There are cubital tunnel exercises and other strategies that can help your pain, numbness, and tingling. Cubital tunnel syndrome causes pain, abnormal sensation, and potential weakness in the forearm, wrist, and hand. The good news is that the vast majority of cases can be successfully treated without surgery. Read on to learn more about this condition and how to manage it. Let’s start with anatomy.
The elbow
The elbow joint is where the humerus, ulna, and radius come together. The humerus is the upper arm bone and forms individual joints with the ulna and radius, which are the forearm bones. Movements of the elbow include flexion and extension. Flexion is when the forearm and upper arm come closer together (bending the elbow) and extension is when they move farther apart (straightening the elbow). The upper parts of the radius and ulna will also form a joint which allows for the movements of pronation and supination. This is called the radioulnar joint. Pronation is rotating the forearm, so the palm faces downward, and supination is forearm rotation where the palm faces upward.
The medial epicondyle
At the elbow, there are two big bony bumps on either side of the joint. These are the epicondyles at the end of the humerus. Epicondyles are large bony bumps where ligaments and the tendons of muscles attach. There is a lateral epicondyle and a medial epicondyle. The medial epicondyle is the one closest to the body when the arms are beside the body with the palms up. The lateral epicondyle will be farther from the body in this position.
The olecranon
The olecranon is the part of the ulna that connects to the humerus to make the humeroulnar joint. It helps to provide the flexion and extension movement of the elbow. The olecranon is a very superficial bone, and you can easily feel it under the skin. It is the bony point in the back of the elbow.
The cubital tunnel
The cubital tunnel is a tunnel of tissue that begins behind the medial epicondyle and runs to the olecranon of the ulna. It is the most common area of entrapment for the ulnar nerve.
The ulnar nerve
The ulnar nerve is one of the major nerves of the upper extremity. It begins near the armpit and travels all the way down to the hand. As it travels down the back of the arm, it will travel through the cubital tunnel. This is the area that is also known as the funny bone. The sensation that you feel after hitting your funny bone is the irritation of the ulnar nerve.
The ulnar nerve provides sensation to the little finger side of the forearm, the little finger, and half of the ring finger. It supplies innervation to the muscles that help flex the forearm and fingers.
What is cubital tunnel syndrome?
Cubital tunnel syndrome is a compressive neuropathy of the ulnar nerve while it is in the cubital tunnel. Neuropathy indicates some type of damage to the nerve. There are many different ways that the nerve could become compressed or pinched. These include:
- Pressure
- Hitting your elbow on a hard surface or leaning on your elbows for a long period of time could irritate your ulnar nerve.
- Stretching
- The ulnar is in a stretched position when your elbow is bent. Keeping the elbow in a bent position or repeatedly bending the elbow can cause irritation of the nerve. Sleeping with your elbow bent can cause you to wake up with your fingers asleep.
- Injuries
- Elbow fractures (bone break), dislocations, or other traumas could cause damage or swelling that could compress the ulnar nerve.
Cubital tunnel syndrome is the second most common compression neuropathy of arm. Carpal tunnel syndrome is the most common. Cubital tunnel syndrome is more common in males than in females and is associated with smoking.
What are the symptoms of cubital tunnel syndrome?
There are several symptoms associated with cubital tunnel syndrome. These include:
- Intermittent pain, numbness, and tingling in the little finger side of the forearm and hand
- Pain or loss of sensation that increases with bending the elbow
- Tenderness at the cubital tunnel
- Difficulty gripping and holding objects
- Decreased muscle size in the hand
Are there risk factors for cubital tunnel syndrome?
There are some risk factors associated with cubital tunnel syndrome. These include:
- Smoking
- Overhead throwing sports or activities
- Work that requires repeated or sustained elbow flexion
- Previous elbow fracture or dislocation
- Elbow arthritis
- Swelling at the elbow
- Cysts at the elbow
Who should I see?
- Physical therapy – Conservative treatment including physical therapy has a 90% success rate in resolving symptoms after a few months. Physical therapy can help decrease pain and inflammation with techniques including manual therapy and dry needling. PT can evaluate and address abnormal joint mobility, muscle weakness, muscle tone, and flexibility. With cubital tunnel syndrome it is important to decrease the stress on the cubital tunnel. Your PT can help you activate other muscles to decrease the load on this area. They can assess your posture or positioning during work or sports to prevent the problem from happening again.
