Cubital Tunnel Syndrome

Cubital Tunnel Syndrome is a nerve compression condition caused by pressure on the ulnar nerve in the region called the cubital tunnel at the elbow. It is clinically diagnosed by symptoms such as numbness, burning, and pain in the ring and little fingers, reduced grip strength, and a positive Tinel’s test at the cubital tunnel.

Treatment of cubital tunnel syndrome varies depending on the severity and duration of symptoms. In the early stages, it is managed with non-surgical methods, such as using a splint to keep the elbow straight. If conservative treatment fails, surgery may be performed to move the ulnar nerve to the front of the elbow.

What Is Cubital Tunnel Syndrome?

Cubital tunnel syndrome is a nerve entrapment disorder that occurs when the ulnar nerve becomes compressed as it passes through the inner part of the elbow.

The ulnar nerve runs through a narrow channel known as the cubital tunnel, located between the humerus (upper arm bone) and the olecranon (bony prominence at the back of the elbow).

When the ulnar nerve is exposed to repeated pressure or trauma in this area, it can become compressed and lose its normal function.

People at risk include those who:

• Spend long hours at the computer

• Drive for extended periods

• Work at a desk

• Frequently rest with elbows bent

According to the Journal of Hand Surgery (2021), cubital tunnel syndrome is the second most common peripheral nerve entrapment after carpal tunnel syndrome.

What Is the Cubital Tunnel?

The cubital tunnel is a narrow passageway formed by bone, muscle, and ligaments on the inner side of the elbow through which the ulnar nerve passes.

The roof of the cubital tunnel is covered by a thin membrane (fascia). Compression of the ulnar nerve in this tunnel results in cubital tunnel syndrome.

What Is the Ulnar Nerve?

The ulnar nerve originates from the C8–T1 spinal roots in the neck. After branching from the brachial plexus beneath the collarbone, it travels down the arm, passing behind the medial epicondyle of the elbow and through the cubital tunnel.

What Causes Cubital Tunnel Syndrome?

Common causes include:

• Holding a phone for long periods

• Prolonged computer use

• Playing video games for extended hours

• Sleeping with the elbows bent

Additionally, resting the inner elbow on a hard surface (like a desk) for extended periods may also lead to cubital tunnel syndrome.

Other causes include:

• Trauma

• Fractures or dislocations near the elbow

• Bony spurs, ganglion cysts, or tumors that cause direct pressure on the ulnar nerve within the cubital tunnel

What Are the Symptoms of Cubital Tunnel Syndrome?

Common symptoms include:

• Numbness, tingling, and pain in the ring and little fingers and the inner part of the hand, initially intermittent but potentially becoming constant over time

• Worsening symptoms at night, especially if the patient sleeps with bent elbows

• Pain on the inner side of the elbow

• Reduced pinching strength of the fingers

• Weak grip strength

• Loss of fine motor control, causing difficulty in holding small objects or frequent dropping

• In advanced cases, muscle wasting in the hand and permanent nerve damage

Symptoms of cubital tunnel syndrome tend to develop gradually. If left untreated, the condition can lead to permanent nerve damage in the hand.

How Is Cubital Tunnel Syndrome Diagnosed?

Cubital tunnel syndrome is diagnosed through a detailed patient history and physical examination. In some cases, additional diagnostic tools such as EMG (electromyography), X-rays, or MRI scans may be required for confirmation or differential diagnosis.

What Are the Differences Between Cubital Tunnel Syndrome and Carpal Tunnel Syndrome?

The location of symptoms is the key difference.

• In cubital tunnel syndrome, numbness and pain typically occur in the little finger and the ulnar side of the ring finger.

• In carpal tunnel syndrome, symptoms are usually felt in the thumb, index finger, middle finger, and the radial side of the ring finger.

What Is the Role of EMG in Cubital Tunnel Syndrome?

EMG (electromyography) helps evaluate how well the ulnar nerve is functioning. It can determine:

• Whether the nerve is compressed

• The location and severity of the compression

How Is Cubital Tunnel Syndrome Treated?

If there is no muscle atrophy or permanent nerve damage, treatment usually begins with non-surgical options aimed at reducing symptoms such as pain and numbness.

Non-Surgical Treatment of Cubital Tunnel Syndrome

Initial recommendations include:

• Avoid frequent elbow flexion and try to keep the elbow in a straight position as much as possible.

• Avoid leaning on the elbows; use elbow pads to reduce pressure when working at a desk.

• Use a night splint to keep the elbow in a nearly extended position during sleep.

• Ultrasound-guided cortisone injection into the cubital tunnel.

• Avoid activities that trigger symptoms like numbness or burning in the fingers.

If pain, numbness, and tingling persist despite non-surgical treatment, and muscle wasting begins, then surgery becomes the only option.

Use of Elbow Braces in Treatment

Wearing an elbow brace during sleep that maintains the elbow at about a 45-degree angle is an effective treatment strategy.If such braces are not available, you can:

• Wrap a towel around the elbow

• Secure it with a safety pin

This provides cushioning and prevents the elbow from bending excessively during sleep, which could otherwise compress the ulnar nerve.

Ultrasound-Guided Cortisone Injections

Ultrasound-guided cortisone injections into the cubital tunnel have been used safely and effectively for many years. Scientific studies show that this method significantly reduces pain and numbness in patients with cubital tunnel syndrome.

For other effective injection therapies, feel free to explore our related articles.

Exercises for Cubital Tunnel Syndrome

Home exercises play a vital role in managing cubital tunnel syndrome. These exercises help reduce nerve compression and improve mobility. When done regularly, they can promote smoother nerve movement and relieve symptoms.

