Cubital tunnel syndrome is a nerve pressure problem causing pain, numbness, and pins and needles. Many people have heard of carpal tunnel syndrome, where the nerve is compressed at the wrist. Cubital tunnel syndrome — sometimes called elbow tunnel syndrome — is caused by pressure on the ulnar nerve at the elbow. So how do we treat cubital tunnel syndrome, and does an ulnar nerve injection work?
Why is it called cubital tunnel syndrome?
The ulnar nerve courses along the inside of the elbow to supply muscles in the hand. As it passes the elbow, the nerve sits between the bony point on the inside of the elbow (the medial epicondyle) and the back of the elbow (the olecranon). This position forms a tunnel — the cubital tunnel.
A note on names: cubital tunnel syndrome is often called “ulnar tunnel syndrome”, because both involve the ulnar nerve. Strictly speaking, ulnar tunnel syndrome (also known as Guyon’s canal syndrome) refers to compression of the same nerve at the wrist rather than at the elbow. The symptoms overlap, but the site of compression — and therefore the treatment — differs, which is why an accurate assessment matters. This page covers compression at the elbow.
Causes of cubital tunnel syndrome
Long-term pressure on the nerve within the tunnel causes the typical symptoms. Causes of that pressure include:
- Bony spurs, a cyst, or a ganglion within the tunnel
- Repeated elbow bending under load, such as gym exercises
- Excessive movement of the nerve itself, with repeated elbow bending, irritates it
- Prolonged leaning on the elbow, for example, at a desk
Symptoms of cubital tunnel syndrome
Pinching of the ulnar nerve at the elbow typically causes:
- Pain, numbness, and pins and needles in the ring and little fingers
- Hand weakness
- Symptoms that are worse when the elbow bent
- In severe cases, clawing and wasting of the hand muscles
How is cubital tunnel syndrome diagnosed?
The diagnosis combines a clinical assessment with tests.
Nerve studies confirm pressure on the nerve at the elbow, although their diagnostic accuracy isn’t high — people with mild ulnar nerve pressure often have normal studies. Diagnostic ultrasound can show a thickened nerve and a possible cause of pressure, such as a bony spur, ganglion, or abnormal muscle bands. In some cases, we also suggest an MRI of the elbow.
It’s essential to see a doctor to rule out other causes, such as a pinched nerve in the neck, or nerve inflammation from conditions like diabetes or inflammatory neuritis.
Treatment of cubital tunnel syndrome
We start with simple treatments to reduce pressure on the nerve — elbow padding, wearing a splint at night, and anti-inflammatory medication. Physiotherapy, including massage, nerve glides, and strengthening exercises, plays an essential role in relieving symptoms.
A few things you can try yourself:
- If you work at a desk, wear a soft neoprene elbow brace. These help protect the ulnar nerve from further compression.
- If you have pain at night, an elbow splint prevents bending at the elbow and protects the nerve.
A steroid shot for cubital tunnel syndrome can help more complex cases.
If other treatments fail, surgery may be required. This usually involves moving the nerve to the front of the elbow — an ulnar nerve transposition — which reduces pressure during elbow bending. Sometimes surgeons remove bone from the inside of the elbow (the medial epicondyle). As not all surgeries are successful, we suggest a trial of conservative treatment first.
More on the ulnar nerve injection
Cortisone is a potent anti-inflammatory that reduces inflammation and pain.
In cubital tunnel syndrome, cortisone is injected at the site where the nerve is trapped. The key is to place cortisone above and below the trapping site. Ultrasound improves the accuracy and effectiveness of a cortisone injection by precisely targeting the site of nerve compression. Recent evidence suggests that an ultrasound-guided ulnar nerve injection improved pain and nerve function.
In some cases, we use nerve hydrodissection — using fluid under ultrasound to free the nerve from surrounding tissue — as an alternative or addition to cortisone.
How much does an ulnar nerve injection cost?
Dr Masci offers a one-stop appointment — consultation, diagnostic ultrasound, and injection in a single visit. At the Chelsea clinic (the most cost-effective location), a consultation with an ultrasound-guided injection is £400; other clinic locations cost more. See the full one-stop injection fees here, along with our clinic locations.
Frequently asked questions about cubital tunnel syndrome
Can cubital tunnel syndrome cause shoulder pain?
Sometimes. Pressure on the ulnar nerve in the elbow can radiate to the shoulder and neck. It can be hard to tell whether the pain comes from the elbow or a trapped nerve in the neck — your doctor should examine you to determine the likely site, and nerve studies can help clarify it.
What other conditions mimic cubital tunnel syndrome?
Several. Nerve trapping at the neck, thoracic outlet syndrome, and brachial plexopathy can all produce similar symptoms. Medical conditions such as diabetes and hypothyroidism increase the chance of ulnar nerve trapping. Pain on the inside of the elbow can also be due to golfer’s elbow, a medial collateral ligament tear, or elbow arthritis.
Is an ulnar nerve injection effective?
Yes — but we suggest an ultrasound-guided injection. Ultrasound enables the precise placement of cortisone at the site where the nerve is trapped. Risks include infection (rare), a cortisone flare, skin changes, and damage to other structures — all of which are reduced by using ultrasound. If you’re considering one, ask your practitioner these four questions before an ultrasound-guided injection.
How effective are non-surgical treatments for cubital tunnel syndrome?
We don’t know precisely. However, a review of treatment studies showed that at least 50% of people with cubital tunnel syndrome settle without needing surgery.
What’s the difference between cubital tunnel and ulnar (Guyon’s canal) tunnel syndrome?
Both involve the ulnar nerve, but at different sites. Cubital tunnel syndrome is compression at the elbow, and it is far more common. Ulnar tunnel (Guyon’s canal) syndrome is a compression at the wrist, often seen in cyclists from handlebar pressure. Symptoms overlap, but examination and nerve studies identify which is involved, and the treatments differ.
How is cubital tunnel different from carpal tunnel syndrome?
Different nerves and different fingers. Cubital tunnel syndrome affects the ulnar nerve, causing symptoms in the ring and little fingers, and is worse with the elbow bent. Carpal tunnel syndrome affects the median nerve at the wrist, causing symptoms in the thumb, index, and middle fingers, and is often worse at night.
Final word from Sport Doctor London about cubital tunnel syndrome
It’s essential to confirm the diagnosis of ulnar nerve entrapment at the elbow and to rule out nerve entrapment elsewhere. We suggest trying simple treatments before considering injections or surgery.
To discuss cubital tunnel syndrome or an ulnar nerve injection with Dr Masci in London, contact the team here or call +44 (0) 203 488 0350.
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