⭐ What is Cubital Tunnel Syndrome?
Cubital Tunnel Syndrome is the 2nd most common nerve compression problem in upper extremities (the most common one is carpal tunnel syndrome).
It happens when your ulnar nerve is compressed in the elbow, causing tingling and numbness in your inner forearm, ring and little finger. However, even if you are having the above symptoms, it doesn’t mean you are a victim of cubital tunnel syndrome (it can be Thoracic Outlet Syndrome ! ).
Cubital tunnel syndrome can eventually lead to hand weakness and atrophy (intrinsic muscles) and even cause severe shooting pain of the affected hand.
⭐ Elbow Flexion Test
One of the most sensitive (0.75) and specific (0.99) test for this ulnar nerve compression problem is Elbow Flexion Test ¹.
1. Palm facing up (forearm supinated), then hold elbow joint in the maximum flexion.
2. Hold for 1 minute, it is positive if the symptom is reproduced.
* Tinel Sign is another good test with high specificity (0.98) and sensitivity (0.70) ². Tingling and numbness triggered in ring and small finger when tapping your ulnar nerve at the cubital tunnel.
⭐ Tip 1: Manual Therapy
As ulnar nerve pass beneath the muscle mass of Flexor Carpi Ulnaris (FCU). Therefore, FCU tightness and muscle stiffness can lead to more ulnar nerve stress.
* According to my clinical experience, it is important to release FCU, Pects Major and Lat. Dorsi muscles at the same time (based on the theory of Anatomy Trains, see the picture below) to get the best treatment outcome.
⭐ Tip 2: Nerve Gliding Exercise
“The biggest mistake of nerve gliding exercise is doing too much or too fast !“
A systematic review ³ published in 2008 compared 11 randomized controlled trials (RCTs) studies, found nerve gliding exercise (neuro-mobilization) has therapeutic benefits for nerve compression problems.
“However, Most of the ulnar nerve gliding exercise shared online is too aggressive !”
Please make sure to follow the exercises in the video step by step , this is so far the best ulnar nerve exercises I found on youtube.
For exercise picture, click here. (10 reps/time ; 3 times/day)
⭐ Tip 3: Elbow Orthosis / Brace
* Sleeping time: Wear the elbow brace (such as Pil-O-Splint) that keep your elbow bending in 30-45°, it helps to rest your ulnar nerve in the least stressful position.
* You can also wrap your elbow with a towel and tape to prevent elbow over-bending at night.
☀ Day time: Padded elbow sleeve (such as heelbo sleeve) can relieve direct pressure on ulnar nerve in daily activities.
⭐ Tip 4: Activity Modification
Make sure to prevent the following activities which will largely increase the risk of getting cubital tunnel syndrome:
* Putting pressure on inner elbow for too long, such as resting your elbow on the desk while using the computer for too long, or sleeping on your side with the bending elbow.
* Holding your elbow in a bent position for too long, such as guitar player and pianist.
* Repetitive and forceful elbow motions, such as athletes in javelin, tennis and weight lifting.
⭐ Tip 5: Therapeutic Taping
1. FCU relaxation. (start at wrist, end at elbow)
2. Facilitate Triceps to help reminding elbow not to over-bending.
3. Decompress cubital tunnel (donut hole taping).
Overall, conservative treatments of cubital tunnel syndrome consist of Manual Therapy, Nerve Gliding Exercises, Elbow Orthosis, Activity Modification and Therapeutic Taping.
One scientific research even showed these non-invasive treatments have up to 90% success rate within 2-3 months for acute ulnar nerve compression problem ⁴. Therefore, never underestimate the importance of early intervention to prevent severe muscle atrophy and nerve damage!
1. Behr CT, Altchek DW. The elbow. Clin Sports Med. 1997;16:681-704.
2. Novak CB, Lee GW, Mackinnon SE, Lay L. Provacative testing for cubital tunnel syndrome. J Hand Surg Am. 1994;19:817-820.
3. Ellis RF, Hing WA. Neural Mobilization: A Systematic Review of Randomized Controlled Trials with an Analysis of Therapeutic Efficacy. The Journal of Manual & Manipulative Therapy. 2008;16(1):8-22.
4. Shrivastava N, Szabo, RM. Decision making in upper extremity entrapment neuropathies. The Journal of Musculoskeletal Medicine, 2008;25(6), 278-280,284-285,288-289.