This condition involves the compression of the ulnar nerve at the elbow.
Cubital tunnel syndrome typically occurs with the elbow in flexion and causes intermittent paraesthesia of the little and ring fingers and ulnar aspect of the forearm. In advanced cases there may be wasting of the hypothenar and intrinsic muscles of the hand and a claw (flexion) deformity of the little and ring fingers.
Pain, paraesthesia and weakness may be caused by compression of the involved nerve at any point along its path. Careful history and examination, including that of the neck, will often point to the likely site of compression, but nerve conduction studies (NCS) are often arranged to confirm the diagnosis when the clinical impression is unclear (This is usually arranged in clinic if appropriate).
Surgical decompression may be required and is typically performed as general anaesthetic daycase procedure through a 15-20cm incision overlying the ulnar nerve at the elbow. The speed and degree of symptomatic relief is dependant upon their duration and severity. Post-operatively, the patient may require several weeks off work.
M.A & L.L – 28-10-26
Who to refer
Please see Primary care management section for Trial of Therapy pre-referrral
- Pins and needles +/- muscle weakness and wasting in ulnar nerve distribution (little & ring fingers, intrinsic muscle weakness in the hand, wasting of dorsal 1st web space) of duration over 6 months not responding to conservative measures or present all the time
Who not to refer
- Early (<6 months) intermittent pins and needles in ulnar nerve distribution without trial of non-operative treatment (eg. reduced elbow flexion, simple measures at work, preventive measures)
- Radicular pain – please consider referring to Neurosurgery
How to refer
SCI Gateway: SJH > Plastic Surgery – Hand Service > Hand Clinic
Conservative treatment includes awareness and avoidance of postures that initiate symptoms and avoidance of prolonged pressure at the elbow. Soft splints can limit elbow flexion and therefore relieve symptoms at night.
Trial of therapy pre-referral
- Patient education to avoid elbow flexion with pressure on the nerve
- Please consider advising the followings:
- trial of sleeping with elbow in extension, to be done every night for at least three months even if no immediate benefit is seen. Advise on using a towel wrapped around arm/elbow/forearm rather than an elbow splint, which is poorly tolerated
- avoid pressure on medial elbow at work/use soft pads if necessary
- avoid activities that keep the elbow in flexion for prolonged periods or put in place preventive measures (i.e. earphones, book supports..)
- consider referring to physiotherapy for nerve gliding exercises if available
