Think it’s carpal tunnel? It might be cubital tunnel syndrome

Numbness or tingling in your hand is often blamed on carpal tunnel syndrome, but similar symptoms can come from a different nerve being compressed at the elbow.

Cubital tunnel syndrome affects the ulnar nerve (the one associated with your “funny bone”) and can cause pain, tingling and weakness in the hand. In this Q&A, Ryan Riel, MD, an orthopedic surgeon with MultiCare Orthopedics & Sports Medicine – Good Samaritan, explains how to recognize it and what treatments may help.

Q: What is cubital tunnel syndrome? Is there a more common name?

Dr. Riel: There isn’t a more common or well-known name for it, but the nerve that’s involved is what is referred to as the “funny bone,” which is actually the ulnar nerve. So cubital tunnel syndrome is compression of the ulnar nerve in the elbow. The compression causes pain, numbness and tingling in the fingers.

Q: How is it different from carpal tunnel syndrome?

Dr. Riel: Carpal tunnel has to do with the median nerve in the wrist. Cubital tunnel syndrome is with the ulnar nerve in the elbow. Both conditions cause numbness, tingling and weakness in the hand.

Q: How common is cubital tunnel syndrome?

Dr. Riel: It’s perhaps not quite as common as carpal tunnel, which most people have heard of, but it is much more common than people realize.

Q: What are the symptoms people notice first?

Dr. Riel: Early signs are typically numbness and tingling in ring finger and pinky finger.

Q: How can cubital tunnel syndrome affect everyday activities?

Dr. Riel: Commonly people will wake up in the middle of the night and their hand is tingling or feels like it’s asleep. They may have issues while driving, holding a pen, typing — basically any time when your elbow is in a bent position. These symptoms will increase in frequency.

Q: At what point should someone see a specialist instead of waiting it out?

Dr. Riel: If it’s been going on for more than six weeks with some regularity, it would be good to see your family doctor. I would emphasize that hand weakness is an important symptom. People may notice difficulty holding things — their grip is abnormal, they are dropping things without knowing why.

Q: What happens if cubital tunnel syndrome goes untreated for too long?

Dr. Riel: Numbness is the early sign, but what we really worry about is muscle atrophy or muscle loss. A person will lose strength, control and dexterity that will affect day-to-day function. In really bad cases, you can get hand deformity due to severe muscle atrophy.

Q: How do you diagnose cubital tunnel syndrome?

Dr. Riel: There’s electrodiagnostic testing, which is the same testing used to diagnose carpal tunnel syndrome. They can be similar, and sometimes patients have both conditions. 

Q: What nonsurgical treatments are often tried first?

Dr. Riel: Activity modification and bracing are often tried first. If you have a habit of resting your elbow on the car door, for example, that should be avoided. Postural adjustment, such as how you hold the phone, can also play a role. At night, there are braces that will keep the elbow in a better position. Physical therapy can be an option, too. Injections are less commonly used.

Q: What does the surgery involve?

Dr. Riel: Surgery can be done to take pressure off the nerve and sometimes release tension. The most common type of surgery for this condition is called ulnar nerve decompression. By opening up the cubital tunnel, it takes the pressure off the nerve itself. Ulnar nerve transposition is sometimes done in addition to opening the tunnel, which moves the nerve to a location where it’s under less tension. Some patients also have carpal tunnel surgery at the same time.

Q: How long does recovery typically take?

Dr. Riel: Typical recovery will be between six and 12 weeks. Therapy is common but not always necessary. People can self-modify and gradually increase their level of activity.