Cubital Tunnel Syndrome - Modern Treatment Options
DOI:
https://doi.org/10.12775/QS.2025.37.57045Keywords
Cubital tunnel syndrome, Ulnar nerve entrapment, Cell-phone elbow, conservative therapy, Surgical management, Elbow anatomyAbstract
Introduction: Cubital Tunnel Syndrome (CuTS) is the second most prevalent compression neuropathy affecting the upper extremity. Patients typically present with symptoms of paresthesia in the fourth and fifth digits, accompanied by hand weakness and pain. Most patients respond well to conservative treatments, but some of them require surgical intervention.
Aim of the study: The aim of this study is to assess and compare both surgical and conservative treatment methods. Conservative treatment for CuTS is typically pursued before surgical intervention, but there are no universally agreed-upon diagnostic and treatment algorithms for the condition.
State of knowledge: Symptoms of Cubital Tunnel Syndrome manifest in approximately 5% of the general population. Etiological factors include repetitive pressure, stretching, flexion, or trauma to the elbow joint. If not appropriately managed, advanced stages of the disease may lead to irreversible muscle atrophy and hand contractures.
Summary: Early diagnosis and intervention are the key factors in managing Cubital Tunnel Syndrome. The condition is frequently underdiagnosed, primarily due to patients' reluctance to seek treatment for their symptoms. No studies have definitively proven that one treatment approach is more effective than another. The choice of treatment should be based on the severity of the condition and the individual needs of the patient.
References
REFERENCES:
Osei, Daniel A. MD, MSc; Groves, Andrew P. BS; Bommarito, Kerry PhD, MPH; Ray, Wilson Z. MD. Cubital Tunnel Syndrome: Incidence and Demographics in a National Administrative Database. Neurosurgery 80(3):p 417-420, March 2017. | DOI: https://doi.org/10.1093/neuros/nyw061
Baron A, Strohl A. Severe Cubital Tunnel Syndrome: Considerations for Nerve Transfer Surgery. Curr Rev Musculoskelet Med. 2020 Dec;13(6):708-716. | DOI: https://doi.org/10.1007/s12178-020-09676-2. PMID: 32852749; PMCID: PMC7661668.
An TW, Evanoff BA, Boyer MI, Osei DA. The Prevalence of Cubital Tunnel Syndrome: A Cross-Sectional Study in a U.S. Metropolitan Cohort. J Bone Joint Surg Am. 2017 Mar 1;99(5):408-416. | DOI: https://doi.org/10.2106/JBJS.15.01162. PMID: 28244912; PMCID: PMC5324036.
Mondelli, M., Giannini, F., Ballerini, M., Ginanneschi, F., & Martorelli, E. (2005). Incidence of ulnar neuropathy at the elbow in the province of Siena (Italy). Journal of the neurological sciences, 234(1-2), 5-10 | DOI: https://doi.org/10.1016/j.jns.2005.02.010
Bartels, R., Verbeek, A. Risk factors for ulnar nerve compression at the elbow: a case control study. Acta Neurochir (Wien) 149, 669–674 (2007)| DOI: https://doi.org/10.1007/s00701-007-1166-5. PMID: 17502986; PMCID: PMC2779416.
Bradley A. Palmer, Thomas B. Hughes, Cubital Tunnel Syndrome, The Journal of Hand Surgery, Volume 35, Issue 1, 2010, Pages 153-163, | DOI: https://doi.org/10.1016/j.jhsa.2009.11.004.
Polatsch DB, Melone CP Jr, Beldner S, Incorvaia A. Ulnar nerve anatomy. Hand Clin. 2007 Aug;23(3):283-9, v. | DOI: https://doi.org/10.1016/j.hcl.2007.05.001. PMID: 17765580.
Posner, Martin A. MD. Compressive Ulnar Neuropathies at the Elbow: I. Etiology and Diagnosis. Journal of the American Academy of Orthopaedic Surgeons 6(5):p 282-288, September 1998. | DOI: https://doi.org/10.5435/00124635-199809000-00003
Dolenšek J. The prevalence of the anconeus epitrochlearis muscle in a Central European population. Folia Morphol (Warsz). 2024 Jan 23. | DOI: https://doi.org/10.5603/fm.98231. PMID: 38258614.
