Can a steroid injection be given in the cubital tunnel?

From the Guidelines

Steroid injections can be administered into the cubital tunnel to treat cubital tunnel syndrome, but their use should be approached with caution due to potential side effects and the lack of evidence supporting their long-term efficacy. The procedure typically involves injecting a corticosteroid such as methylprednisolone (40-80 mg) or triamcinolone (10-40 mg) mixed with a local anesthetic like lidocaine (1-2%) 1. The injection is delivered directly into the cubital tunnel where the ulnar nerve passes behind the medial epicondyle of the humerus. This treatment aims to reduce inflammation around the nerve, potentially providing temporary relief from symptoms like numbness, tingling, and pain in the ring and little fingers.

Key Considerations

• The use of steroid injections in the cubital tunnel should be considered as part of a comprehensive treatment approach that may include activity modification, splinting, physical therapy, and in some cases, surgical decompression 1.
• Patients should be aware that while steroid injections may provide temporary symptom relief, they don't address the underlying cause of nerve compression and multiple injections are generally not recommended due to potential side effects including tissue atrophy, skin depigmentation, and tendon weakening 1.
• The procedure should be performed by a trained medical professional using ultrasound guidance when possible to ensure accurate placement and avoid nerve injury.

Evidence Summary

The most recent evidence from 2022 suggests that steroid injections can be used to treat cubital tunnel syndrome, but their use should be approached with caution 1. An older study from 2005 highlights the potential risks of steroid injections, including deleterious effects on the tendon when injected into the tendon substance 1. However, the more recent study provides more relevant guidance on the use of steroid injections in the cubital tunnel.

From the Research

Steroid Injection in the Cubital Tunnel

• The cubital tunnel is a narrow passageway in the elbow through which the ulnar nerve passes, and steroid injections are sometimes used to treat conditions such as ulnar neuropathy at the elbow.
• According to a study published in 1996, splinting alone is adequate to improve symptoms and ulnar nerve conduction across the elbow, and the addition of a steroid injection did not provide further benefit in the treatment of cubital tunnel syndrome 2.
• The study found that there was significant improvement in symptoms in both groups (splinting alone and splinting with steroid injection) at 1 and 6 months after treatment, but there was no significant difference between the two groups in all parameters.
• Another study published in 2011 compared the effects of local steroid injection into the carpal tunnel via proximal and distal approach in patients with carpal tunnel syndrome, but did not specifically address the cubital tunnel 3.
• There is limited evidence to suggest that steroid injections can be safely and effectively administered in the cubital tunnel, and more research is needed to fully understand the benefits and risks of this treatment option.
• It is worth noting that the studies available primarily focus on carpal tunnel syndrome, and there is a lack of research specifically addressing steroid injections in the cubital tunnel, making it difficult to provide a definitive answer to this question.