Elbow

Cubital Tunnel Syndrome

Cubital tunnel syndrome is the second most common peripheral nerve entrapment in the upper extremity, after carpal tunnel syndrome. It results from compression or traction of the ulnar nerve at the medial elbow, causing pain, numbness, and — if left untreated — progressive weakness and permanent nerve damage. At Maryland Orthopedic Specialists, we combine electrodiagnostic testing with clinical examination to accurately stage cubital tunnel syndrome and tailor treatment to each patient's anatomy and lifestyle demands.

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What is cubital tunnel syndrome?

The ulnar nerve travels through the cubital tunnel — a fibro-osseous passageway on the medial side of the elbow bounded by the medial epicondyle anteriorly, the olecranon posteriorly, and the arcuate ligament (Osborne's ligament) as its roof. The nerve is vulnerable here for several reasons: 1.

The ulnar nerve travels through the cubital tunnel — a fibro-osseous passageway on the medial side of the elbow bounded by the medial epicondyle anteriorly, the olecranon posteriorly, and the arcuate ligament (Osborne's ligament) as its roof. The nerve is vulnerable here for several reasons:

Traction: With elbow flexion, the nerve stretches up to 5 mm and intraneural pressure increases dramatically.
Compression: Direct pressure from the overlying fascia, hypertrophied muscle, or an accessory anconeus epitrochlearis muscle.
Subluxation: In some patients, the nerve snaps over the medial epicondyle with flexion, causing repetitive micro-trauma.
Anatomic narrowing: Valgus deformity ("cubitus valgus"), medial epicondyle osteophytes, or ganglion cysts narrow the tunnel.

Risk factors include prolonged elbow flexion (sleeping with arm bent, talking on the phone), direct compression over the medial elbow, prior elbow fracture/dislocation, and overhead athletic activities that generate valgus stress.

Treatment options

Conservative Management (First-Line for Mild–Moderate Disease)

Elbow extension splinting at night — prevents sustained elbow flexion that elevates intraneural pressure. Activity modification — avoiding prolonged elbow flexion, leaning on the medial elbow, or sustained gripping. Occupational/physical therapy — nerve gliding exercises, ergonomic education. Anti-inflammatory medications — NSAIDs for associated medial elbow pain. A supervised 3–6 month trial of conservative management is appropriate for patients with intermittent symptoms and normal or mild NCS findings.

Surgical Procedure

Cubital Tunnel Release (Ulnar Nerve Decompression)

Surgical decompression of the ulnar nerve at the elbow through in-situ release or anterior transposition. Technique is selected based on nerve subluxation, severity, and anatomic factors to achieve lasting relief.

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Frequently Asked Questions

How is cubital tunnel syndrome different from carpal tunnel syndrome?

Carpal tunnel syndrome compresses the median nerve at the wrist, causing thumb, index, and middle finger symptoms. Cubital tunnel syndrome compresses the ulnar nerve at the elbow, affecting the ring and small fingers and the intrinsic hand muscles.

Will my numbness go away after surgery?

Sensory symptoms (tingling, numbness) recover in most patients after decompression. Recovery is more complete and faster in patients with mild-to-moderate disease. Established muscle atrophy may not fully reverse but typically stabilizes.

Do I need a nerve test before seeing a surgeon?

Not always before a consultation, but NCS/EMG are typically ordered to confirm diagnosis, stage severity, and guide surgical planning.

Is cubital tunnel surgery done on an outpatient basis?

Yes — all three surgical procedures are performed as outpatient procedures under regional or general anesthesia.

Can cubital tunnel syndrome come back after surgery?

Recurrence is uncommon after properly performed decompression or transposition. Revision surgery has lower success rates, making thorough initial treatment important.

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Peter G. Fitzgibbons, MD

Hand Surgery · Orthopedic Surgery

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Medically reviewed by Peter G. Fitzgibbons, MD, MD

Last reviewed May 1, 2026

References

Dellon AL. Review of treatment results for ulnar nerve entrapment at the elbow. Journal of Hand Surgery. 1989;14(4):688–700. https://doi.org/10.1016/S0363-5023(89)80025-9
Caliandro P, La Torre G, Padua R, Giannini F, Padua L. Treatment for ulnar neuropathy at the elbow. Cochrane Database of Systematic Reviews. 2016;11:CD006839. https://doi.org/10.1002/14651858.CD006839.pub4
Zlowodzki M, Chan S, Bhandari M, Kalliainen L, Schubert W. Anterior transposition compared with simple decompression for treatment of cubital tunnel syndrome: a meta-analysis of randomized, controlled trials. Journal of Bone and Joint Surgery (JBJS). 2007;89(12):2591–2598. https://doi.org/10.2106/JBJS.G.00183
American Academy of Orthopaedic Surgeons. Cubital Tunnel Syndrome — OrthoInfo. https://orthoinfo.aaos.org/en/diseases--conditions/cubital-tunnel-syndrome (accessed May 2026).
Staples JR, Calfee R. Cubital tunnel syndrome: current concepts. Journal of the American Academy of Orthopaedic Surgeons (JAAOS). 2017;25(10):e215–e224. https://doi.org/10.5435/JAAOS-D-15-00261