Cubital Tunnel Syndrome: Signs You Have It and Exercises to Treat It, According to Physical Therapists

Feeling numbness or tingling in your hand? You may think it’s carpal tunnel syndrome. But it could be another, less common and well-known condition: cubital tunnel syndrome. “Unlike carpal tunnel, which is caused by pressure on the median nerve in your wrist, cubital tunnel syndrome is due to pressure on the ulnar nerve, which is another main nerve in your arm,” explains Christine Dang, PT, DPT, a physical therapist with Hinge Health. It affects nearly two percent of people in the United States, according to a 2023 report in the Journal of Hand Surgery Global Online.

Symptoms of cubital tunnel syndrome can make life a little uncomfortable: You may find it hard to drive, hold your phone, or unscrew a jar, says Dr. Dang. Thankfully, the condition responds well to exercise therapy. 

Read on to learn more about what cubital tunnel syndrome is, what causes it, and what treatments and exercises our Hinge Health physical therapists recommend to start feeling better.

What Is Cubital Tunnel Syndrome?

Cubital tunnel syndrome is compression or irritation of the ulnar nerve, one of the main nerves in your arm. “It travels from your neck down into your hand,” explains Dr. Dang. The ulnar nerve can get compressed in several different places. In the case of cubital tunnel syndrome, the compression occurs at the inside part of your elbow. 

“Right at your elbow, your ulnar nerve travels through a very small tunnel that runs right under your funny bone at the inside of your elbow,” says Dr. Dang. “Since it’s such a small space, it’s very easy for it to become compressed or irritated if you bend your elbow for too long or place direct pressure on that area.”

Symptoms of Cubital Tunnel Syndrome

It’s easy to confuse cubital tunnel syndrome with carpal tunnel syndrome, but there’s an important difference: Carpal tunnel syndrome affects your thumb, index, and middle fingers, while cubital tunnel syndrome mainly affects your pinky and ring fingers, says Dr. Dang. Other symptoms of cubital tunnel syndrome may include:

• Numbness and tingling in your ring finger and pinky, especially when your elbow is bent. You may also wake up at night with numb fingers.

• Difficulty moving these fingers or manipulating objects with them.

• Trouble with grip and finger coordination. “You may notice it’s harder to type or open a jar,” says Dr. Dang.

• Muscle weakness. One hand may seem weaker or smaller. This usually happens if the nerve is very compressed, or has been compressed for a long time, says Dr. Dang. (If you notice your weakness is significant or progressively worsening, see a PT or doctor right away.)

Cubital tunnel syndrome can be diagnosed fairly easily. “If a patient says they feel symptoms in their ring or pinky finger, and it’s worse when they bend their elbow, those symptoms are often consistent with cubital tunnel syndrome,” says Dr. Dang. Another test: Your PT or doctor may tap the ulnar nerve over your funny bone — if it’s irritated, it can cause a little shock into your pinky and ring finger.

What Causes Cubital Tunnel Syndrome?

Cubital tunnel syndrome occurs when the ulnar nerve in your arm is irritated. Some common cubital tunnel syndrome causes include:

• You use your elbows a lot. If your job or daily activities require a lot of pulling, reaching, or lifting, all of which requires you to move your elbow back and forth, you may be more prone to cubital tunnel syndrome if you haven’t incorporated the right strengthening exercises first, says Dr. Dang.

• You lean on your elbows frequently. “We can see cubital tunnel syndrome in people who sit at a desk with their elbows bent at 90 degrees for hours at a time,” says Dr. Dang. Some people also sleep with their elbows bent, which can cause ulnar nerve compression.

• Injury to the funny bone. Banging your funny bone can hurt. It can also cause your ulnar nerve tunnel to swell, causing symptoms of cubital tunnel syndrome.

• Certain medical conditions. Osteoarthritis or rheumatoid arthritis can cause narrowing of the ulnar nerve tunnel, says Dr. Dang. People who are overweight or have type 2 diabetes also appear to be at greater risk, according to a study in the journal Hand.

