Using ultrasound guidance allows clinicians to precisely target the site of compression, ensuring accurate placement of the medication. This approach minimises the risk of complications and helps to deliver treatment directly where it is needed.

Mechanism of Action of Cortisone

Cortisone is a corticosteroid, a substance that mimics naturally occurring hormones in the body. Its main actions include:

  • Anti-inflammatory effect: Cortisone reduces the activity of inflammatory mediators, helping to decrease swelling and irritation around the nerve.
  • Reduction in pressure: By reducing tissue inflammation, cortisone may help relieve pressure on the ulnar nerve within the cubital tunnel.
  • Improved function: Decreased inflammation can support improved nerve conduction and reduce symptoms.

When delivered under ultrasound guidance, the accuracy of cortisone placement is significantly improved compared to traditional methods.

Benefits of Ultrasound Guidance

Ultrasound-guided injections provide several advantages:

  • Precision: Visualisation of the nerve and surrounding structures ensures correct placement.
  • Safety: The risk of damaging surrounding tissues is minimised.
  • Real-time monitoring: Clinicians can see the needle and medication distribution as the injection is performed.
  • Patient comfort: Ultrasound guidance often leads to a smoother procedure.

Why Choose Joint Injections for Treatment

At Joint Injections, our approach is patient-centred and tailored to individual needs. We specialise in ultrasound-guided procedures, ensuring that cortisone injections are performed with a high level of accuracy and safety. Our clinicians have experience in managing joint, tendon, and nerve conditions, and we focus on providing treatments that are guided by best practice.

By choosing Joint Injections, patients receive care that is based on precision, comfort, and attention to detail.

Conclusion

Cubital tunnel syndrome is a common cause of elbow, forearm, and hand symptoms related to ulnar nerve compression. While mild cases may improve with conservative measures, more persistent or severe cases may require targeted interventions.

Ultrasound-guided cortisone injections provide a precise way of delivering medication directly to the site of irritation, supporting clinicians in managing inflammation and nerve compression. At Joint Injections, our team is dedicated to offering detailed, patient-focused care for conditions such as cubital tunnel syndrome.

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