Lee SK, Hwang SY, Kim SG, Choy WS (2020) Analysis of the anatomical factors associated with cubital tunnel syndrome. Ortho Traumatol: Surg Res 106:743–749. | DOI: https://doi.org/10.1016/j.otsr.2020.01.016
James, J., Sutton, L. G., Werner, F. W., Basu, N., Allison, M. A., & Palmer, A. K. (2011). Morphology of the cubital tunnel: an anatomical and biomechanical study with implications for treatment of ulnar nerve compression. The Journal of hand surgery, 36(12), 1988-1995. | DOI: https://doi.org/10.1016/j.jhsa.2011.09.014
Schuind Fa, Goldschmidt D, Bastin C, Burny F. A Biomechanical Study of the Ulnar Nerve at the Elbow. Journal of Hand Surgery. 1995;20(5):623-627. | DOI: https://doi.org/10.1016/S0266-7681(05)80124-X
Zhang, D., Earp, B. E., & Blazar, P. (2017). Rates of complications and secondary surgeries after in situ cubital tunnel release compared with ulnar nerve transposition: a retrospective review. The Journal of Hand Surgery, 42(4), 294-e1.| DOI: https://doi.org/10.1016/j.jhsa.2017.01.020
Maslow JI, Johnson DJ, Block JJ, Lee DH, Desai MJ (2018) Prevalence and clinical manifestations of the anconeus epitrochlearis and cubital tunnel syndrome. Hand 15:69–74.| DOI: https://doi.org/10.1177/1558944718789412
Bozentka DJ. Cubital tunnel syndrome pathophysiology. Clin Orthop Relat Res. 1998 Jun;(351):90-4. PMID: 9646751.| DOI: https://doi.org/10.1097/00003086-199806000-00012
Folberg C.R., Weiss A.P., Akelman E. Cubital tunnel syndrome. Part I: presentation and diagnosis. Orthop Rev. 1994;23(2):136–144 PMID: 8196972
Mihata T, Akeda M, Künzler M, McGarry MH, Neo M, Lee TQ. Ulnar collateral ligament insufficiency affects cubital tunnel syndrome during throwing motion: a cadaveric biomechanical study. Journal of Shoulder and Elbow Surgery. 2019;28(9):1758-1763. | DOI: https://doi.org/10.1016/j.jse.2019.02.009
Stewart J. Ulnar neuropathies: where, why, and what to do? Practical Neurology. 2006;6(4):218-229. | DOI: https://doi.org/10.1136/jnnp.2006.097899
McGowan, A.J. The Results of Transposition of the Ulnar Nerve for Traumatic Ulnar Neuritis. J. Bone Jt. Surg. Br. 1950, 32, 293–301. | DOI: https://doi.org/10.1302/0301-620X.32B3.293
Stirling PHC, Harrison SJ, McEachan JE. The effect of diabetes mellitus on the outcome of surgery for cubital tunnel syndrome. Journal of Hand Surgery (European Volume). 2023;48(4):316-320. | DOI: https://doi.org/10.1177/17531934221143500
Naran S, Imbriglia JE, Bilonick RA, Taieb A, Wollstein R. A demographic analysis of cubital tunnel syndrome. Annals of Plastic Surgery. 2010;64(2):177-179. | DOI: https://doi.org/10.1097/sap.0b013e3181a2c63e
Beekman R., Zijlstra W., Visser L.H. A novel points system to predict the prognosis of ulnar neuropathy at the elbow. Muscle Nerve. 2017;55(5):698–705. | DOI: https://doi.org/10.1002/mus.25406.
Goldman S.B., Brininger T.L., Schrader J.W., Curtis R., Koceja D.M. Analysis of clinical motor testing for adult patients with diagnosed ulnar neuropathy at the elbow. Arch Phys Med Rehabil. 2009;90(11):1846–1852. | DOI: https://doi.org/10.1016/j.apmr.2009.06.007.
Montagna P., Liguori R. The motor tinel sign: a useful sign in entrapment neuropathy? Muscle Nerve. 2000;23(6):976–978. | DOI: https://doi.org/10.1002/(sici)1097-4598(200006)23:6<976::aid-mus22>3.0.co;2-6
Ciccotti M.C., Schwartz M.A., Ciccotti M.G. Diagnosis and treatment of medial epicondylitis of the elbow. Clin Sports Med. 2004;23(4):693–705. | DOI: https://doi.org/10.1016/j.csm.2004.04.011.
