What is the treatment for cubital tunnel syndrome?

Treatment of Cubital Tunnel Syndrome

The treatment of cubital tunnel syndrome should begin with conservative management for mild to moderate cases, progressing to surgical intervention for severe cases or those that fail non-operative treatment. 1, 2

Initial Conservative Management

• Education and activity modification are first-line treatments with moderate evidence of effectiveness for mild to moderate cubital tunnel syndrome 3
• Night splinting to prevent elbow flexion during sleep shows similar effectiveness to activity modification and should be offered as an initial treatment option 2, 3
• Conservative treatment should typically be trialed for approximately 3 months before considering surgical options 3
• Avoid activities that involve repetitive elbow flexion or direct pressure on the ulnar nerve at the elbow 1

Advanced Conservative Options

• Elbow padding to prevent external compression of the nerve during daily activities 1
• Nerve gliding exercises may be incorporated into the treatment plan, though evidence for their effectiveness is limited 3
• Non-steroidal anti-inflammatory medications may provide symptomatic relief but have limited evidence for long-term effectiveness 3

Indications for Surgical Management

• Persistent symptoms despite 3 months of appropriate conservative management 2, 3
• Motor weakness, muscle atrophy, or fixed sensory changes indicate more advanced disease requiring surgical intervention 2
• Progressive neurological deficits that affect quality of life and fine motor function 1

Surgical Treatment Options

• Simple in situ decompression (open or endoscopic) is the treatment of choice for primary cubital tunnel syndrome and can be performed under local anesthesia 2, 4

  • Decompression should extend at least 5-6 cm distal to the medial epicondyle 2

• Anterior transposition of the ulnar nerve (subcutaneous, intramuscular, or submuscular) is indicated for:

  • Painful ulnar nerve subluxation 2
  • Cases with significant elbow deformity or cubitus valgus 2, 4
  • Severe bone or tissue changes at the elbow 2

• Medial epicondylectomy is less commonly performed but remains an option in select cases 4, 5

Post-Treatment Considerations

• Recurrence of symptoms may occur after surgical treatment, requiring revision surgery 2
• Risks of transposition procedures include compromise of blood flow to the nerve and kinking if inadequate mobilization is performed 2
• Early intervention is critical to prevent irreversible muscle atrophy and hand contractures that can occur in advanced disease 5

Monitoring and Follow-up

• Regular assessment of motor and sensory function to evaluate treatment effectiveness 1
• Electrophysiological studies may be used to objectively monitor nerve recovery 3
• Patient-reported outcomes should be tracked to assess symptomatic improvement 3

Remember that if left untreated, cubital tunnel syndrome can lead to significant disability with atrophy of intrinsic hand muscles and permanent sensory changes, negatively impacting quality of life and fine motor function 1, 5.