Advice from a Certified Hand Therapist on Cubital Tunnel Syndrome

Cubital tunnel syndrome: Hand numbness and tingling is not always carpal tunnel syndrome.

I have a funny tingling in my small and ring fingers while holding my cell phone to my ear or while holding a book when reading in bed. Why?

That “funny” sensation could be compression of the ulnar nerve at the elbow. The path of the ulnar nerve runs just behind the boney part on the inside of the elbow. The nerve is close to the skin and runs through a boney ridge without any substantial padding. The nerve must slide and stretch through this cubital tunnel with elbow movement.

Wait a minute! What does the nerve at my elbow have to do with the funny sensations in my hand?

Good question! The job of the ulnar nerve is to facilitate communication from your brain to your hand. This communication operates the muscles that help you perform coordinated movements with your fingers. Another job of the ulnar nerve is to take information about sensation at the ring and small fingers back to the brain. If the nerve is compressed or irritated, it can’t do its job. This condition leads to difficulty manipulating objects with your hand, feelings of weakness and sensations of tingling, numbness, burning or tightness in your fingers.

That doesn’t sound good. What can I do?

There is good news. There are some things you can try that might calm the nerve. Nerves do not like to be crowded. The ulnar nerve becomes crowded at the elbow with direct pressure over its path or when the elbow is held in a bent position for an extended period of time.

Here are a few tips:

• Avoid resting the elbow on hard surfaces, such as the arm rests in the car or on chairs and tables. If you need to rest your elbows, pad either your elbow or the hard surface.
• Avoid keeping the elbow bent for long periods of time. Use an earpiece for your cell or work phone. At night, splint the elbow in a straighter position by wrapping and taping a bath towel around the elbow (pictured) or using an orthosis made by a certified hand therapist. There are nighttime orthoses available to purchase online (pictured), as well.

• Make the entire path of the ulnar nerve a better place. The ulnar nerve runs behind the pectoralis muscles and through some of the muscles in the neck. Poor posture makes these areas tight and can also cause some nerve compression. If you work at a desk, stand up periodically and stretch your shoulders and neck. I also recommend working on breathing patterns. Make sure to take a few breaths that come from deep in your belly. This helps the muscles in your neck relax.

The tingling goes away if I shake my hands around. I don’t think it is really that serious.

Yikes! It is always important to take care of your nerves. Nerve compression syndromes can worsen over time, and nerves take months to recover even with the best of care. If your issues persist, find a hand surgeon to help. The hand surgeon may refer you to a certified hand therapist for additional non-operative treatment.
 

Stacy Hite, PT, DPT, MS, CHT is a Certified Hand Therapist and member of the American Society of Hand Therapists (ASHT).