Cubital Tunnel Syndrome
Ulnar Nerve Compression at the Elbow
The second most common nerve compression syndrome - expert diagnosis and treatment
Understanding Cubital Tunnel Syndrome
Cubital tunnel syndrome is the second most common compressive neuropathy in the upper extremity after carpal tunnel syndrome. The ulnar nerve passes behind the medial epicondyle of the elbow in a space called the cubital tunnel.
Epidemiology
- • Second most common compression neuropathy (after carpal tunnel)
- • Incidence: ~25 per 100,000 person-years
- • More common in men than women
- • Peak age: 40-60 years
- • Associated with diabetes, obesity, and repetitive elbow flexion
The ulnar nerve is vulnerable at the elbow because it lies superficially (the "funny bone" area) and is stretched with elbow flexion. Compression can occur from direct pressure, repetitive bending, or anatomical abnormalities.
McGowan/Dellon Classification
Intermittent paresthesias (numbness/tingling)
No weakness or atrophy
Often responds to conservative treatment
Constant paresthesias
Measurable weakness in grip/pinch
Surgery often recommended
Persistent sensory changes
Visible muscle atrophy (hand intrinsics)
Claw hand deformity possible
Surgical treatment indicated
Symptoms & Diagnosis
Common Symptoms
Late Sign: Claw hand deformity (hyperextension of ring/small finger MCPs with flexion of IPs) indicates severe, long-standing compression
Clinical Tests
Tinel's Sign
Tingling with percussion over cubital tunnel
Elbow Flexion Test
Symptoms reproduced with full elbow flexion held for 60 seconds
Froment's Sign
Thumb IP flexion when pinching paper (weakness of adductor pollicis)
Wartenberg's Sign
Small finger abduction at rest (weak interossei)
Investigations
Nerve Conduction Studies/EMG: Gold standard for confirming diagnosis and severity. Shows slowed conduction velocity across the elbow (>10 m/s difference compared to below-elbow segment).
Treatment Options
Night Splinting
Elbow extension splint keeps elbow straight during sleep (most symptoms occur at night)
Activity Modification
Avoid prolonged elbow flexion, leaning on elbow, repetitive bending
Elbow Pad
Protects the nerve from direct pressure and trauma
Nerve Gliding Exercises
Gentle exercises to improve nerve mobility and reduce adhesions
Indicated for moderate/severe cases or failed conservative treatment
In Situ Decompression
Simple release of the cubital tunnel roof without moving the nerve
- • Less invasive
- • Faster recovery
- • Fewer complications
- • Good results in most cases
Anterior Transposition
Nerve moved to front of elbow
- • Subcutaneous (under skin)
- • Intramuscular (within muscle)
- • Submuscular (under muscle)
- • For recurrent cases or subluxation
Success Rate: 80-90% improvement in symptoms. Results depend on severity and duration of compression. Early intervention generally yields better outcomes.
Evidence & References
• Dellon AL. Review of treatment results for ulnar nerve entrapment at the elbow. J Hand Surg Am 1989
• Bartels RH, et al. A randomized controlled trial comparing simple decompression versus anterior subcutaneous transposition for cubital tunnel syndrome. Neurology 2005
• Caliandro P, et al. Treatment for ulnar neuropathy at the elbow. Cochrane Database Syst Rev 2016
Last Updated: January 2025 | Content reviewed by Dr. Deepthi Nandan Reddy, FRCS (Ortho)