Cubital tunnel

syndrome
Carson Law
Overview
Cubital tunnel syndrome (ulnar nerve entrapment)
 Compression or irritation of the ulnar nerve as it
passes through the cubital tunnel
 2nd most common upper limb neuropathy
 Estimated up to 6.8% of the population
 It can happen to individuals of any age
 Can be caused by repetitive pressure, prolonged
long periods of flexion or direct trauma to the
elbow joint
 Can progress to severe muscle atrophy and loss
of hand function if left untreated

(Anderson et al., 2022) (BSSH, 2024)

 Ulnar nerve
 Terminal branch of the medial cord of the
brachial plexus
 One of the three major upper limb nerves
 Contains nerve fibers C8 to T1 nerve roots
 Travels from brachial plexus down to cubital
tunnel then the Guyon’s canal, splits into
palmer and dorsal branches in the hand
 Motor function: Innervates forearm flexor
muscles, also innervates intrinsic muscles of
the hand
 Sensory function: Supplies the medial
forearm. Medial wrist and one-half digit

(Woo, Bakri and Moran, 2015) (Becker and Manna, 2023)

 Symptoms
 Aching or shooting pain along the medial
forearm to the medial half of the 4th digit and
5th digit
 Pins and needles or tingling
 Popping or snapping feeling of elbow joint
on movement
 Weakness or atrophy of hand muscles
 Poor grip strength, unable to grasp onto
objects
 Claw like deformity in severe cases

(Chauhan et al., 2023) (BSSH, 2024)

 Risk factors
 Over 40 years old
 Diabetic
 Smoker
 Pregnancy
 Osteoarthritis or rheumatoid arthritis
 Work that involves long periods of elbow
flexion or repetitive wrist motions
 Throwing or overhead throwing athletes

(Cutts, 2007) (Conti et al., 2016)

Diagnosis
 High resolution neuro ultrasonography
- Visualization of internal structures
- Non-invasive
- Accuracy rates of 98%
- Shorter time
 Electromyogram/ Nerve conduction study
- Evaluate speed of strength of nerve signals
- Uncomfortable due to electrical simulation
- Accuracy rates of 37% to 86%
- Longer time

(Breitenseher et al.,, 2015) (Nakashian, Ireland and Kane, 2020) (Terlemez et al., 2018)
 Diagnosis - Special tests
 Reproduction of symptoms = Positive test

1. Elbow flexion test 2. Tinel’s sign 3. Scratch collapse test

Treatments
 Immobilization
- Night splinting
 Exercises
- Ulnar nerve glides
 Activity modification
- Avoid leaning on elbow, use of
elbow pad
 Ultrasound guided injections
- Reduction in pain and swelling
 Surgery
- Cubital tunnel release
- Ulnar nerve transposition

(Shah et al., 2013) (Graf et al., 2023) (NHS Royal Berkshire, 2024)
 Case study
Patient overview Analysis
 Positive elbow flexion test
Subjective 34-year-old woman, mother of 4, ongoing radiating
pain from elbow to hand for 2 years, fibromyalgia and  Elbow ROM and strength limited by shooting
assessment B12 deficiency, previously suspected CTS. pain
 Tightness in right upper trapezius
 Exacerbated by neck stiffness
VAS 8/10 w 0/10 b. Dull, intermittent pain travels from
medial elbow to pinky finger
Symptoms AM stiffness, occasional pins and needles
Cutting vegetables and lifting heavy objects aggravates
Treatment/Exercises given
pain, sleep affected.
1 Nerve glide exercise for ulnar nerve
2 Cervical rotation and side flexion stretches
Cervical range limited by neck tightness

