Cubital tunnel syndrome, or CuTS, is the second most common nerve problem in the arm. The most common is carpal tunnel syndrome. CuTS happens when there is too much pressure on a nerve in your elbow called the ulnar nerve.

This pressure can cause pain or discomfort in your elbow, forearm, and hand. It also can make your hand feel weak or clumsy. Symptoms often show up while you sleep (if your elbow is bent), when your elbow stays bent for a long time, or when you lean on your elbow.

CuTS is more common in people whose work or hobbies involve repeated or prolonged elbow movements, such as using hand tools, typing, painting, or playing instruments. The risk also may be higher in individuals who smoke, are male, or have underlying conditions like diabetes or cardiovascular disease.

Physical therapists can help people with CuTS feel better. They teach ways to avoid activities that make symptoms worse, reduce pain and swelling, and help you regain movement and strength.

Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To find a physical therapist in your area, visit Find a PT.

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On this page

• What Is Cubital Tunnel Syndrome?
• Signs and Symptoms
• How Is It Diagnosed?
• How Can a Physical Therapist Help?
• Can This Injury or Condition Be Prevented?
• What Kind of Physical Therapist Do I Need?

What Is Cubital Tunnel Syndrome?

Signs and Symptoms

Initial symptoms of cubital tunnel syndrome may include:

• Pain and tenderness at the inside of the elbow
• Pain during sleep (if your elbow stays bent)
• Pain, numbness, and tingling that comes and goes in the inner forearm and hand, as well as the ring and pinky finger

These symptoms typically respond well to treatment but can advance to:

• Difficulty gripping and clumsiness
• Loss of muscle size and strength (atrophy) in the small muscles of the hand
• A hand condition in which the ring and pinky fingers bend toward the palm. This is called an "ulnar claw hand."

Caution: Severe symptoms, especially with muscle atrophy and hand deformities, should be evaluated by a physician.

How Is It Diagnosed?

Physicians or physical therapists can diagnose cubital tunnel syndrome. Your physical therapist will ask about your symptoms and how long you've had them. They will also observe how you move and assess your: 

• Joint range of motion
• Strength and flexibility
• How well you can feel different types of pressure

Your physical therapist will conduct special tests to determine what is causing stress and pain in your elbow. They will use these findings to design the best treatment plan for you.

If a diagnosis cannot be made with these tests, your physical therapist will send you to your physician, who may order:

• EMG (electromyography): looks at how your muscle is working
• NCS (nerve conduction study): looks at how well your nerves send signals to your muscles
• Ultrasound: looks to see where your nerve may be getting squeezed
• MRI: helps rule out other causes of your symptoms

How Can a Physical Therapist Help?

If you have a mild or moderate case of cubital tunnel syndrome, physical therapy can help improve your symptoms.

At first, the goal of physical therapy is to reduce how often and how badly your symptoms happen. This part of treatment may include:

• Changing some of your daily activities to take pressure off your arm
• Wearing a brace or using tape to help your arm heal
• Using heat, ice, or other treatments to reduce pain and swelling
• Learning better ways to move, sit, or work to protect your arm
• Having hands-on therapy to relax tight muscles and help you move more easily
• Doing gentle stretches and exercises to improve flexibility and nerve movement
• Performing light resistance exercises to help your muscles heal and get stronger

As you start to feel better, your physical therapist will slowly add more challenging exercises. This helps make sure your symptoms don’t come back when you return to normal activities. This part of therapy may include:

• Exercises to fix muscle imbalances and improve how you move
• Slowly adding more stress to your arm to build strength and endurance
• Carefully returning to your regular activities while watching how your body responds

During your recovery, your physical therapist will keep checking how you’re doing, how well you move, and how your symptoms are changing. The goal is to help you meet all your treatment goals and get back to your normal activities without pain.

If Surgery Is Required

Sometimes, surgery is needed for more serious cases of cubital tunnel syndrome. This may happen if other treatments like changing activities, wearing braces, doing physical therapy, or taking medicine haven’t worked after six months. Surgery also may be needed if the muscles in your hand have gotten smaller and weaker.

After surgery, your physician may send you to physical therapy with instructions to guide healing and gradually return to activity.

Can This Injury or Condition Be Prevented?

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat a variety of conditions, including cubital tunnel syndrome. You may want to consider the following:

• A physical therapist who is experienced in treating people with cubital tunnel syndrome. Some physical therapists focus on treating elbow, wrist, and hand (upper extremity) conditions.
• A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedic physical therapy. These physical therapists have demonstrated advanced knowledge, experience, and skills that may apply to your condition.
• A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in hand therapy (a certified hand therapist). This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can search for physical therapists near you who meet these criteria by using Find a PT, provided by the American Physical Therapy Association.

General tips when you're looking for a physical therapist (or any other health care provider):

• Ask family, friends, or other health care providers to recommend a physical therapist.
• Ask about the physical therapists' experience in helping people with cubital tunnel syndrome when you contact the clinic for an appointment.
• Be prepared to describe your symptoms in as much detail as possible. Make a note of what makes your symptoms better or worse.