Cubital Tunnel Syndrome

If you’re experiencing numbness, tingling, or pain in your ring and little fingers, especially when your elbow is bent, cubital tunnel syndrome may be the culprit. Iowa Ortho’s hand and upper extremity specialists provide expert evaluation and treatment to help relieve symptoms, restore function, and prevent permanent nerve damage.

What is cubital tunnel syndrome?

Cubital tunnel syndrome is compression or irritation of the ulnar nerve as it passes through the cubital tunnel, a narrow passageway on the inside of the elbow. The ulnar nerve supplies sensation to your ring and small fingers and helps control some of the hand’s fine motor functions.

Because this nerve has to bend and stretch when you flex your elbow, repeated bending, pressure, or anatomical irregularities in the tunnel can contribute to symptoms.

Causes & risk factors

Several factors increase the risk of developing cubital tunnel syndrome:

• Frequent elbow bending (e.g., holding phone, driving, sleeping with bent elbows)
• Leaning or resting on the elbow for prolonged periods (elbow pressure)
• Prior elbow injury (fracture, dislocation) or arthritis, bone spurs near the elbow joint
• Anatomical variation or thickened tissue around the cubital tunnel

Symptoms to watch for

Signs and symptoms of cubital tunnel syndrome often progress gradually and may include:

• Numbness, tingling, or “pins and needles” in the ring and small fingers, especially when the elbow is bent
• Pain or aching on the inside of the elbow, which may radiate into the forearm or hand
• Weakness in grip or difficulty with fine motor tasks (like buttoning or typing)
• Symptoms worsen at night or during activities when the elbow is flexed
• In advanced cases, muscle wasting in the hand, if left untreated

Diagnosis

At Iowa Ortho, diagnosing cubital tunnel syndrome involves:

1. Medical history & physical exam — Questions about your symptoms, activities, and elbow postures. Your doctor will test strength, sensation, and look for signs like Tinel’s sign (tapping over the nerve to reproduce tingling) and elbow flexion tests.
2. Electrodiagnostic studies (EMG / nerve conduction studies) — These tests assess how well the ulnar nerve is functioning and locate the site and severity of compression.
3. Imaging (X-ray, MRI, possibly ultrasound) — To check for anatomical causes, bone spurs, arthritis, or other structures compressing the nerve.

Treatment options

Non-surgical care

Most patients begin with conservative treatments, including:

• Activity modification – Limiting elbow bending, avoiding pressure on the elbow, and changing sleep positions.
• Bracing or splinting, especially at night, to keep the elbow more extended and reduce nerve stretch.
• Elbow pads or protection when leaning on arms or hard surfaces.
• Physical / hand therapy, including nerve gliding/flossing and strengthening exercises.
• Anti-inflammatory medications to reduce pain and swelling.

Surgical treatment

If symptoms persist, worsen, or there is evidence of nerve damage (weakness, muscle wasting), surgery may be necessary. Surgical options include:

• In situ decompression / cubital tunnel release — releasing the constricting tissues without moving the nerve.
• Ulnar nerve transposition — moving the nerve away from the elbow (anteriorly) so it doesn’t stretch or rub against bone.
• Medial epicondylectomy — removing part of the medial epicondyle to eliminate pressure or friction on the ulnar nerve.

Recovery & outlook

• Many patients see improvement with non-surgical care within weeks to months.
• After surgery, recovery usually involves splinting or bracing, followed by hand therapy to restore strength, flexibility, and function. Time to full recovery can vary depending on how long symptoms were present and how severe the nerve compression was.
• Early treatment is important. If treatment is delayed once muscle wasting or severe weakness occurs, full recovery may be harder.

Why choose Iowa Ortho for cubital tunnel syndrome?

• Specialists in hand & upper extremity care with experience treating nerve compression disorders
• Access to advanced diagnostic tools (nerve conduction/EMG, imaging) and in-house therapy
• Personalized treatment plans, including both non-surgical and surgical options, tailored to your symptoms, anatomy, and lifestyle
• Commitment to restoring function, relieving pain, and preventing long-term complications

When should you call us?

You should contact Iowa Ortho if:

• Numbness or tingling in your hand/fingers persists for several weeks
• You have a weakness in grip, or notice your hand is dropping items
• Symptoms interfere with daily activities or sleep
• You notice muscle wasting or decreased motion

Take the next step

If you have symptoms of cubital tunnel syndrome, numbness, tingling, elbow pain, or hand weakness, don’t wait. Early diagnosis and treatment can help prevent permanent nerve damage.

Call Iowa Ortho at 515-247-8400 or schedule an appointment online with one of our hand and upper extremity specialists.