3 Essential Skills for Resolving Cubital Tunnel Syndrome
Reading time: 3 minutes
As an evidence-based chiropractor, you see enough cases of carpal tunnel syndrome to recognize that it’s the most pervasive peripheral nerve entrapment in the upper extremity, but did you know that cubital tunnel syndrome is the second most common? (1,18,20)
A September 2022 article in Orthopedic Reviews reminded us how frequently this problem presents.
“It is estimated that up to 5.9% of the general population have had symptoms of cubital tunnel syndrome [which], if left untreated, can significantly alter an individual's quality of life.” (23)
This week’s updated blog & video will demonstrate three essential tools to solve this frequently overlooked problem. You’ll learn the top assessment, treatment, and ulnar nerve floss exercise for cubital tunnel syndrome in less than three minutes!
1. What Is Cubital Tunnel Syndrome?
Short answer: Irritation of the ulnar nerve at the elbow.
Deeper dive: Elbow flexion requires the ulnar nerve to both stretch and slide through the cubital tunnel. As the elbow flexes, the distance between the medial epicondyle and olecranon increases, thereby stretching the ulnar nerve. Flexion also tensions the fascia resulting in ovoid deformation and reduced cubital tunnel volume. Sustained traction or compression may exceed the nerve's resiliency, leading to irritation and cubital tunnel syndrome symptoms (2).
2. What Are Cubital Tunnel Syndrome Symptoms?
Short answer: Pain or paresthesia in the 4th and 5th digits.
Deeper dive:
Patients with cubital tunnel often complain of symptoms extending distally from the medial epicondyle to the 4th and 5th digits.
Cubital tunnel symptoms may vary from vague hypersensitivity to pain.
Since motor fibers are located deep to sensory fibers, sensory irritation precedes motor deficits.
Like many other neuropathies, nocturnal symptoms are common.
Cubital tunnel syndrome presents 50% more frequently on the left side, regardless of handedness. (13)
3. Who Gets Cubital Tunnel Syndrome?
Short answer: Workers and athletes who repetitively flex or compress their elbow.
Deeper dive: Symptoms of cubital tunnel syndrome are commonly seen in baseball, tennis, and racquetball players. Workers who maintain sustained elbow flexion, such as holding a tool or telephone, or those who press the ulnar nerve against a hard surface, like a desk, are at increased risk. Cubital tunnel syndrome has more recently been coined cell phone elbow.
Did You Know?
Women’s elbows have a thicker fat pad on the medial aspect providing greater protection; men experience cubital tunnel syndrome complaints 3-8 times more often than women. (4)
4. What is the Best Cubital Tunnel Syndrome Test?
Short answer: The ulnar nerve tension test is the most useful diagnostic test for cubital tunnel syndrome. (6,7,8)
Deeper dive: The ulnar nerve tension test entails maintaining shoulder abduction while flexing the elbow past 90 degrees, supinating the forearm, and extending the wrist with thumb/ index opposition. A positive test results in the reproduction of the chief complaint within 60 seconds.
5. What Is the Best Cubital Tunnel Syndrome Treatment?
Short answer: Chiropractic manual therapy.
Deeper dive: Management of ulnar nerve compression includes activity modification, nerve mobilization techniques, myofascial release techniques, manipulation, splinting, and patient education. (11,20,23)
The cubital tunnel release, aka ulnar nerve release, is particularly beneficial for treating cubital tunnel syndrome. Subscribers can review this ulnar nerve release tutorial here.
6. What Is Ulnar Nerve Flossing for Cubital Tunnel Syndrome?
Short answer: Ulnar nerve flossing or ulnar nerve glide maneuvers are cornerstones of conservative cubital tunnel syndrome treatment.
Deeper dive: Flossing the ulnar nerve with an ulnar nerve glide or ulnar nerve floss has shown remarkable benefits for cubital tunnel patients. (22) Subscribers can review this ulnar nerve floss tutorial here.
Want to learn more about neurodynamic tests and treatments? Check out this prior blog detailing 3 Simple Nerve Flossing Exercises To Help Resolve Arm Pain.
7. What Are the Best Cubital Tunnel Syndrome Exercises?
Short answer: An ulnar nerve floss exercise.
Deeper dive: In addition to stretching the wrist flexors, cubital tunnel syndrome exercises should include an ulnar nerve self-floss.
Ulnar Nerve Floss
Hold your arm in front of you with your elbow, wrist, and fingers straight as though you are getting ready to shake hands. Touch the tips of your thumb and first finger together to make a ring. Slowly flex your elbow until your hand reaches your face. The ring position should be maintained, and your forefinger should be just beneath your eye socket. Slowly raise your elbow to flip the ring up into a monocle around your eye. Lower your arm back to the starting position and repeat ten repetitions three times per day or as directed.
To complement management and exercises for cubital tunnel syndrome, patients should consider the following home advice:
Limit prolonged flexion and direct pressure on the elbow.
Avoid sleeping with fully flexed elbows. A night-time cubital tunnel syndrome splint or cubital tunnel syndrome brace that limits flexion may be helpful. (30-45 degrees of flexion is thought to be the optimal position to decrease intraneural pressure). (9)
Consider a protective pad to limit repetitive daytime trauma from work or sports.
Want to automate your patient education and home exercise prescription? Did you know you can create a lay condition report, including video demonstrations of the most appropriate exercises, for any of the top 100+ chiropractic diagnoses in 4 clicks? Watch this video to see how.
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