Cubital Tunnel Syndrome
Recognising the Symptoms and Signs
Ali Phillips | Hand & Wrist Specialist
Tingling in your little finger?
I'm Ali Phillips. If you're experiencing numbness or "pins and needles" in your ring and little fingers, especially when your elbow is bent, you might have Cubital Tunnel Syndrome. Let's explore what's happening to your "funny bone" nerve and how we can get it sorted.
Book a ConsultationWhat is Cubital Tunnel Syndrome?
Cubital Tunnel Syndrome is a condition where the ulnar nerve—often called the "funny bone" nerve—gets squeezed or irritated as it passes through a narrow passage on the inside of your elbow called the cubital tunnel.
This pressure can be caused by leaning on your elbow, frequently bending it for long periods (like when talking on the phone or sleeping), or sometimes from your unique anatomy. When the nerve is compressed, it can't function properly, leading to the classic symptoms in your hand and fingers.
What are the symptoms of Cubital Tunnel Syndrome?
Numbness & Tingling
A "pins and needles" feeling or numbness, especially in the ring and little fingers. This is often worse at night or when the elbow is bent.
Pain on Inner Elbow
A dull ache or sharp pain on the inside of the elbow, where the "funny bone" is located.
Hand Weakness
Difficulty with grip, dropping things, or a loss of coordination in your fingers for fine motor tasks.
Are Your Fingers Tingling?
If these symptoms are affecting your daily life or waking you up at night, it's time to get an accurate diagnosis. Let's find out what's going on and create a plan to help.
Get a Clear DiagnosisHow will I diagnose your elbow?
A diagnosis is usually made from our conversation and a gentle examination of your arm and hand. A simple test you can try at home is the Elbow Flexion Test, but please stop if it makes your symptoms significantly worse.
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Hold your elbow fully bent, as if holding a phone to your ear.
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Keep your wrist straight in a neutral position.
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Hold this position for up to one minute.
If this position reproduces the tingling or numbness in your ring and little fingers, it's a strong indicator of Cubital Tunnel Syndrome. In the clinic, I may also use nerve tests (NCS/EMG) to confirm the diagnosis and check the severity of the nerve compression.
How can I help you get better?
The goal is simple: to take the pressure off your ulnar nerve. We'll create a plan together, always starting with the simplest options.
Activity Modification We'll identify and change habits that compress the nerve, like leaning on your elbow or keeping it bent for long periods.
Night Splinting Wearing a simple splint at night to keep your elbow straight can make a huge difference by preventing nerve compression while you sleep.
Hand Therapy A therapist can teach you "nerve gliding" exercises to help the ulnar nerve move more freely through the cubital tunnel.
Medications Over-the-counter anti-inflammatory medications can sometimes help relieve pain and swelling.
Surgery is a very effective and reliable option if your symptoms are severe, constant, or if you have muscle weakness. The goal is to give the nerve more space and prevent permanent damage.
Cubital Tunnel Decompression
This is the most common procedure. I make a small incision on the inside of the elbow and carefully cut the tight ligament (Osborne's ligament) that forms the roof of the cubital tunnel. This immediately gives the nerve more room.
Ulnar Nerve Transposition
If I find that your nerve is unstable and snaps over the bone when you bend your elbow, I will move it to a new, more protected position in front of the bone. This prevents the ongoing friction and irritation.
Understanding Consent for Surgery
If we decide surgery is the right path, it is imperative that you understand the process, the risks, and your rights. This is a partnership, and your informed consent is the most important part.
You have every right to choose not to have surgery, even after we have discussed it. We can always continue with non-surgical treatments or decide on no treatment at this time. The decision is always yours.
It is critical to appreciate that all surgery has risks. The decision to proceed is a fine balance between the potential benefits and these risks.
The only person who can judge that balance is you. My role is to give you the clearest possible information so you can make the choice that is right for you.
Cubital tunnel surgery is very safe, with an overall complication rate of about 1 in 11. Most issues are minor. Potential risks include:
- Haematoma: A collection of blood under the skin, which occurs in about 1 in 10 cases and usually resolves on its own.
- Infection: The risk of a wound infection is low, around 1 in 25 cases.
- Nerve Instability: In a small number of cases (about 1 in 50), the nerve may become unstable and snap over the bone, which might require further surgery.
- Ongoing Symptoms: While surgery has a high success rate (around 87%), some numbness or pain can persist, especially if the nerve damage was severe before the operation.
- Scar Tenderness: The scar can be tender or sensitive for a time, and there can be some numbness around it from stretching small skin nerves. This affects about 1 in 10 patients but usually improves.
Frequently Asked Questions
The key difference is the nerve involved and the fingers affected. Cubital tunnel syndrome involves the ulnar nerve and causes numbness in your ring and little fingers. Carpal tunnel syndrome involves the median nerve and affects your thumb, index, and middle fingers.
Mild cases can sometimes improve by changing your habits, like avoiding leaning on your elbow and wearing a splint at night. However, if symptoms are persistent or getting worse, it's important to seek treatment to prevent long-term nerve damage.
Surgery is considered when your symptoms are severe, constant, or if you have muscle weakness and wasting. It's also an option if non-surgical treatments haven't provided enough relief. The goal of surgery is to prevent permanent nerve damage.
The most common procedure is a simple "decompression," where I make a small incision and release the tight tissue over the nerve to give it more space. In some cases, if the nerve is unstable, I may move it to a new, more protected position in front of the elbow bone (an "anterior transposition").
Recovery is usually quick. The wound needs to be kept clean and dry for two weeks, but you can start using your hand for light activities right away. Numbness can take longer to improve as nerves heal very slowly, but the goal is to stop it from getting any worse.
If left untreated, severe and constant pressure on the ulnar nerve can lead to permanent damage. This can result in irreversible muscle weakness and wasting in the hand, as well as a permanent loss of sensation in the ring and little fingers.
Many people sleep with their elbows bent, often tucked up towards their head. This position puts the ulnar nerve on stretch and increases the pressure within the cubital tunnel, which is why symptoms are often most noticeable at night or upon waking.
Yes, but it's important to be mindful of your posture. Avoid resting your elbows on the hard surface of a desk or the arms of your chair. Try to keep your elbows more open (less bent) and take regular breaks to stretch and change position.
These are a specific set of gentle movements designed to help the ulnar nerve slide back and forth smoothly within its tunnel. A hand therapist can teach you the correct technique to perform these exercises safely and effectively.
If you are struggling with these symptoms, it is best to see a specialist hand surgeon like me. I have the expertise to accurately diagnose the problem, assess its severity, and offer the full range of modern non-surgical and surgical treatments.
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