top of page

Cubital Tunnel Syndrome Treatment in London

What is cubital tunnel syndrome?

Cubital tunnel syndrome is compression of the ulnar nerve as it passes behind the inner side of the elbow, the spot known as the "funny bone". It causes numbness and tingling in the ring and little fingers and, in time, weakness of the hand. It is the second most common nerve compression in the arm after carpal tunnel syndrome.

Mild cases improve with simple measures such as night splints and avoiding pressure on the elbow. Persistent symptoms, or any weakness or muscle wasting, need assessment, as surgery to release the nerve protects hand function.

​

Written and reviewed by Mr Dafydd (Taff) Edwards FRCS(Tr&Ortho), Consultant Hand, Wrist and Elbow Surgeon, Cleveland Clinic London.

Last reviewed: 31 October 2026.

​

Private consultations at Cleveland Clinic London, 55 Moorgate, EC2R 6BH. Call 020 3423 7183 or book online.

Symptoms

Symptoms start as intermittent tingling and can progress to constant numbness and weakness:

  • Numbness or pins and needles in the little finger and half of the ring finger

  • Symptoms worse with the elbow bent, such as holding a phone, driving or sleeping with the arm folded

  • Waking at night with a numb hand

  • Aching on the inner side of the elbow

  • Clumsiness, dropping objects, or difficulty with buttons and fine tasks

  • Weak pinch grip and loss of speed or control on an instrument

  • Thinning of the muscles in the hand, seen first between the thumb and index finger

Muscle wasting is a sign of advanced compression and needs prompt specialist review.

Causes and who is at risk

The ulnar nerve runs through a narrow tunnel behind the bony point on the inner side of the elbow (the medial epicondyle). Bending the elbow stretches the nerve and raises pressure inside the tunnel several-fold. Over time, repeated or sustained bending reduces blood flow to the nerve and affects its function.

Risk factors include:

  • Sustained elbow bending, at work, on the phone or during sleep

  • Leaning on the elbow, for example on a desk or car door

  • Repetitive gripping and throwing sports

  • Musical instruments held with the elbow bent, including violin, viola and guitar

  • A nerve that slips over the bony point when the elbow bends

  • A previous elbow fracture, arthritis or bony spurs

  • Diabetes, which makes nerves more vulnerable to pressure

  • Male sex, with men affected at about twice the rate of women

How is cubital tunnel syndrome diagnosed?

Diagnosis combines examination with nerve tests. At your consultation I examine the elbow, the hand muscles and sensation, and check the neck and wrist for other sites of compression. Key findings include:

  • Tingling when the nerve is tapped behind the elbow

  • Symptoms reproduced by holding the elbow fully bent for one minute

  • Weakness spreading the fingers apart or pinching

  • Whether the nerve slips over the bony point as the elbow bends

I arrange tests to confirm the diagnosis and measure severity:

  • Nerve conduction studies and electromyography (EMG) show where the nerve is compressed and how much damage there is. They guide the timing of surgery.

  • Ultrasound shows the nerve's size, its movement and any cause of pressure such as a cyst.

  • X-rays where there is arthritis or a previous fracture.

These tests also exclude conditions that cause similar symptoms: a trapped nerve in the neck, compression at the wrist (Guyon's canal) and thoracic outlet syndrome.

Non-surgical treatment

For mild symptoms without weakness, non-surgical treatment is the first step. In one randomised trial, 89% of patients with mild or moderate symptoms improved over six months with advice and activity change alone.

  1. Avoid sustained elbow bending. Use a headset or speakerphone, and keep the elbow straighter at the keyboard and wheel.

  2. Night splint. A splint or a towel wrapped round the elbow stops it bending fully while you sleep.

  3. Protect the elbow. Avoid leaning on it; use an elbow pad if your work requires it.

  4. Hand therapy. Advice on posture, workstation and instrument set-up, and on activity pacing.

  5. Review. I reassess symptoms and strength at 6 to 12 weeks.

Steroid injections are not recommended for cubital tunnel syndrome.

