What Is Cubital Tunnel Syndrome?
Cubital tunnel syndrome is when your ulnar nerve — one of the three main nerves in your arm — is compressed. The ulnar nerve runs from your neck to your hand and passes through a tunnel of tissue known as the cubital tunnel. This is located under a bony bump on the inside of your elbow called the medial epicondyle.
“People often refer to that spot as their funny bone, because when they smack it, they get a tingly feeling in their hand due to damage to their ulnar nerve,” says Lisa Lattanza, MD, Chair of Orthopedics & Rehabilitation at Yale School of Medicine in New Haven, Connecticut.
Your ulnar nerve provides feeling to your little finger and half of your ring finger. It also controls some hand and forearm muscles. If it’s compressed at your cubital tunnel, it can lead to severe pain, numbness, tingling, and muscle weakness in the hands and arms.
In most cases, cubital tunnel syndrome can be managed with conservative (nonsurgical) treatments. But more severe cases may require surgery to ease pressure on the affected nerve.
Cubital Tunnel Syndrome Causes
Cubital tunnel syndrome, also known as ulnar neuropathy, happens when there is too much pressure on the ulnar nerve around the elbow. You’re more likely to develop cubital tunnel syndrome if you:
- Repeatedly lean on your elbow, especially on a hard surface
- Bend your elbow for long periods, such as while talking on a cell phone or sleeping with your hand crooked under your pillow
Sometimes, cubital tunnel syndrome results from abnormal bone growth in the elbow or from intense physical activity that increases pressure on the ulnar nerve. Baseball pitchers, for example, are at a high risk of cubital tunnel syndrome. That’s because the twisting motion required to throw a slider can damage delicate ligaments in the elbow.
You are also more likely to get cubital tunnel syndrome if you have certain underlying medical conditions. Both osteoarthritis and rheumatoid arthritis can cause narrowing of the ulnar nerve tunnel, Lattanza says. Research also suggests that people who are overweight or have type 2 diabetes are at a greater risk, too.
Cubital Tunnel Syndrome Symptoms
“Cubital tunnel syndrome causes an ache in your forearm close to your elbow,” Lattanza says. Other early symptoms of cubital tunnel syndrome include:
- Pain and numbness in the elbow that gets worse when your elbow is bent, like when you drive or hold your phone
- Tingling, especially in the ring and little fingers
- Numb fingers that wake you up at night
More serious symptoms of cubital tunnel syndrome include:
- Weakness affecting the ring and little fingers
- Decline in the ability to pinch the thumb and little finger
- A weaker overall hand grip
- Wasting of the hand muscles
- Claw-like deformity of the hand
Diagnosing Cubital Tunnel Syndrome
If you have any of these symptoms, your doctor may be able to diagnose cubital tunnel syndrome by a physical exam alone. “We usually have them sit with their elbow in a bent position, to see if it brings up symptoms,” Lattanza says. They may tap over the ulnar nerve at your funny bone. If you have cubital tunnel syndrome, this may cause a shock in both your little and ring fingers. They’ll also check your hand and finger strength.
Your doctor also may order a nerve conduction study and a test called electromyography. During electromyography, electrodes are placed into muscles and on the skin to measure the health of muscles and the nerve cells that control them. This helps confirm the diagnosis, identify the area of nerve damage, and check the severity of the condition. “It can help us rule out that no other medical condition is causing symptoms,” Lattanza says.
Cubital Tunnel Syndrome Treatment
Cubital tunnel syndrome can often be managed conservatively, especially in the early stages. Research suggests that around 90% of people respond to the following initial treatments:
Bracing or splinting. You should wear a cubital tunnel syndrome brace or splint at night to keep your elbow in a straight position. “If you sleep on your elbow for eight hours, that’s a lot of pressure on your ulnar nerve,” Lattanza says. She also recommends a daytime protective elbow pad to avoid accidentally bumping it during daily activities.
Over-the-counter medications. An over-the-counter anti-inflammatory such as ibuprofen (Advil, Motrin) or naproxen (Aleve) can help ease ulnar nerve inflammation and pain. Just check with your doctor if it’s safe for you before you take it.
Posture tweaks. You want to avoid positions where you lean on your elbow, as it puts pressure on your ulnar nerve. Use a headset when you’re on the phone, for example, and try not to sit with crossed arms.
Ergonomic changes. For example, if you sit for long hours at a desk, you can make some changes to ease pressure on your elbow, Lattanza says. Your eyes should be level with your computer monitor to make sure it’s at the right height. Your elbows should also be bent to 90 degrees when you work on your mouse or keyboard. You can also place a towel under your forearm to take pressure off your elbow and wrist.
Prescription medications. Your doctor may prescribe medications such as gabapentin (Neurontin) to help treat nerve pain, Lattanza says. While some physicians still do steroid injections, research suggests they’re no more effective than placebo.
Cubital tunnel surgery
In cases where splinting doesn’t help or nerve compression is more severe, research suggests that over 85% of patients respond to some form of surgery to release pressure on the ulnar nerve.
The most common type of surgery is ulnar nerve decompression, or cubital tunnel release. The ligaments on top of the cubital tunnel are cut. This increases the size of the tunnel and creates more space for the nerve. It’s best for mild or moderate nerve compression.
Another procedure, ulnar nerve transposition, involves moving the nerve to a new place, usually to the front of the elbow. It can help for more severe cases of nerve compression.
For either type of surgery, you’ll need to wear a splint for up to six weeks after surgery. You’ll usually be told to start moving your elbow immediately, to prevent nerve scarring. You won’t be able to do heavy lifting for a few weeks. Physical therapy is also recommended to help your arm and hand regain strength and motion. Although numbness and tingling may or may not quickly improve, recovery of hand and wrist strength may take several months.
Cubital tunnel syndrome exercises
If you have cubital tunnel syndrome, your doctor or physical therapist may suggest specific types of exercises. Here are the three main types:
Nerve gliding exercises. These make it easier for your ulnar nerve to slide through your cubital tunnel at your elbow. They provide blood flow to your nerve and help stretch it out. The best exercise to start with is a simple ulnar nerve glide. Hold your arm in front of you with your elbow straight, then curl your wrist and fingers toward your body. Then, push them away from you and bend your elbow.
Muscle strengthening exercises. Cubital tunnel syndrome, especially in the advanced stages, can cause muscles to shrink. These exercises work to restore strength, which will also help ease the strain on your ulnar nerve.
Range of motion exercises. These help lengthen any muscles near your ulnar nerve that may have shortened due to pain or injury.
Cubital Tunnel Syndrome FAQs
What is the difference between cubital tunnel and carpal tunnel syndrome?
“Cubital tunnel syndrome is due to pressure on your ulnar nerve at your elbow, while carpal tunnel syndrome is due to pressure on your median nerve at your wrist,” Lattanza says. As a result, they have different symptoms. “You’ll notice numbness and tingling with carpal tunnel in the three fingers on the thumb side of your hand, whereas cubital tunnel syndrome will affect your ring and small finger,” she says.
How do you sleep with cubital tunnel syndrome?
Wear an elbow splint to keep your elbow straight and extended. If that makes it too hard to sleep, you can also wrap your elbow with a towel to limit movement.
Can cubital tunnel syndrome go away?
Yes. Most people have it for a short period. Conservative treatments, such as exercises and physical therapy, may cause it to go away completely.
