Cubital Tunnel Syndrome
Pins and needles in the little and ring fingers, which can worsen when the elbow is bent, may point to cubital tunnel syndrome. Assessment and treatment to settle the symptoms and protect the nerve.
- Certified Hand Therapist (CHT)
- Consultant Hand Therapist
- Hand, wrist & upper limb specialist
What is Cubital Tunnel Syndrome?
Cubital tunnel syndrome is the second most common peripheral nerve compression condition in the upper limb after carpal tunnel syndrome. It occurs when the ulnar nerve is compressed or stretched as it passes through the cubital tunnel, a narrow groove on the inner side of the elbow. The ulnar nerve supplies sensation to the ring and little fingers and powers most of the small intrinsic muscles of the hand.
The ulnar nerve is particularly vulnerable at the elbow because it must stretch and glide considerably during elbow bending and the cubital tunnel narrows as the elbow bends. Sustained or repeated elbow bending, such as sleeping with the elbow bent or resting the elbow on a hard surface, is the most common provocation. Early treatment prevents progression to permanent nerve damage and muscle wasting.
What you might notice
- Numbness and tingling in the ring and little fingers, often worse at night or when the elbow is bent
- Aching pain along the inner side of the elbow and forearm
- Weakness of grip and pinch: difficulty with tasks requiring strong finger pinch
- Clawing of the ring and little fingers, in advanced cases: caused by intrinsic muscle weakness
- Wasting of the intrinsic hand muscles
Why it happens
- Prolonged bending of the elbow, particularly during sleep, driving or desk work
- Direct pressure on the inner side of the elbow: leaning on a desk, hard surface or armrest
- Repetitive elbow movement in manual workers and overhead athletes
- Previous elbow fracture or dislocation causing scar tissue or bone changes around the cubital tunnel
- Anatomical variances that increase ulnar nerve stretch at the elbow
- Elbow arthritis causing bone spur formation within the cubital tunnel
How it's treated
After a thorough assessment, a personalised treatment plan is built around your needs and goals.
Ms Razo fits orthoses and supports that aim to reduce compressesion on the ulnar nerve. Positional advice is also prescribed.
Targeted exercises are prescribed to reduce ulnar nerve tension and improve symptoms. The exercises are carefully progressed to avoid overstretching the nerve, which can worsen symptoms.
Detailed assessment of provocative activities at work, home and with leisure. Practical advice is given to reduce sustained nerve compression during daily tasks.
Where surgical decompression, in-situ release or ulnar nerve transposition has been performed - Ms Razo provides specialist post-operative rehabilitation addressing wound care, scar management, nerve recovery monitoring and progressive restoration of hand strength and function.
Common questions
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Both are upper limb peripheral nerve compressions causing hand numbness, but they affect different nerves at different sites. Carpal tunnel syndrome compresses the median nerve at the wrist, causing symptoms in the thumb, index, middle and half the ring finger. Cubital tunnel syndrome compresses the ulnar nerve at the elbow, causing symptoms in the ring and little fingers and weakness of the intrinsic hand muscles.
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Mild to moderate cubital tunnel syndrome frequently responds to Hand Therapy management. Surgery is generally recommended for moderate to severe cases, cases that have not responded to non-operative treatment, and any case showing evidence of muscle wasting, as this indicates progressive nerve damage.
Clinically reviewed by Ms Michelle Razo CHT · May 2026