In short, there are multiple paths to relief for ulnar nerve compression, formally known as cubital tunnel syndrome.
- Nonsurgical options work. Most mild cases improve significantly with simple changes like bracing and anti-inflammatory medication.
- Surgery is effective. Procedures such as nerve transposition or decompression offer long-term solutions for severe or persistent cases.
- Early intervention matters. Seeking medical advice quickly prevents permanent nerve damage and chronic muscle weakness in the hand.
This guide explores the full spectrum of care available to patients.
What Is Cubital Tunnel Syndrome?
Before discussing how to fix the problem, it is helpful to understand the anatomy. The ulnar nerve runs from your neck down into your hand. It passes through a tunnel of tissue (the cubital tunnel) on the inside of the elbow.
When you bend your elbow, the nerve stretches around the bony ridge known as the medial epicondyle. If the nerve gets squeezed or irritated in this spot, you experience numbness in the ring and small fingers. You may also feel significant elbow pain on inside the arm.
The goal of all treatments for cubital tunnel syndrome is to reduce pressure on this nerve. By relieving the pressure, the nerve can heal, and normal feeling and strength can return to the hand.
Diagnosing the Severity Before Treatment
A physician cannot determine the best course of action without a thorough evaluation. They will likely tap over the nerve at the “funny bone” to see if it causes a shock-like sensation (Tinel sign).
They may also check for weakness in your grip or a loss of bulk in the small muscles of the hand. To confirm the diagnosis and rule out other issues like diabetes or thyroid conditions, they might order tests.
An electromyography (EMG) and nerve conduction study measure how well the nerve is working. These tests help the doctor see if the compression is mild, moderate, or severe. X-rays help rule out bone spurs or arthritis that might be crowding the tunnel.
Nonsurgical Treatments for Cubital Tunnel Syndrome
For many patients, especially those whose symptoms are intermittent or mild, surgery is not the first step. Conservative management is often highly effective. The primary goal of nonsurgical care is to stop the irritation so that the nerve inflammation can subside.
Medications To Reduce Inflammation
The first line of defense often involves reducing the swelling around the nerve. If the tissue inside the tunnel is swollen, it leaves less room for the nerve.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly recommended. Drugs such as ibuprofen (Advil) or naproxen (Aleve) can help decrease swelling. While these do not cure the compression if it is caused by a physical issue, they provide symptom relief.
- Steroid injections are another option, though they are used less frequently for this condition than for carpal tunnel syndrome. A corticosteroid (Cortisone) is a powerful anti-inflammatory medicine. However, injecting it near the ulnar nerve carries a risk of damaging the nerve itself.
Bracing And Splinting
We bend our elbows frequently while we sleep. This puts the ulnar nerve in a stretched and compressed position for hours at a time. This is why many people wake up with numb fingers.
A padded brace or splint worn at night keeps the elbow in a straight position. This simple step rests the nerve and is often one of the most effective treatments for cubital tunnel syndrome.
Nerve Gliding Exercises
Physical therapy plays a major role in recovery. Therapists prescribe specific movements called nerve gliding exercises. These exercises help the ulnar nerve move smoothly through the cubital tunnel.
They prevent the nerve from getting stuck or tethered to surrounding tissue. These exercises also help improve range of motion and reduce stiffness.
Lifestyle Modifications
Changing how you use your arm is vital. You should avoid leaning on your “funny bone” or resting your elbow on hard surfaces like a desk or armrest.
Headsets for telephones can prevent you from holding your elbow bent for long periods. If your workstation requires you to keep your elbows bent greater than 90 degrees, you may need ergonomic adjustments.
Surgical Treatments for Cubital Tunnel Syndrome
If nonsurgical methods do not provide relief after several months, or if the nerve compression is severe, surgery becomes necessary. If you already have muscle wasting in the hand, surgery is usually recommended immediately to prevent further irreversible damage.
There are several surgical techniques used to relieve pressure on the ulnar nerve. Your surgeon will recommend the best option based on your anatomy.
Cubital Tunnel Release
This procedure is also known as decompression. It is similar in concept to carpal tunnel release. The surgeon cuts the roof of the cubital tunnel.
This ligament, called the Osborne ligament, is divided to increase the size of the tunnel. This gives the nerve more room. The nerve remains in its original location behind the bump of the bone.
This surgery is often performed through a small incision on the inner side of the elbow. It is generally effective for mild to moderate compression where the nerve does not pop out of place when the elbow bends.
Ulnar Nerve Anterior Transposition
In many cases, the nerve needs to be moved out of its original groove. This is called an anterior transposition. The surgeon moves the ulnar nerve from behind the medial epicondyle to the front of it.
By moving the nerve to the front, it is no longer stretched when the elbow bends. There are two main ways to place the nerve:
- Subcutaneous transposition: The nerve is placed under the skin but on top of the muscle.
- Submuscular transposition: The nerve is placed deeper, underneath the muscle.
Medial Epicondylectomy
Another surgical option involves removing part of the medial epicondyle. This is the bony bump on the inside of the elbow.
By shaving down this bone, the nerve has more space and is not stretched as tightly when the elbow moves. This procedure is less common than transposition but is still a valid option in specific anatomical situations.
Recovery After Surgery
Recovery times vary depending on the type of surgery performed. If you have a simple decompression, you may only need a soft dressing. You can likely start moving your elbow gently within a few days.
If you undergo a transposition, recovery takes longer. You may need to wear a splint for a few weeks to keep the nerve protected in its new position.
Physical therapy is usually required after surgery to restore strength and motion. You will learn exercises to prevent stiffness.
Treatments for Cubital Tunnel Syndrome in Maryland
Do not let numbness and pain limit your life. The sooner you address the compression on your ulnar nerve, the better your chances for a complete recovery.
Whether you need guidance on nonsurgical options like bracing or require advanced surgical intervention, our team at Greater Chesapeake Hand to Shoulder is here to help. We specialize in the diagnosis and treatment of conditions affecting the hand and upper extremity.
Call Greater Chesapeake Hand to Shoulder at (410) 296-6232 to schedule an evaluation and discuss the best treatments for cubital tunnel syndrome for your specific needs. Let us help you restore comfort and function to your hands.
