Cubital Tunnel Syndrome (Ulnar Nerve at the Elbow)

Overview

The ulnar nerve is the nerve you hit when you bang your "funny bone". It runs down the inside of the arm, passes through a narrow channel behind the bony point on the inner elbow (the cubital tunnel), and continues to the little finger and half of the ring finger. It also powers many of the small muscles in the hand.

Cubital tunnel syndrome happens when this nerve is squeezed or stretched at the elbow. Bending the elbow fully tightens the tunnel and stretches the nerve, so symptoms are typically worst when holding a phone to your ear, sleeping with the arms curled up, or resting the elbow on a desk. The classic symptom is tingling or numbness in the little finger and ring finger — the "pinky side" of the hand — with aching on the inner elbow and forearm.

It is the second most common nerve entrapment in the arm after carpal tunnel syndrome. Mild cases often improve by changing habits that keep the elbow bent or under pressure. More severe or long-standing compression can lead to weakness of grip, clumsiness with fine tasks, and eventually wasting of the small hand muscles, which is why persistent symptoms should be assessed properly.

Causes and risk factors

• Prolonged elbow bending: phone calls, sleeping with arms curled, driving with the elbow on the window
• Leaning on the inner elbow at a desk
• Repetitive elbow bending in work or sport (throwing, weightlifting)
• A previous elbow fracture, dislocation or arthritis that narrows the tunnel
• A nerve that slips over the bony point when the elbow bends
• Diabetes and other conditions that make nerves more vulnerable

How we may be able to help

Because tingling in the hand can come from the neck, the shoulder, the elbow or the wrist, our assessment traces the whole path of the nerve. We test sensation and strength in the hand, check the nerve's mobility at the elbow, and examine the neck and shoulder to rule out other sources. If there is weakness, muscle wasting, or symptoms have not improved after a period of conservative care, we can arrange an online private GP consultation for nerve conduction studies or a specialist opinion.

For mild to moderate cases, physiotherapy focuses on taking pressure off the nerve: detailed advice on elbow positions at work, on the phone and in bed; nerve gliding exercises that help the ulnar nerve move freely without over-stretching it; and strengthening of the shoulder and arm so the elbow is not held bent for support. Kinesiology taping can act as a reminder to keep the elbow straighter at night.

Hands-on treatment — soft tissue work and dry needling for the tight forearm flexor muscles and the muscles around the elbow that can compress the nerve — may reduce irritation. If the neck or upper back is contributing, our chiropractor can assess and treat it, as nerve symptoms are often worse when the nerve is irritated at more than one point.

What you can do at home

• Avoid holding the elbow fully bent for long periods — use a headset or speaker for calls
• At night, wrap a towel loosely around the elbow or wear an elbow sleeve to stop it curling up fully
• Do not lean on the inner elbow; pad the armrest or desk edge if needed
• Keep the elbow straighter when carrying bags
• Try gentle nerve glides your therapist shows you, stopping if tingling increases
• Review your desk set-up so your forearms are supported without pressure on the elbows