Adult
Cubital tunnel syndrome
Ulnar nerve · elbow
What it is
The ulnar nerve passes behind the inner side of the elbow, in a bony groove, and then under a band of fascia. It is the nerve you hit when you knock your elbow.
Bending the elbow stretches the nerve and narrows the passage, which is why symptoms worsen when the elbow stays bent for a long time. An old elbow fracture, a cyst, or an unstable nerve can all contribute.
Symptoms
Numbness and tingling in the little finger and half the ring finger, worse with the elbow bent — on the phone, driving, at night. A dull ache can run along the inner side of the forearm.
Loss of grip strength, difficulty crossing the fingers and clumsiness with fine tasks follow. At an advanced stage there is a hollow between the thumb and index and clawing of the last two fingers.
Non-operative treatment
Avoiding a sustained bent elbow and direct pressure on it — on an armrest, on a desk — often changes a great deal.
A night splint, or simply a towel wrapped around the elbow to stop it bending during sleep, is effective and well tolerated. Nerve gliding exercises complete the treatment. Many mild cases settle this way.
Surgical treatment
In-situ decompression releases the structures compressing the nerve while leaving it in its groove. It is the least invasive option and suits the majority of cases.
If the nerve is unstable and flips over the bony prominence with each bend, or if there is deformity left from an old fracture, the nerve is moved to the front of the elbow — a transposition. The choice is made on examination and sometimes during the operation.
Recovery expectations
Movement is encouraged early. After a transposition a sling or splint is worn briefly.
Nerve recovery is slower than in carpal tunnel: improvement is spread over several months, and muscle wasting that has been present a long time does not always recover completely. What matters is that surgery reliably stops the progression, which is the argument for not waiting too long.
These pages give general information for patients and referring physicians. They do not replace an individual assessment: the treatment plan is decided in consultation, based on your examination and your goals.