Recommended Exercises:

• Elbow flexion and extension: Gently straighten the elbow fully, then slowly bend it.

• Wrist rotations: Rotate the wrist gently to reduce pressure on the ulnar nerve.

Note: We recommend starting these exercises under the supervision of a qualified physiotherapist to ensure they are performed correctly and do not worsen symptoms.

How Is Cubital Tunnel Syndrome Surgery Performed?

The goal of cubital tunnel release surgery is to relieve pressure on the ulnar nerve and allow it to move freely during elbow movements.

One of the most effective surgical techniques is the subcutaneous anterior transposition of the ulnar nerve.

Anterior Transposition of the Ulnar Nerve:

• The ulnar nerve is released from its original tunnel.

• A new tunnel-like bed is created in front of the elbow, above the flexor muscle and beneath the fat layer.

• The nerve is relocated and secured in a compression-free environment.

What Is the Recovery Process After Cubital Tunnel Surgery?

After cubital tunnel surgery, the wound typically heals within 10–14 days. During this period, you can shower using waterproof dressings.Once pain subsides, there are usually no restrictions on elbow movement.

In the first few days, elbow movement may be limited due to pain, but mobility gradually improves. Keeping the arm elevated above heart level and moving the fingers helps reduce swelling.

Applying cold therapy to the surgical area reduces pain and decreases the need for painkillers. Ice should be applied over a towel for 20 minutes every hour.

Patient Experiences After Cubital Tunnel Surgery

Most patients who undergo cubital tunnel surgery report significant relief from pain and numbness. Here are some selected reviews:

• M.Y. – "After surgery performed by Dr. Özer, the numbness in my hand and fingers significantly decreased. I'm very grateful for the surgery and the attentive care afterward."

• S.T. – "Dr. Utku Erdem Özer explained everything clearly before and after the surgery. He answered all my questions patiently, which was very reassuring for me."

• H.K. – "My recovery was faster than expected. The exercises and follow-up care recommended by Dr. Özer were extremely helpful."

Frequently Asked Questions (FAQs) About Cubital Tunnel Syndrome

What is cubital tunnel syndrome?

A nerve entrapment condition caused by compression of the ulnar nerve in the cubital tunnel at the elbow.

What does the ulnar nerve do?

It provides sensation to the ring and little fingers, and controls certain muscles in the hand.

What are the symptoms of cubital tunnel syndrome?

Numbness and tingling in the ring and little fingers, loss of fine motor skills, grip weakness, and muscle wasting in advanced cases.

What causes cubital tunnel syndrome?

Frequent elbow bending, prolonged pressure on the elbow, trauma, anatomical narrowing, and nerve dislocation.

Who is at risk?

Computer users, drivers, musicians, people who lean on their elbows, and those with joint issues around the elbow.

How is cubital tunnel syndrome diagnosed?

Through clinical examination, nerve stretch tests, and electrodiagnostic studies like EMG and nerve conduction tests.

What’s the difference between cubital tunnel and carpal tunnel syndrome?

Carpal tunnel affects the median nerve in the wrist, while cubital tunnel involves the ulnar nerve in the elbow, leading to different symptom patterns.

Why are symptoms worse at night?

Sleeping with bent elbows increases pressure on the nerve, which can intensify numbness and pain at night.

Can cubital tunnel syndrome resolve on its own?

In mild cases, avoiding pressure and correcting elbow position may help symptoms improve. However, advanced cases require treatment.

What are the treatment options?

Preventive strategies, night splints, exercises, physical therapy, medications, and surgery in severe cases.

How does a splint help?

Night splints keep the elbow straight, reducing pressure on the nerve and preventing nighttime symptoms.

What activities should be avoided?

Avoid prolonged elbow flexion, leaning on hard surfaces, and repetitive hand-arm movements.

Does physical therapy help?

Yes. Nerve gliding and stretching exercises can relieve pressure and improve mobility.

When is surgery necessary?

If symptoms persist despite conservative care or if muscle weakness occurs, surgery is considered.

What surgical methods are used?

Nerve decompression, anterior transposition of the ulnar nerve, and removal of compressive bone structures.

What is recovery like after surgery?

Healing usually takes a few weeks. Regaining full function may take several months in some cases.

Can it recur?

Yes, especially if post-op care is inadequate or underlying anatomical issues remain.

Is a popping sound in the elbow normal?

Yes. The ulnar nerve can sometimes pop in and out of position, creating a clicking or snapping sound.

Why is early diagnosis important?

When diagnosed early, it can often be treated without surgery through protective measures and activity modification.

How can I prevent cubital tunnel syndrome?

Avoid prolonged elbow bending, don't rest elbows on hard surfaces, and maintain ergonomic posture during daily activities.

Conclusion

Cubital Tunnel Syndrome occurs when the ulnar nerve becomes compressed within the cubital tunnel located on the inner side of the elbow.

This condition can cause numbness, burning, and pain in the ring and little fingers, significantly impacting daily life.

As mentioned in this article, treatment typically begins with non-surgical methods such as using a night splint to keep the elbow straight, and if symptoms persist, surgery to move the ulnar nerve to the front of the elbow may be needed.

The condition often stems from prolonged elbow flexion or leaning on hard surfaces. Diagnosis is made through a thorough clinical evaluation and, if needed, supported with EMG nerve conduction studies.

If left untreated, it can lead to permanent nerve damage and muscle atrophy, which is why early diagnosis and effective treatment are critical.

Thank you for reading our article. For more information, feel free to visit the homepage at utkuerdemozer.com.