An Occupational Therapy Guide to Cubital Tunnel Syndrome
If you have ever knocked your "funny bone," then you know what it can feel like to have Cubital Tunnel Syndrome. Calling it a "funny bone" is actually a misnomer as the structure that is affected is the ulnar nerve, not a bone.
Cubital Tunnel Syndrome causes pain, weakness, and numbness/tingling in the hand on the ring finger and small finger side. Left untreated, Cubital Tunnel Syndrome can progress to become more problematic affecting work, function, and lead to permanent damage.
If you think you may have the symptoms of Cubital Tunnel Syndrome, you may notice that you struggle with removing items from your wallet or gripping strongly. If it's been going on for some time, you may experience a droopy ring or small finger.
This guide gives you in-depth information about Cubital Tunnel Syndrome, its treatment, and how seeing a Certified Hand Therapist and occupational or physical therapist can help.
- Understanding Cubital Tunnel Syndrome
- Symptoms of Cubital Tunnel Syndrome
- What are the Most Common Causes of Cubital Tunnel Syndrome?
- Diagnosing Cubital Tunnel Syndrome
- What to Expect from Hand Therapy
- What If Conservative Treatment Does Not Work?
- Preventing Cubital Tunnel Syndrome
- Is It Time to Seek Treatment?
Cubital Tunnel Syndrome is the second most common site for nerve compression after Carpal Tunnel Syndrome. Cubital Tunnel Syndrome causes numbness, tingling, and weakness in your ring and small fingers due to entrapment of the nerve at the elbow where Carpal Tunnel Syndrome causes numbness in your thumb, index, and middle fingers due to compression at the wrist. 1
Your Elbow and the Nervous System
To understand Cubital Tunnel Syndrome, it is important first to understand your nervous system as it functions normally.
Your body and brain communicate through a network of tissues called nerves. Nerves send and collect information from your environment back to your brain.
From your brain comes your spinal cord, which is the most central area of your nervous system. Like an interstate highway, your spinal cord then branches into exit roads, major thoroughfares, and tiny dirt roads — all collectively called "nerves."
To help guide your nerve down its path, your body creates a series of anchors and tunnels, just as a road is guided by the surrounding landscape.
Cubital Tunnel Syndrome and Nerve Dysfunction
Now, let's shift your focus to more details about the nerves themselves as it relates to Cubital Tunnel Syndrome.
Nerves act like a water hose to your skin and muscles. If there is a kink in your water hose, your grass does not get watered. If your grass does not get watered, your grass will become weak and eventually die.
This is the case in Cubital Tunnel Syndrome. Your ulnar nerve is the water hose that gets compressed under the cubital tunnel at the elbow either from stretching around the corner of the elbow or compression from swelling.
Since the ulnar nerve supplies both sensory (feeling) and motor (muscle) function to your ring finger and small finger, you may begin to notice weakness or numbness/tingling in those fingers specifically.
If your ring and small finger muscles (your "grass") are not supplied with stimulation from your ulnar nerve, they can become weak and start to die (numbness and atrophy or weakness). At a certain point, this can result in permanent damage and muscle loss.
What are the symptoms of Cubital Tunnel Syndrome? Let's review.
- Poor coordination during fine motor tasks (like removing items from your wallet)
- Weak grip or key pinch
- Numbness and tingling especially in the ring finger and small finger
- Muscle weakness or atrophy, with a loss of muscle bulk on the pinky finger side of the hand and/or the first web space
- Inability to fully straighten the ring finger or small finger
While many different types of folks can experience cubital tunnel syndrome, below are the most common risk factors.2
- Prior trauma to the elbow
- Bone spurs or arthritis of the elbow
- Prolonged bending of the elbow beyond 90 degrees
- Poor ergonomic work station
Cubital Tunnel Syndrome can be diagnosed clinically with a few different tests and screens. Your doctor may order imaging like an MRI, ultrasound, or nerve conduction test (EMG) to determine whether or not your nerve is compressed at some point on its way from your brain down to your hand.
A Certified Hand Therapist can also help diagnose your elbow issue properly — you can even schedule with one directly with no need for a doctor referral in most cases. They use clinical tools to help rule out other factors like potential neck issues.
If caught early enough, Cubital Tunnel Syndrome can respond well to conservative management. However, if your symptoms progress past a certain point, surgery to release the nerve from its entrapment may become necessary to address your pain, weakness, and muscle atrophy.
Many people avoid medical intervention due to poor past experiences, which is understandable. However, we try to keep it simple and help you understand what to expect. At your first visit, your therapist may ask questions like:
- When did your symptoms start?
- What activities or positions make it better or worse?
- Do you have any medical conditions we should know about?
- What are three things you cannot do right now that you wish you could because of your wrist pain?
- What major life changes have you experienced in the last year?
Your therapist will also perform a thorough physical evaluation which may include:
- Evaluation of soft tissue, joint, or muscle integrity
- Measuring range of motion and strength
- Testing functional abilities and coordination
- Noting sensory changes, like numbness or tingling
- Palpating areas of tenderness
- Observing swelling (edema)
Treatment sessions will vary but will include some combination of:
- Custom splint making to keep your arm straight during the night
- Wound care (especially if you have surgery)
- Edema (swelling) control
- Pain reduction techniques like manual therapy (hands-on treatment), modalities like deep heat, and meditation
- Being your guide through education and validation of your pain
- Gentle, progressive exercises to build motion, function, coordination, and strength
- Activity modification to improve your independence with activities of daily living
If your condition has progressed beyond what conservative management has to offer, your doctor may offer a surgical release of your ulnar nerve (called Cubital Tunnel Release) and may even move your nerve to a safer spot around the corner (called an Ulnar Nerve Transposition).
You may be referred to hand therapy post-operatively to assist in your recovery.
One can reduce the chances of experiencing Cubital Tunnel Syndrome with the following suggestions:
- Stay active: Brisk walking provides good circulation to your whole body, including your nerves, which can be helpful in preventing nerve damage.
- Evaluate your work station: If you work from a computer like much of the workforce these days, ensure you have your station evaluated for ergonomic use. You can ask your employer or seek help from an ergonomic specialist.
- Make healthy lifestyle choices: Try to get enough sleep, stay hydrated, and eat nutrient dense foods. Practice healthy stress management. Do your best to stop tobacco use. Your whole body will thank you!
- Protect your elbow from micro-traumas: Avoid resting on your elbow for prolonged periods of time, like while driving or texting. Keep moving and stretching throughout your day.
- Talk to a Certified Hand Therapist: If you have concerns or want professional advice on splinting, treatments at home, and functional adaptations, make an appointment!
If you suspect Cubital Tunnel Syndrome, and your symptoms keep getting worse, it's time to talk to a Certified Hand Therapist (CHT) to determine next steps. Certified Hand Therapists are occupational or physical therapists with specialized training in upper extremity rehabilitation that can help diagnose, treat, and heal your Cubital Tunnel Syndrome.
To get started on your road to recovery, book an an appointment with a CityPT CHT.
This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.
An TW, Evanoff BA, Boyer MI, Osei DA. The Prevalence of Cubital Tunnel Syndrome: A Cross-Sectional Study in a U.S. Metropolitan Cohort. J Bone Joint Surg Am. 2017 Mar 1;99(5):408-416. doi: 10.2106/JBJS.15.01162. PMID: 28244912; PMCID: PMC5324036. ↩