Cubital Tunnel Syndrome

Overview

Occurs when the ulnar nerve becomes impinged at the cubital tunnel in the elbow
Causes symptoms such as numbness/tingling and muscle weakness on the ulnar side of the forearm and ulnar nerve innervation of the hand
Is a form of neuropathy (2nd most common in the upper extremity behind carpal tunnel syndrome)

What is the Cubital Tunnel?

Also called the ulnar tunnel
Is a passageway for the ulnar nerve to get from the arm to the forearm

Borders:

Medial wall: Medial epicondyle of the humerus
Lateral wall: Olecranon of the ulna
Floor: Elbow joint capsule and medial collateral ligament of elbow
Roof: Ligament of Osborne (also called cubital tunnel retinaculum)
- Ligament of Osborne is fascia that spans across both heads of the flexor carpi ulnaris (FCU) muscle

Contents:

Ulnar nerve

Causes

The ulnar nerve can become entrapped in many ways
Repetitive or prolonged elbow flexion - elbow flexion reduces space in the cubital tunnel which increases compression
- The two heads of the ulnar carpi ulnaris can squeeze the ulnar nerve when activating during elbow flexion
- The ligament of Osborne can compress on the ulnar nerve as well during elbow flexion
- Can be from work, phone use, sleeping position, etc.
- Prolonged leaning on elbow is another common cause
Genetics
- Some individuals may be predisposed to a narrow cubital tunnel
Direct trauma to the elbow
Subluxation of the ulnar nerve
- Ulnar nerve shifts out of its normal position and goes over the medial epicondyle with elbow movement
- Can cause repeated irritation or compression of the ulnar nerve
Systemic conditions like diabetes or thyroid disease

Symptoms

Early symptoms:

Numbness/tingling in the ulnar nerve distribution of the hand
Pain or tenderness on the medial aspect of the elbow
Symptoms often worsen during activities such as repetitive elbow use, sleeping with the elbow bent, or holding a phone

Advanced symptoms:

Muscle weakness in the hand
Clumsiness or difficulty with fine motor activities
Muscle atrophy in the hand
Claw deformity of the 4th and 5th digits

Treatment Ideas

Always ask your fieldwork educator or supervising therapist and review any followed protocols before implementing any of the following

Ulnar nerve flossing and gliding

Theraputty for strengthening

Patient education on positioning (person in this photo with elbow at 90 degrees will compress the ulnar nerve)

Quiz Questions

What nerve is affected in cubital tunnel syndrome?

A. Ulnar nerve

B. Radial nerve

C. median nerve

D. Axillary nerve

Which muscle surrounds the cubital tunnel and can contribute to nerve compression?
A. Flexor digitorum superficialis
B. Flexor carpi radialis
C. Flexor carpi ulnaris
D. Pronator teres
Which movement commonly increases pressure in the cubital tunnel?
A. Wrist extension
B. Elbow flexion
C. Shoulder flexion
D. Finger abduction
Which of the following is an early symptom of cubital tunnel syndrome?
A. Thumb pain
B. Numbness in the index finger
C. Numbness in the ring and pinky fingers
D. Muscle wasting in the thenar eminence
Which activity is most likely to worsen cubital tunnel symptoms?
A. Typing with straight wrists
B. Sleeping with the elbow extended
C. Holding a phone with a bent elbow
D. Lifting with a straight arm
Which of the following is a sign of advanced cubital tunnel syndrome?

A. Increased grip strength

B. Tingling that resolves quickly

C. Elbow dislocation

D. Claw deformity of the 4th and 5th digits

Quiz Answers

References

Andrews, K., Rowland, A., Pranjal, A., & Ebraheim, N. (2018). Cubital tunnel syndrome: Anatomy, clinical presentation, and management. Journal of Orthopaedics, 15(3), 832–836. https://doi.org/10.1016/j.jor.2018.08.010

Cubital tunnel syndrome. (2024, April 26). https://www.hopkinsmedicine.org/health/conditions-and-diseases/cubital-tunnel-syndrome

Jones, O. (2022). The Ulnar Tunnel. Teach Me Anatomy. https://teachmeanatomy.info/upper-limb/areas/ulnar-tunnel/

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