Beekman R, Schreuder AHCML, Rozeman CAM, et alThe diagnostic value of provocative clinical tests in ulnar neuropathy at the elbow is marginalJournal of Neurology, Neurosurgery & Psychiatry 2009;80:1369-1374. | DOI: https://doi.org/10.1136/jnnp.2009.180844
Burahee AS, Sanders AD, Shirley C, Power DM. Cubital tunnel syndrome. EFORT Open Rev. 2021 Sep 14;6(9):743-750. | DOI: https://doi.org/10.1302/2058-5241.6.200129. PMID: 34667645; PMCID: PMC8489474.
Ellegaard HR, Fuglsang-Frederiksen A, Hess A, Johnsen B, Qerama E. High-resolution ultrasound in ulnar neuropathy at the elbow: A prospective study. Muscle Nerve. 2015;52(5):759-766. | DOI: https://doi.org/10.1002/mus.24638
Simon NG, Ralph JW, Poncelet AN, Engstrom JW, Chin C, Kliot M. A comparison of ultrasonographic and electrophysiologic ‘inching’ in ulnar neuropathy at the elbow. Clin Neurophysiol 2015;126:391–398. | DOI: https://doi.org/10.1016/j.clinph.2014.05.023.
Beekman R, Schoemaker MC, Van Der Plas JP, Van Den Berg LH, Franssen H, Wokke JH, et al. Diagnostic value of high-resolution sonography in ulnar neuropathy at the elbow. Neurology 2004;62:767–773. | DOI: https://doi.org/10.1212/01.wnl.0000113733.62689.0d
Raeissadat SA, Youseffam P, Bagherzadeh L, Rayegani SM, Bahrami MH, Eliaspour D. Electrodiagnostic Findings in 441 Patients with Ulnar Neuropathy - a Retrospective Study. Orthop Res Rev. 2019 Dec 2;11:191-198. | DOI: https://doi.org/10.2147/ORR.S230116. PMID: 31819676; PMCID: PMC6897064.
Jinny Tavee, Chapter 14 - Nerve conduction studies: Basic concepts, Handbook of Clinical Neurology, Elsevier, Volume 160, 2019, | DOI: https://doi.org/10.1016/B978-0-444-64032-1.00014-X
Robert M. Szabo, Christine Kwak, Natural History and Conservative Management of Cubital Tunnel Syndrome, Hand Clinics, Volume 23, Issue 3, 2007.| DOI: https://doi.org/10.1016/j.hcl.2007.05.002.
Stutz C.M., Calfee R.P., Steffen J.A., Goldfarb C.A. Surgical and nonsurgical treatment of cubital tunnel syndrome in pediatric and adolescent patients. J Hand Surg. 2012;37(4):657–662. | DOI: https://doi.org/10.1016/j.jhsa.2012.01.016
Kenichi Nakamichi, Shintaro Tachibana, Masayoshi Ida, Seizo Yamamoto, Patient Education for the Treatment of Ulnar Neuropathy at the Elbow, Archives of Physical Medicine and Rehabilitation, Volume 90, Issue 11, 2009.| DOI: https://doi.org/10.1016/j.apmr.2009.06.010.
Shah CM, Calfee RP, Gelberman RH, Goldfarb CA. Outcomes of Rigid Night Splinting and Activity Modification in the Treatment of Cubital Tunnel Syndrome. J Hand Surg. 2013;38(6):1125-1130.e1. | DOI: https://doi.org/10.1016/j.jhsa.2013.02.039
Boone, S., Gelberman, R. H., & Calfee, R. P. (2015). The Management of Cubital Tunnel Syndrome. Journal of Hand Surgery, 40(9), 1897-1904..| DOI: https://doi.org/10.1016/j.jhsa.2015.03.011. PMID: 26243318.
