Cubital tunnel syndrome is the second most common compression neuropathy in the upper limb after carpal tunnel syndrome. It is caused by compression of the ulnar nerve in the cubital tunnel of the elbow. Numerous factors have been identified that result in compression of the nerve at this site. Most commonly these include normal or variations of normal anatomic structures around the elbow. Rarer causes that may need to be excluded include inflammation, ganglion cysts and tumours.

As the elbow flexes, the shape of the cubital tunnel narrows from a round to an oval shape, causing increased pressure on the ulnar nerve. Traction is also placed on the ulnar nerve as the elbow flexes, causing elongation of the nerve. Chronic and repeated injury to the nerve in the forms of increased pressure and traction may cause inflammation and irritation.

Cubital tunnel can be associated with both sensory and motor symptoms. Sensory complaints usually present first and may include numbness and paraesthesia in the ring and little fingers; and/or aching in the medial elbow and forearm. Motor complaints include weakness of grip, pinch and strength, loss of fine dexterity, and dropping objects. More severe cases may demonstrate clawing posture of the small and ring fingers and muscle wasting of the hand.

Prolonged resting on the elbow while in flexion will typically cause symptoms. Patients often wake at night if sleeping in a position of elbow flexion, such as arms beneath the pillow.

Diagnosis is based on history and careful examination including sensory and motor testing. Electrodiagnostic testing is often used to confirm clinical findings and localise the level of compression. X-rays may help rule out bony abnormalities, and ultrasound or magnetic resonance imaging (MRI) may be used if the cause remains unclear.

Treatment will depend on the history, examination and investigation findings carefully collated by Dr Tolerton. Depending on the underlying cause, initial management may be non-surgical including education, postural modification, nonsteroidal anti-inflammatory drugs (NSAIDs)  and/or splinting with the aid of our hand therapists.

If surgical treatment is indicated, there are multiple operations for cubital tunnel syndrome. The choice of operation is dependent on the contributing factors or underlying cause of ulnar nerve compression, and potential previous surgery performed. The most common operations include in situ decompression, decompression and transposition of the nerve (various techniques) and medial humeral epicondylectomy.

Rehabilitation is an integral part of all treatments for cubital tunnel syndrome. This includes range-of-motion exercises and potential splinting under the guidance of our hand therapists. The rehabilitation will be individualised to your clinical situation and treatment, and will determine the timing for return to work and regular activities.