Cubital tunnel syndrome is a condition caused by the compression or irritation of the ulnar nerve as it passes through the cubital tunnel on the inside of the elbow joint. This nerve compression often manifests as numbness and tingling, primarily affecting the ring and little fingers. The ulnar nerve also controls some small muscles in the hand, meaning advanced cases can lead to weakness or muscle wasting. Treatment depends on the severity of the symptoms and the extent of nerve damage, ranging from simple modifications to specialized surgical procedures.
Initial At-Home Management
For individuals experiencing mild or intermittent symptoms, the first step involves activity modification to reduce pressure on the nerve. The ulnar nerve is particularly vulnerable to stretching when the elbow is bent deeply for long periods, such as when sleeping, driving, or holding a phone. Avoiding or limiting these prolonged periods of elbow flexion is the initial strategy.
Night-time splinting is an effective technique to prevent the elbow from bending excessively while sleeping. Over-the-counter devices can function as a splint to maintain a straighter position, minimizing nerve stretch. Cushioning the elbow with a pad during the day helps prevent direct external compression when leaning on hard surfaces like a desk or armrest.
Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can be used for short-term relief of pain and inflammation. While NSAIDs may alleviate the symptoms, they do not address the underlying mechanical compression of the nerve. If these conservative, at-home measures do not improve symptoms within a few weeks, professional medical evaluation is the next step.
Professional Non-Surgical Therapies
When at-home adjustments prove insufficient, professional, non-surgical therapies are guided by a healthcare provider. Physical therapy often forms a large part of this approach, focusing on specific exercises and techniques. A central component of this specialized therapy is the use of nerve gliding exercises, sometimes called nerve flossing.
These exercises are designed to gently mobilize the ulnar nerve, helping it slide more freely within the cubital tunnel and reducing irritation or tension. A therapist may also prescribe custom bracing or splinting that is more rigid or precisely fitted than over-the-counter options, ensuring the elbow is maintained in an optimal, non-aggravating position.
Another intervention is a corticosteroid injection. The steroid acts as a potent anti-inflammatory agent, which can temporarily reduce swelling around the nerve, offering symptom relief. However, injections are generally used less frequently for cubital tunnel syndrome compared to carpal tunnel syndrome, and their benefits tend to be temporary rather than providing a long-term solution.
Surgical Solutions for Definitive Relief
Surgery becomes necessary when conservative treatments fail to relieve symptoms, or when the nerve compression is severe enough to cause persistent weakness, loss of sensation, or visible muscle wasting in the hand. The goal of any surgical procedure is to relieve the pressure on the ulnar nerve. Electromyography (EMG) and nerve conduction studies help determine the severity of the compression and the best surgical approach.
One of the most common procedures is Ulnar Nerve Decompression, or In Situ Release, where the surgeon cuts the tight band of tissue forming the roof of the cubital tunnel. This release widens the tunnel, allowing the nerve to sit in its natural position. This technique is often preferred for milder cases where the nerve does not tend to snap or subluxate (slip out of place) when the elbow is bent.
For more advanced cases, or when the nerve is unstable and snaps over the bony prominence of the elbow, an Ulnar Nerve Transposition is performed. This surgery involves moving the ulnar nerve from its position behind the medial epicondyle to a new location in front of the elbow. The nerve is secured in its new, less constrained position, which can be just under the skin (subcutaneous), within the muscle (intramuscular), or beneath the muscle (submuscular).
Long-Term Recovery and Preventing Recurrence
Following any intervention, whether surgical or non-surgical, long-term success relies on a commitment to rehabilitation. Nerve healing is a slow process, and patients are cautioned that it can take anywhere from six to twelve months to experience the final results. Complete resolution of symptoms, especially in severe, chronic cases, is not always guaranteed, but surgery should prevent symptoms from worsening.
Post-operative physical therapy is required to restore strength and full range of motion to the elbow and hand. This may involve continuing nerve gliding exercises and strengthening routines. Patients must also integrate long-term ergonomic changes into their daily lives, such as maintaining a proper workstation setup and remaining mindful of activities that require prolonged elbow flexion, to prevent the condition from returning.