Cubital tunnel syndrome occurs when the ulnar nerve is compressed or irritated as it passes through the cubital tunnel on the inside of the elbow. This nerve controls sensation in the ring and little fingers, as well as most of the small muscles within the hand. Symptoms commonly include numbness and tingling in these two fingers, often described as the fingers “falling asleep,” and occasionally a weakened grip or clumsiness. Recovery ranges from simple self-management to complex surgical procedures, depending on the severity of the nerve compression.
Initial Steps for Self-Care and Rest
The first line of defense against cubital tunnel syndrome involves immediate activity modification to reduce pressure on the ulnar nerve. It is important to avoid prolonged or repetitive elbow flexion, which stretches the nerve and exacerbates symptoms. Simple changes, such as not resting the elbow on hard surfaces like armrests or desks, can significantly decrease irritation.
Nighttime positioning is an effective self-care measure that prevents the elbow from bending excessively during sleep. This can be achieved by wearing a brace or splint that keeps the elbow in a straighter, less compressive position. Alternatively, loosely wrapping a towel around the elbow can serve a similar purpose by limiting the degree of flexion.
Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) can be used for short-term relief to help manage pain and reduce inflammation around the nerve. While NSAIDs offer temporary comfort, they do not resolve the underlying nerve compression itself. These initial steps are often successful in treating mild to moderate symptoms and should be attempted before progressing to more invasive medical treatments.
Physical Therapy and Medical Injections
When self-care measures prove insufficient, professional treatment often begins with physical therapy focused on restoring nerve mobility. A specific technique called ulnar nerve gliding, or “nerve flossing,” involves gentle, controlled movements of the arm, wrist, and neck designed to help the ulnar nerve slide smoothly through the cubital tunnel. These exercises are thought to prevent the formation of adhesions or scar tissue that can restrict the nerve’s movement.
A physical therapist can also guide the patient through range-of-motion and strengthening exercises for the muscles around the elbow and hand to improve overall stability and function. The goal of this rehabilitation is to decrease pain, improve grip strength, and allow the patient to return to normal activities without irritation.
Medical injections, typically involving a corticosteroid mixed with a local anesthetic, may be considered to reduce inflammation around the nerve. However, steroid injections for cubital tunnel syndrome are used cautiously due to the nerve’s superficial location and the potential for direct damage. Splinting alone is often as effective as adding a steroid injection for improving symptoms and nerve conduction.
When Surgery Becomes Necessary
Surgery is reserved for cases where symptoms persist despite months of conservative treatment, or when the condition has progressed to include severe weakness or muscle wasting in the hand. These advanced signs indicate ongoing nerve damage that requires mechanical relief from compression.
Two primary surgical approaches are used to treat cubital tunnel syndrome. The first is ulnar nerve decompression, also known as cubital tunnel release, which involves cutting the ligament forming the roof of the cubital tunnel to create more space for the nerve. This procedure relieves pressure on the ulnar nerve, often resulting in a shorter recovery period compared to other surgical options.
The second common procedure is ulnar nerve transposition, where the nerve is physically moved from behind the medial epicondyle to the front of the elbow. This repositioning prevents the nerve from stretching or getting caught on the bony prominence when the elbow is bent. After either surgery, the arm is immobilized briefly, and a period of rehabilitation is necessary to regain full function, with recovery extending from a few weeks to several months.
Long-Term Strategies for Maintaining Recovery
Preventing the recurrence of cubital tunnel syndrome, whether after successful conservative treatment or surgery, focuses on sustained lifestyle and ergonomic modifications. At a workstation, proper setup includes adjusting chair height to ensure the elbows are kept relatively straight and avoiding leaning on the elbows while typing. The arms should float over the work surface rather than resting on armrests that press directly on the nerve.
Habits that involve prolonged elbow flexion must be addressed, such as holding a phone to the ear or sleeping with the arms fully bent. Using a headset for phone calls and continuing to use a night splint helps maintain the neutral position of the elbow. Maintaining an ongoing regimen of gentle stretching and nerve gliding exercises ensures the continued mobility and health of the ulnar nerve.