Cubital Tunnel Syndrome and OT intervention
If you’ve been experiencing numbness or tingling in your ring and pinky fingers, a weak grip, or elbow pain that worsens at night, you may have been told it’s carpal tunnel syndrome but what if it’s not?
Frequently misdiagnosed as Carpal Tunnel, Cubital Tunnel Syndrome actually affects a different nerve and requires a different treatment approach. As occupational therapists, especially those trained as Certified Hand Therapists (CHTs,) we specialize in identifying these patterns and treating not just symptoms, but root causes.
What Is Cubital Tunnel Syndrome?
Cubital Tunnel Syndrome is a compression of the ulnar nerve at the elbow, where it passes through a narrow passageway called the cubital tunnel (on the inner side of the elbow). We often refer to the nerve as “the funny bone,” that we have felt as a jolting or electrical sensation if we have ever banged the elbow against a hard surface. Ouch!
When irritated or compressed, the ulnar nerve can cause:
- Numbness or tingling in the ring and small fingers
- Hand weakness or clumsiness
- Pain or aching along the inner elbow
- Difficulty with fine motor tasks (e.g., buttoning, typing, gripping)
- Weakness when trying to squeeze the pinky against the ring finger
- Symptoms that worsen when the elbow is positioned in a bent position (e.g., sleeping with bent elbows, talking on the phone, leaning on an armrest)
Cubital Tunnel vs. Carpal Tunnel: What’s the Difference?
It’s easy to confuse the two:
Cubital Tunnel: Affects the ulnar nerve at the level of the elbow and causes numbness or tingling in the ring and pinky fingers. Symptoms are often provoked when holding the elbow in a bent position or when leaning on the elbow.
Carpal Tunnel: Affects the median nerve at the wrist and causes
numbness in the index, middle and thumb. Symptoms are often provoked when bending the wrist forward, reaching down or when weight bearing on the hand
OT CHTs are trained to pinpoint the correct nerve involvement using detailed assessments, nerve glide testing, and postural screening.
The Bigger Picture: Why Symptoms Might Start Higher Up
Sometimes, what looks like an elbow or hand problem is actually part of a larger nerve irritation pattern. This is where a postural assessment is essential, especially when someone is having numbness/tingling in the ring and pinky fingers.
The Brachial Plexus Connection
The brachial plexus is a network of nerves that runs from the neck, through the shoulder, down to the hand. If nerves are restricted or irritated higher up, from poor posture, tight scalene muscles, thoracic outlet compression, or forward shoulder positioning , you may experience symptoms that mimic cubital or carpal tunnel syndrome, or even have features of both.
You may also have a “double crush” that happens when the smaller diameter nerve fibers are highly irritable due to compression of the more robust fibers up the chain. You can have symptoms in the hand and elbow, as well as symptoms at the level of the brachial plexus.
That’s why we assess:
- Cervical spine screening
- Shoulder girdle posture
- Muscle strength
- Thoracic outlet mobility
- Nerve tension
- Daily habits
- Ergonomic set up
Individualized assessment helps to determine whether cubital tunnel syndrome is the primary issue or part of a broader upper limb neurodynamic problem. Often there is more than one culprit at play.
How A Certified Hand Therapist Can Help
OTs trained in hand therapy and nerve conditions offer evidence-based, function-focused treatments tailored to your lifestyle and job demands.
Activity and Postural Modification
- Avoid prolonged elbow flexion
- Use a headset or speakerphone instead of holding a phone to your ear
- Modify workstation setup to reduce nerve tension
- Correct forward head or rounded shoulder posture
Orthotic Intervention
- Night orthosis: A padded elbow splint worn at night keeps the elbow in a slightly extended position to reduce pressure on the ulnar nerve
- Soft daytime sleeves: Reduce direct pressure of bumping the “funny bone” during the day
Ulnar Nerve Gliding Exercises
- Gentle nerve mobilizations help maintain nerve mobility without overstretching
- Move gently and fluidly–like a graceful dance.
- Avoid sharp, staccato motions and stop the glides if they reproduce the sensations bringing you to therapy.
Your exercises must be tailored to your needs and performed mindfully. Aggressive gliding can worsen symptoms if not appropriate. Your therapist will guide you.
Proximal Stabilization and Postural Training
- Scapular stabilization exercises
- Cervical and thoracic posture correction
- Diaphragmatic breathing to reduce tension in the thoracic outlet area
Ergonomics and Functional Retraining
- Adapting work tasks to minimize compression
- Training safe arm positioning for driving, desk work, sleep, and hobbies
- Graded return to fine motor or strength-based tasks
When to Seek Help
If you’ve been diagnosed with carpal tunnel but your symptoms don’t match, especially if your pinky finger is involved, or if traditional wrist treatments aren’t helping, ask your provider about cubital tunnel syndrome. Early intervention with a trained OT, CHT can:
- Relieve symptoms before permanent nerve damage occurs
- Prevent surgery or prolong the need for it
- Restore functional use of the hand and arm
Final Thoughts
Cubital Tunnel Syndrome is a common but at times misunderstood condition. With the right diagnosis and a comprehensive OT plan that includes nerve protection, posture, activity modification, and targeted therapy, many people see lasting relief without needing invasive treatments.
Elbowing Out Pain: Tackle Cubital Tunnel Syndrome
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