S.K. Trehan, J.R. Parziale, E. Akelman Cubital tunnel syndrome: diagnosis and management Med Health R I, 95 (11) (2012), pp. 349-352, | DOI: https://doi.org/10.1007/978-3-030-14171-4
B. Svernlöv, M. Larsson, K. Rehn, et al. Conservative treatment of the cubital tunnel syndrome J Hand Surg Eur, 34 (2) (2009), pp. 201-207, | DOI: https://doi.org/10.1177/1753193408098480
Rozmaryn LM, Dovelle S, Rothman ER, Gorman K, Olvey KM, Bartko JJ. Nerve and tendon gliding exercises and the conservative management of carpal tunnel syndrome. J Hand Ther. (1998) 11:171–9. | DOI: https://doi.org/10.1016/S0894-1130(98)80035-5
Coppieters MW, Butler DS. Do “sliders” slide and “tensioners” tension? An analysis of neurodynamic techniques and considerations regarding their application. Man Ther. (2008) 13:213–21. | DOI: https://doi.org/10.1016/j.math.2006.12.008
Ozkan, F.U.; Saygı, E.K.; Senol, S.; Kapcı, S.; Aydeniz, B.; Aktaş, İ.; Gozke, E. New Treatment Alternatives in the Ulnar Neuropathy at the Elbow: Ultrasound and Low-Level Laser Therapy. Acta Neurol. Belg. 2015, 115, 355–360 | DOI: https://doi.org/10.1007/s13760-014-0377-9
Wolny T, Fernández-de-Las Peñas C, Buczek T, Domin M, Granek A, Linek P. The Effects of Physiotherapy in the Treatment of Cubital Tunnel Syndrome: A Systematic Review. J Clin Med. 2022 Jul 21;11(14):4247. | DOI: https://doi.org/10.3390/jcm11144247. PMID: 35888010; PMCID: PMC9318553.
Gervasio, Olga M.D.; Gambardella, Giuseppe M.D.; Zaccone, Claudio M.D.; Branca, Damiano M.D.. Simple Decompression versus Anterior Submuscular Transposition of the Ulnar Nerve in Severe Cubital Tunnel Syndrome: A Prospective Randomized Study. Neurosurgery 56(1):p 108-117, January 2005. | DOI: https://doi.org/10.1227/01.NEU.0000145854.38234.81
Adkinson JM, Zhong L, Aliu O, Chung KC. Surgical treatment of cubital tunnel syndrome: trends and the influence of patient and surgeon characteristics. J Hand Surg Am. (2015) 40:1824–31. | DOI: https://doi.org/10.1016/j.jhsa.2015.05.009
Balogh ZJ, Lumsdaine W, Khalid SI, Carlton A. Surgical Approaches and Their Outcomes in the Treatment of Cubital Tunnel Syndrome. Front Surg. 2018;5(48). | DOI: https://doi.org/10.3389/fsurg.2018.00048
Byvaltsev VA, Stepanov IA, Kerimbayev TT. A systematic review and meta-analysis comparing open versus endoscopic in situ decompression for the treatment of cubital tunnel syndrome. Acta Neurol Belg. (2020) 120:1–8. | DOI: https://doi.org/10.1007/s13760-019-01149-9
Zhang D, Earp BE, Blazar PE. Complication rates of cubital tunnel surgery: in situ cubital tunnel release compared with ulnar nerve transposition. J Hand Surg Am 2016;41:S19–S20. | DOI: https://doi.org/10.1016/j.jhsa.2017.01.020
Kim KW, Lee HJ, Rhee SH, Baek GH. Minimal epicondylectomy improves neurologic deficits in moderate to severe cubital tunnel syndrome. Clin Orthop Relat Res. (2012) 470:1405–13. | DOI: https://doi.org/10.1007/s11999-012-2263-1
Anderson D, Woods B, Abubakar T, Koontz C, Li N, Hasoon J, Viswanath O, Kaye AD, Urits I. A Comprehensive Review of Cubital Tunnel Syndrome. Orthop Rev (Pavia). 2022 Sep 15;14(3):38239. | DOI: https://doi.org/10.52965/001c.38239. PMID: 36128335; PMCID: PMC9476617.
Said J, Van Nest D, Foltz C, Ilyas AM. Ulnar nerve in situ decompression versus transposition for idiopathic cubital tunnel syndrome: an updated meta-analysis. J Hand Microsurg. (2019) 11:18–27. | DOI: https://doi.org/10.1055/s-0038-1670928
Davidge KM, Yee A, Moore AM, Mackinnon SE. The supercharge end-to-side anterior interosseous-to-ulnar motor nerve transfer for restoring intrinsic function: clinical experience. Plast Reconstr Surg. 2015;136:344e–352e. | DOI: https://doi.org/10.1097/PRS.0000000000001514
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Aleksandra Sieradzka, Krzysztof Szerej, Alicja Kot, Marta Wojtczak, Natalia Myśliwiec, Adrian Różycki, Michał Pniak, Paweł Miklis, Maciej Mawlichanów, Aleksandra Ciesielska
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 16
Number of citations: 0
