Ask the MSK Expert: Cubital Tunnel Syndrome


What is cubital tunnel syndrome? What are symptoms and possible treatment options?

Dr. Pfaeffle says: “Cubital tunnel syndrome is caused by a pinched ulnar nerve at the elbow. Everyone knows the ulnar nerve as your funny bone. It runs in a groove along the inside of your elbow.

“Common symptoms of cubital tunnel syndrome include pain in the elbow at the funny bone, which travels down the inside of the arm into the ring and small fingers. As with any pinched nerve, there is usually intermittent numbness and tingling. In cubital tunnel syndrome, numbness occurs in the ring and small fingers. Patients may also experience weakness in grip and pinch. The hand can feel clumsy as the ulnar nerve runs the small muscles in the hand.  Symptoms are worse when the elbow is bent or leaned upon. Often, patients wake up at night with pain and numbness because they sleep with a bent elbow.

“An EMG (Electromyography) nerve conduction study is usually ordered to help evaluate and diagnose cubital tunnel syndrome. This test looks for a pinched nerve at the wrist, elbow and neck; all of which can cause hand numbness. Disease is graded as mild, moderate or severe. In early cubital tunnel syndrome, this study may be normal.

“When disease is severe, weakness can be profound, and patients have difficulty keyboarding and holding forks and pencils. The muscles in the hand can become smaller over time (muscle wasting). Numbness will become constant instead of intermittent. 

“It is important to treat cubital tunnel syndrome. If left unchecked, disease will become severe and lead to permanent ulnar nerve damage. Nonsurgical treatment is recommended for several months when disease is not severe. Options include avoiding activities that cause direct pressure on the ulnar nerve at the elbow, wearing a protective elbow pad during the day and a night splint that keeps the elbow straight.  If conservative measures don’t work, or if disease is severe, there are surgical options that can alleviate symptoms with a high success rate.

“When disease is severe, the ulnar nerve does not always fully recover, and additional measures such as supercharging recovery with a nerve transfer or a tendon transfer to help weakness may be additional surgical options. Following surgery, it takes usually six weeks before patients can use their arm for heavy activity, and the ulnar nerve continues to recover for a year.”

Physician Spotlight

H. James Pfaeffle, MD, PhD, is a fellowship-trained hand and upper extremity surgeon at Tri Rivers. He treats conditions including arthritis of the hand, wrist and elbow; carpal tunnel syndrome; tendinitis; fractures; dislocations; and ligament and tendon injuries.

Dr. Pfaeffle sees patients at our BHS Crossroads Campus and Cranberry/Mars offices. To schedule an appointment with him, or any other Tri Rivers provider, please call 1-866-874-7483 or click here.