Is this presentation consistent with cubital tunnel syndrome or another condition?

Cubital Tunnel Syndrome: Clinical Diagnosis

Yes, this presentation is most consistent with cubital tunnel syndrome, which is the second most common peripheral nerve compression syndrome after carpal tunnel syndrome. 1, 2

Key Diagnostic Features of Cubital Tunnel Syndrome

Classic Presentation

• Numbness and tingling in the ring and small fingers is the earliest and most common sign of cubital tunnel syndrome 1
• Dorsoulnar hand paresthesias accompany the finger symptoms 1
• Pain and point tenderness at the medial elbow may be present 1
• Symptoms worsen with repetitive elbow flexion, prolonged flexion, or direct pressure on the elbow 3

Physical Examination Findings

• Positive Tinel's sign at the cubital tunnel (tapping over the ulnar nerve at the elbow elicits paresthesias) 1
• Positive flexion-compression test (symptoms reproduced with elbow flexion and direct pressure over the cubital tunnel) 1
• Palpable thickening of the ulnar nerve with local tenderness along its course 1
• Ulnar nerve subluxation with elbow flexion/extension may be present 4

Progressive Motor Findings (if untreated)

• Clumsiness of the hand develops as the condition progresses 1
• Atrophy of the first dorsal interosseous muscle is a late finding indicating chronic compression 1
• Hand weakness affecting fine motor function 1

Critical Differential Diagnoses to Exclude

Medial Epicondylitis (Golfer's Elbow)

• Pain with resisted wrist flexion is the hallmark finding 5, 6
• Tenderness directly over the medial epicondyle (not along the ulnar nerve course) 4
• No neurologic symptoms (no paresthesias, numbness, or motor weakness) 4
• Pain worsens with repetitive wrist flexion and forearm pronation 5

Ulnar Collateral Ligament (UCL) Injury

• Pain with valgus stress testing of the elbow 4
• Medial joint line tenderness (distinct from the epicondyle) 4
• Positive moving valgus stress test in throwing athletes 4
• Mechanical instability rather than neurologic symptoms 4

Intra-articular Pathology

• Mechanical symptoms such as locking, clicking, or catching 4
• Pain with passive range of motion (differentiates from tendinopathy) 4
• Limited range of motion and effusion may be present 4

Diagnostic Workup Algorithm

Step 1: Initial Imaging

Obtain plain radiographs (AP and lateral views) of the elbow to rule out osseous pathology including intra-articular bodies, heterotopic ossification, osteochondral lesions, soft tissue calcification, or occult fractures 4, 5

Step 2: Electrodiagnostic Studies

Perform EMG and nerve conduction studies when neurologic symptoms suggest cubital tunnel syndrome to confirm the diagnosis and assess severity 4, 1

Step 3: Advanced Imaging (if needed)

MRI elbow without contrast is indicated for suspected tendon tear, nerve entrapment, or soft tissue pathology when radiographs are normal 4

• T2-weighted MR neurography is the reference standard for imaging ulnar nerve entrapment, showing high signal intensity and nerve enlargement 4

Clinical Pearls and Pitfalls

Red Flags Requiring Urgent Evaluation

• Night pain or pain at rest suggests inflammatory or neoplastic process 4
• Rapid progression of motor weakness or muscle atrophy indicates need for expedited surgical evaluation 1
• Fixed sensory changes or established motor weakness warrant surgical consultation 2

Common Diagnostic Pitfalls

• Failing to distinguish between medial epicondylitis and cubital tunnel syndrome: Medial epicondylitis has no neurologic symptoms, while cubital tunnel syndrome presents with paresthesias in the ulnar nerve distribution 4, 1
• Missing C8 radiculopathy, Pancoast tumor, or pressure palsy as alternative diagnoses in atypical presentations 2
• Overlooking the need for initial radiographs to rule out bony pathology before proceeding with treatment 4, 5

Age-Related Presentation Patterns

• Older patients tend to present with motor symptoms of chronic onset 1
• Younger patients tend to have more acute symptoms 1