Objective
Shoulder full range, pain in elbow 3 Pectoralis stretch using door frame
Full elbow range, pain on extension
assessment Phalen’s test –ve
Tinel’s test –ve
4 Soft tissue massage on trapezius for 3 minutes
Elbow flexion test +ve
5 Advice on heat therapy and self massage
Conclusion/Thoughts
 Cubital tunnel syndrome is the second most
common upper limb nerve entrapment after
CTS
 If left untreated can severely affects quality of
life
 Subjective assessment findings are just as
important as objective assessments
 Non-operative treatments are the first line of
treatment
 Explore other treatment options if needed,
patient education is crucial
 The end
Thank you!
CREDITS: This presentation template was created by Slidesgo, including
icons by Flaticon and infographics & images by Freepik
References
Anderson, D. et al., (2022) ‘A Comprehensive Review of Cubital Tunnel Syndrome’, Orthopedic Reviews, 14(3), pp. 1-9. Doi:
https://doi.org/10.52965/001c.38239

British Society for Surgery of the Hand (2024) Cubital tunnel syndrome. Available at:
https://www.bssh.ac.uk/patients/conditions/22/cubital_tunnel_syndrome. (Assessed on 20/5/24)

Svernlov, B. et al., (2009) ‘Conservative Treatment of the Cubital Tunnel Syndrome’, Journal of Hand Surgery, 34(2), pp. 201-207.
Doi: https://doi.org/10.1177/1753193408098480

Chauhan M, Anand P and Das JM. Cubital Tunnel Syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls
Publishing; 2024 Jan-. Available at: https://www.ncbi.nlm.nih.gov/books/NBK538259/(Assessed on 20/5/24)

Shah, CM. et al., (2013) ‘Outcomes of Rigid Night Splinting and Activity Modification in the Treatment of Cubital Tunnel
Syndrome’, Journal of Hand Surgery, 38(6), pp. 1125-1130. Doi: 10.1016/j.jhsa.2013.02.039

Graf, A. et al., (2023) ‘Modern Treatment of Cubital Tunnel Syndrome: Evidence and Controversy’, Journal of Hand Surgery Global
online, 5(4), pp. 547-560. Doi: 10.1016/j.jhsg.2022.07.008

NHS Royal Berkshire (2024) Cubital Tunnel Syndrome. Available at:

https://www.royalberkshire.nhs.uk/media/svmk5mdd/cubital-tunnel-syndrome_jan24.pdf. (Assessed: 21/05/24)
References
Cutts, S. (2007) ‘Cubital Tunnel Syndrome’, Postgraduate Medical Journal, 83(975), pp. 28-31. Doi: 10.1136/pgmj.2006.047456

Conti, M. et al., (2016)’ Treatment of the ulnar nerve for overhead throwing athletes undergoing ulnar collateral ligament
reconstruction’, World Journal of Orthopaedics, 7(10), pp. 650-656. Doi: 10.5312/wjo.v7.i10.650

Becker, RE. and Manna, B. Anatomy, Shoulder and Upper Limb, Ulnar Nerve. [Updated 2023 Jul 24]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available at: https://www.ncbi.nlm.nih.gov/books/NBK499892/

Woo, A, Bakri, K. and Moran, SL. (2014) ‘Management of Ulnar Nerve Injuries’, The Journal of Hand Surgery. 40(1), pp. 173-181.
Doi: https://doi.org/10.1016/j.jhsa.2014.04.038

Breitenseher, JB. et al., (2015) ‘MR neurography of ulnar nerve entrapment at the cubital tunnel: a diffusion tensor imaging
study’, European Society of Radiology, 25, pp. 1911-1918. Doi: 10.1007/s00330-015-3613-7

Nakashian, MN, Ireland, D. and Kane, PM. (2020) ‘Cubital Tunnel Syndrome: Current Concepts’, Current Reviews in
Musculoskeletal Medicine, 13(5), pp. 520-524. doi: 10.1007/s12178-020-09650-y

Terlemez, R. et al., (2018) ‘Comparison of Ultrasonography and Short-Segment Nerve Conduction Study in Ulnar Neuropathy at
the Elbow’, Archives of Physical Medicine and Rehabilitaion, 99(1), pp. 116-120. Doi: https://doi.org/10.1016/j.apmr.2017.09.111