- Orthopedic physician – An orthopedist might be necessary if the condition is not responding to physical therapy. Your physician can prescribe medication, give an injection, or order testing/imaging if needed. Surgery is an option if all conservative measures fail.
What can I do?
- Relative rest – Resting the area to decrease further pain and damage from occurring is one of the best ways to treat cubital tunnel syndrome. Basically, stay away from the activities that are causing pain. This gives the nerve time to heal. If you keep doing what is causing the injury, it is not going to get better. This might include not participating in your sport or changing how you perform a task or job. If you are not able to participate in your activity or sport, then you can supplement with non-irritating activities such as biking, walking, or jogging while your condition is being treated.
- Ice – Ice can help decrease pain and symptoms at the forearm. Ice the painful area for 15 to 20 minutes at a time. I would recommend using an ice pack several times per day if the pain is constant or is preventing you from participating in an activity. Ice immediately after activity.
- Elbow splint – Using an elbow brace or splint that keeps the elbow straight can help decrease the stress on the nerve. You might only wear it at night if the pain is minimal. However, if you have pain and weakness most of the time, you will probably want to wear it during the day until symptoms subside.
- Posture – Having forward, rounded shoulders cause muscular imbalances in the shoulder and elbow. It decreases the ability of the scapular stabilizers to stabilize the shoulder joint. This causes the muscles at the elbow and forearm to work more. It also shortens the pectoralis major, pectoralis minor, and biceps and causes them to get tight. Stretching this area will make better posture more attainable. Below is a video showing how to stretch the pecs and biceps, and also how to use a wall to check your posture.
- Soft tissue mobilization – Soft tissue mobilization helps release the muscles around the forearm and decreases the pressure on the nerve. Use a massage ball, lacrosse ball, tennis ball, or your own fingers to massagepainful areas all around the elbow. Spend a good 3 to 5 minutes rolling. Do not roll so hard that you bruise the area, but it should be a pretty painful sensation. Roll out the area no more than a few times a week. Do not roll on the area of the cubital tunnel. See the video below.
- Ulnar nerve flossing – You can mobilize the ulnar nerve to ensure that it is not entrapped in an area. Flossing will free-up the nerve if it is stuck and allow it to move along its pathway. Below is a video of ulnar nerve flossing.
- Thumb and finger strengthening – Strengthening the muscles in the thumb and fingers is important since cubital tunnel syndrome can affect these areas. Performing opposition and gripping exercises is important for recovering hand strength. See the video below.
- Wrist strengthening – It is important to strengthen the wrist as well. Cubital tunnel syndrome can affect wrist flexion strength. Below is a video showing how to strengthen the wrist using resistance bands.
- Strengthen the rotator cuff and scapular stabilizers– Elbow injuries tend to occur because of weakness of the rotator cuff muscles and scapular stabilizers. These are the stabilizing muscles of the shoulder that allow the arm to reach, lift, and hold without injury or irritation. Using loop resistance bands and resistance bands can increase strength and difficulty.
In review
- The elbow joint is where the humerus, ulna, and radius come together.
- Movements of the elbow include flexion, extension, pronation, and supination.
- Epicondyles are large bony bumps where ligaments and the tendons of muscles attach.
- There is a lateral epicondyle and a medial epicondyle.
- The olecranon is the part of the ulna that connects to the humerus in order to make the humeroulnar joint.
- The ulnar nerve is one of the major nerves of the upper extremity.
- It begins near the armpit and travels all the way down to the hand.
- The cubital tunnel is a tunnel of tissue that begins behind the medial epicondyle and runs to olecranon of the ulna.
- It is the most common area of entrapment for the ulnar nerve.
- Cubital tunnel syndrome is a compressive neuropathy of the ulnar nerve.
- Symptoms include intermittent pain, numbness, and tingling in the little finger side of the forearm and hand.
- Conservative treatment including physical therapy has a 90% success rate in resolving symptoms after a few months.
- An orthopedist would be needed if the condition is not responding to physical therapy.
- There are things you and do.
- Rest
- Ice
- Elbow splint
- Posture
- Soft tissue mobilization
- Ulnar nerve flossing
- Thumb and finger strengthening
- Wrist strengthening
- Strengthen rotator cuff and scapular stabilizers
As always, If you have questions about the content of this post or any other musculoskeletal questions, please e-mail me.
Additional resources
https://www.physio-pedia.com/Cubital_Tunnel_Syndrome