Treatment for Cubital Tunnel Syndrome

There is a lot you can do to relieve pain and symptoms of cubital tunnel syndrome with simple lifestyle changes and at-home exercises. In fact, studies show almost 90 percent of people respond to this approach. 

Initially, you may need to modify some, but not all, of your activities. If you do something and find that it makes your pinky or ring finger tingle and go numb, Dr. Dang recommends that you modify the movement, often just temporarily. “Every time you modify an activity that hurts 'a lot,' you give the ulnar nerve the opportunity to calm down,” she says. The good news is that these tips can help you heal and get you back on track:

• Take over-the-counter medication. Pain relievers such as ibuprofen (Advil, Motrin) or naproxen (Aleve) can be helpful to relieve nerve inflammation and pain. It’s important to make sure that you’re safely able to take them, based on your medical history.

• Avoid leaning on your elbow. It’s a common pattern when you sit or drive, but the position puts stress on your ulnar nerve, says Dr. Dang. Use headphones when you’re on the phone to avoid holding the phone in a way that activates your elbow and try not to sit with your arms crossed.

• Use an elbow pad or brace. Research suggests that a brace may help relieve symptoms. This is probably because it helps prevent you from doing things inadvertently that put pressure on the nerve, like leaning on it when you sit, says Dr. Dang. You can also wrap your elbow and arm with a towel at night to help prevent you from bending it as you sleep if you find that more comfortable than wearing the brace at night. 

• Rethink your work set-up. “I always ask patients to show me their work station — oftentimes their elbows hang away from their desk because it’s too high or too low,” says Dr. Dang. “If your elbows are bent more than 90 degrees, it puts pressure on the ulnar nerve. We can usually solve this by lowering the desk or increasing chair height.”

• Physical therapy. A PT can show you specific exercises (more on that below) to help strengthen surrounding muscles, which, in turn, takes pressure off your ulnar nerve. This includes range-of-motion exercises to help make sure your arm and hand muscles don’t shorten and nerve gliding exercises that stretch out your nerves. 

While some doctors recommend steroid injections, some research suggests that they’re no more effective than a placebo, according to a study in the journal Archives of Physical Medicine and Rehabilitation.

If your symptoms persist for more than three to six months, Dr. Dang recommends that you see an orthopedic surgeon.

These exercises are recommended by Hinge Health physical therapists to support healing from cubital tunnel syndrome and generally help keep your arms and wrists strong and flexible. 

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Cushion Your Wrists

“Wrist problems sometimes go hand in hand with elbow problems,” says Dr. Dang. If you notice cubital tunnel syndrome flare-ups at work, for example, place an elevated cushion under your wrist while you type to keep it in a more neutral position.

How Hinge Health Can Help You 

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. 

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. 

Additionally, you’ll have a personal care team to guide, support, and tailor our program to you. See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Graf, A., Ahmed, A. S., Roundy, R., Gottschalk, M. B., & Dempsey, A. (2022). Modern Treatment of Cubital Tunnel Syndrome: Evidence and Controversy. Journal of Hand Surgery Global Online, 5(4). doi:10.1016/j.jhsg.2022.07.008

2. Zhang, D., Earp, B. E., Homer, S. H., & Blazar, P. (2021). Factors Associated With Severity of Cubital Tunnel Syndrome at Presentation. Hand, 18(3), 401-406. doi:10.1177/15589447211058821

3. Anderson, D., Woods, B., Abubakar, T., Koontz, C., Li, N., Hasoon, J., Viswanath, O., Kaye, A. D., & Urits, I. (2022). A Comprehensive Review of Cubital Tunnel Syndrome. Orthopedic Reviews, 14(3). doi:10.52965/001c.38239

4. Chen, L.-C., Ho, T.-H., Shen, Y.-P., Su, Y.-C., Li, T.-Y., Tsai, C.-K., & Wu, Y.-T. (2020). Perineural Dextrose and Corticosteroid Injections for Ulnar Neuropathy at the Elbow: A Randomized Double-blind Trial. Archives of Physical Medicine and Rehabilitation, 101(8), 1296–1303. doi:10.1016/j.apmr.2020.03.016