What is Cubital Tunnel Syndrome?
Cubital tunnel syndrome is the second most common nerve compression condition in the upper limb after carpal tunnel syndrome. It occurs when the ulnar nerve becomes compressed or irritated as it passes behind the inside of the elbow.
Many patients improve with activity modification and splinting. However, when symptoms become persistent or muscle weakness develops, surgery may be recommended to relieve pressure on the nerve.
The ulnar nerve travels from the neck, behind the inside of the elbow (the "funny bone") and into the hand.
As it passes through the cubital tunnel, the nerve can become compressed or stretched, resulting in numbness, tingling and weakness affecting the ring and little fingers.
Compression may occur due to:
Repeated elbow bending
Leaning on the elbow
Thickened tissue around the nerve
Previous injury
Elbow arthritis
Nerve instability or subluxation
Symptoms
Symptoms commonly include:
Numbness of the little finger
Numbness of the ring finger
Tingling in the hand
Symptoms worse at night
Symptoms when the elbow is bent
Weak grip strength
Hand clumsiness
Muscle wasting in advanced cases
Many patients notice symptoms while talking on the phone, reading or sleeping with the elbow bent.
Diagnosis
Diagnosis is usually made from your history and examination.
Additional investigations may include:
Nerve conduction studies (NCS)
Electromyography (EMG)
Ultrasound
X-rays where arthritis is suspected
MRI in selected cases
These investigations help confirm the diagnosis and determine the severity of nerve compression.
Non-Surgical Treatment
Many patients improve without surgery.
Treatment options may include:
Avoiding prolonged elbow flexion
Avoiding pressure on the elbow
Night splinting
Physiotherapy
Nerve gliding exercises
Activity modification
Early treatment often prevents progression of nerve damage.
Cubital Tunnel Release Surgery
When cubital tunnel syndrome symptoms persist despite appropriate non-surgical treatment or muscle weakness develops, surgery may be recommended.
The aim of surgery is to relieve pressure on the ulnar nerve and prevent further nerve damage.
Depending on the cause of compression, surgery may involve:
Cubital tunnel release (decompression)
With or without ulnar nerve transposition
The most appropriate procedure depends on whether the nerve is compressed, unstable or both.
Ulnar Nerve Transposition
Some patients have an unstable ulnar nerve that repeatedly moves out of its normal position during elbow movement.
In these cases, simply releasing the nerve may not be sufficient.
An ulnar nerve transposition relocates the nerve to the front of the elbow, reducing tension and preventing recurrent irritation.
Mr Francis Ting will discuss whether decompression alone or nerve transposition is the most appropriate option for your condition.
Recovery After Surgery
Recovery depends on the severity of nerve compression and the procedure performed.
Most patients can expect:
Day surgery
A bulky dressing
Early finger movement
Gradual return to normal activities
Improvement in numbness over weeks to months
Recovery of muscle strength may take longer in patients with severe or longstanding nerve compression.
Frequently Asked Questions
Will surgery restore normal feeling?
Many patients experience significant improvement in numbness and tingling. Recovery depends on the severity and duration of nerve compression before surgery.
Do I always need an ulnar nerve transposition?
No. Many patients are successfully treated with simple cubital tunnel release. Transposition is reserved for patients with nerve instability or specific clinical indications.
Is cubital tunnel syndrome the same as carpal tunnel syndrome?
No. Cubital tunnel syndrome affects the ulnar nerve at the elbow, whereas carpal tunnel syndrome affects the median nerve at the wrist.
How long is recovery?
Most patients return to light activities within several weeks, although nerve recovery may continue for many months.
Related Conditions
Why Choose Peak Orthopaedics?
Mr Francis Ting is a fellowship-trained orthopaedic surgeon specialising in hand and upper limb surgery.
Treatment is tailored to each patient's individual condition. Whether management involves activity modification, splinting, cubital tunnel release or ulnar nerve transposition, the aim is to relieve symptoms, protect nerve function and restore hand strength and function.