​

I follow the British Society for Surgery of the Hand (BSSH) guidance on cubital tunnel syndrome.

Surgery and recovery

I recommend surgery when symptoms persist beyond three months despite non-surgical treatment, when nerve tests show significant compression, or when there is any weakness or muscle wasting. Early release gives the nerve the best chance of recovery.

​​​

The operation

  • Day-case procedure under general or regional anaesthetic

  • Simple decompression: release of the tissue roofing the tunnel through an incision on the inner side of the elbow, leaving the nerve in place

  • Anterior transposition: moving the nerve in front of the elbow, reserved for a nerve that slips out of place, or for revision surgery

  • The operation takes 30 to 60 minutes

Randomised trials and a Cochrane review show simple decompression and transposition give equal results, with fewer wound complications after simple decompression. For this reason simple decompression is my first choice for most patients.

​

Recovery timeline

0 to 2 weeks: Soft bandage. Move the fingers and elbow from day one.

2 weeks: Wound check and stitch removal. Hand therapy if needed.

1 to 3 weeks: Return to desk work and driving.

6 weeks: Return to sport, manual work and instrument practice.

3 to 12 months: Sensation and strength continue to recover.

​

Night-time symptoms are the first to settle. Recovery of numbness and strength depends on how long and how severe the compression was; where muscle wasting is established, the aim of surgery is to stop further loss.

Complications are uncommon. They include a numb patch or tender scar near the incision, infection, elbow stiffness, the nerve slipping out of place after release, and recurrence.

​

​

When to see a specialist

Book an assessment if:

  • Numbness or tingling in the ring and little fingers has lasted more than six weeks

  • Symptoms wake you at night or have become constant

  • You notice weakness, clumsiness or dropping objects

  • You see thinning of the muscles in your hand

  • Symptoms affect your work, sport or playing

  • You have had an elbow fracture and now notice hand numbness

Frequently asked questions

Is cubital tunnel syndrome the same as hitting my funny bone?

It involves the same nerve. A knock causes brief tingling that passes. Cubital tunnel syndrome causes symptoms that last or keep returning.

​

Will it get better on its own?

Mild cases improve with activity change and a night splint. Symptoms that persist, or any weakness, need assessment, as long-standing compression can cause permanent nerve damage.

​

Does it need surgery?

Not in mild cases. Surgery is advised for persistent symptoms, abnormal nerve tests, or weakness and muscle wasting.

​

Will the numbness go after surgery?

Tingling and night symptoms improve within weeks. Numbness and strength can take 3 to 12 months to recover, and recovery is less complete when compression has been severe for a long time.

​

Can I keep playing my instrument?

In most cases, yes, with changes to posture, practice length and breaks. I work with hand therapists experienced in treating musicians.

​

Do I need a GP referral?

Many insurers require one for a claim. Self-funding patients can book direct.

References

  1. Mondelli M, Giannini F, Ballerini M, Ginanneschi F, Martorelli E. Incidence of ulnar neuropathy at the elbow in the province of Siena (Italy). J Neurol Sci. 2005;234(1-2):5-10.

  2. Svernlöv B, Larsson M, Rehn K, Adolfsson L. Conservative treatment of the cubital tunnel syndrome. J Hand Surg Eur Vol. 2009;34(2):201-7.

  3. Bartels RH, Verhagen WI, van der Wilt GJ, et al. Prospective randomized controlled study comparing simple decompression versus anterior subcutaneous transposition for idiopathic neuropathy of the ulnar nerve at the elbow: part 1. Neurosurgery. 2005;56(3):522-30.

  4. Zlowodzki M, Chan S, Bhandari M, Kalliainen L, Schubert W. Anterior transposition compared with simple decompression for treatment of cubital tunnel syndrome: a meta-analysis of randomized, controlled trials. J Bone Joint Surg Am. 2007;89(12):2591-8.

  5. Caliandro P, La Torre G, Padua R, Giannini F, Padua L. Treatment for ulnar neuropathy at the elbow. Cochrane Database Syst Rev. 2016;11:CD006839.

bottom of page