J Hand Microsurg 2009; 01(02): 76-81
DOI: 10.1007/s12593-009-0020-9
Review Article
Thieme Medical and Scientific Publishers Private Ltd.

Cubital tunnel syndrome – Review of current literature on causes, diagnosis and treatment

Bart Wojewnik
Randy Bindra

Subject Editor:
Further Information

Publication History

14 March 2009

12 June 2009

Publication Date:
05 September 2016 (online)


Cubital tunnel syndrome is common, but not fully understood. Fortunately, most cases of ulnar nerve compression improve with nonsurgical treatment and large majority get better with surgical decompression. The fact that most people get better with and without surgical treatment is likely the reason that multiple studies have failed to show improved results with different types of decompressions for mild cubital tunnel syndrome. Transposition surgeries have been shown to yield better results with more severe cases and patients who failed previous simple releases, likely secondary to release of other compression sites that were missed by the initial surgery. Knowing more about pathology of the cutbital tunnel syndrome such as compression versus traction injury and having better modalities for evaluation of the nerve should help us to better tailor treatment for the patients in the future.

  • References

  • 1 Shin R, Ring D. The ulnar nerve in the elbow trauma. J Bone Joint Surg 2007; 89A: 1108-1116
  • 2 Canale ST, Beaty JH. Campbell’s operative orthopaedics, Cubital Tunnel Syndrome. Mosby 2008. 11th ed., Online edition
  • 3 Pederson W. Green’s operative hand surgery. 2005. Elsevier. Cubital Tunnel Syndrome; 5th edn 1024-1033
  • 4 Elhassan et al Entrapment neuropathy of the ulnar nerve. J Am Acad Orthop Surg 2007; 15: 672-681
  • 5 Gelberman RH. Ulnar tunnel syndrome. Orthopaedics. Philadelphia, PA: JB Lippincott; 1993. vol 2. 2nd edn 1419-1465
  • 6 Rogers MR, Bergfield TG, Aulicino PL. The failed ulnar nerve transposition: Etiology and treatment. Clin Orthop Relat Res 1991; 269: 193-200
  • 7 Gelberman RH et al Changes in interstitial pressure and cross-sectional area of the cubital tunnel and of the ulnar nerve with flexion of the elbow. An experimental study in human cadavera. 1998; J Bone Joint Surg Am 80: 492-501
  • 8 Macnicol MF. External pressures affecting the ulnar nerve at the elbow. Hand 1982; 14: 5-11
  • 9 Pechan J, Julis I. The pressure measurement in the ulnar nerve. A contribution to the pathophysiology of the cubital tunnel syndrome. J Biomech 1975; i: 75-79
  • 10 Kleinman WB. Cubital tunnel syndrome: Anterior transposition as a logical approach to complete nerve decompression. J Hand Surg 1999; 24A: 886-897
  • 11 Chung KC. Treatment of ulnar nerve compression at the elbow. J Hand Surg [Am] 2008; 33 ((9)) 1625-1627
  • 12 Bartels RHMA, Menovsky T, Van Overbeeke JJ, Verhangen WIM. Surgical management of ulnar nerve compression at the elbow: an analysis of the literature. J Neurosurg 1998; 89: 722-727
  • 13 Mowlavi A, Andrews K, Lille S, Verhulst S, Zook EG, Milner S. The management of cubital tunnel syndrome: a meta-analysis of clinical studies. Plast Reconstr Surg 2000; 106: 327-334
  • 14 Chan RC, Paine KW, Varughese G. Ulnar neuropathy at the elbow: Comparison of simple decompression and anterior transposition. Neurosurgery 1980; 7 ((6)) 545-550
  • 15 Davies MA, Vonau M, Blum PW, Kwok BC, Matheson JM, Stening WA. Results of ulnar neuropathy at the elbow treated by decompression or anterior transposition. Aust N Z J Surg 1991; 61 ((12)) 929-934
  • 16 Dellon AL. Review of treatment results for ulnar nerve entrapment at the elbow. J Hand Surg [Am] 1989; 14 ((4)) 688-700
  • 17 Fernandez E, Pallini R, Lauretti L, Scogna A, La Marca F. Neurosurgery of the peripheral nervous system: cubital tunnel syndrome. Surg Neurol 1998; 50: 83-85
  • 18 Filippi R et al Cubital tunnel syndrome. Treatment by decompression without transposition of the ulnar nerve. Minim Invasive Neurosurg 2002; 45 ((3)) 164-168
  • 19 Heithoff SJ. Cubital tunnel syndrome does not require transposition of the Ulnar Nerve. J Hand Surg [Am] 1999; 24 ((5)) 898-905
  • 20 Michael Zlowodzki et al Anterior transposition compared with simple decompression for treatment of cubital tunnel syndrome. A meta-analysis of randomized, controlled trials. JBJS [Am] 2007; 89: 2591-2598
  • 21 Kleinman WB, Bishop AT. Anterior intramuscular transposition of the ulnar nerve. J Hand Surg [Am] 1989; 14 ((6)) 972-979
  • 22 Nabhan A et al Simple decompression or subcutaneous anterior transposition of the ulnar nerve for cubital tunnel syndrome. J Hand Surg [Br] 2005; 30 ((5)) 521-524
  • 23 Gervasio O et al Simple decompression versus anterior submuscular transposition of the ulnar nerve in severe cubital tunnel syndrome: A prospective Randomized Study. Neurosurgery 2005; 56 ((1)) 108-117
  • 24 Macadam SA et al Simple decompression versus anterior subcutaneous and submuscular transposition of the ulnar nerve for cubital tunnel syndrome: A meta-analysis. J Hand Surg [Am] 2008; 33A: 1314-1324
  • 25 Macnicol MF. The results of operation for ulnar neuritis. J Bone Joint Surg 1979; 61B: 159-164
  • 26 Adelaar RS et al The treatment of the cubital tunnel syndrome. J Hand Surg [Am] 1984; 9a ((1)) 90-95
  • 27 Caputo AE et al Subcutaneous anterior of the ulnar nerve for failed decompression of cubital tunnel syndrome. J Hand Surg [Am] 2000; 25 ((3)) 544-551
  • 28 Gerritsen AA et al Conservative treatment options for carpal tunnel syndrome: a systematic review of randomized controlled trials. J Neurology 2002; 249 ((3)) 272-280
  • 29 Bultmann C. Results of endoscopic decompression of ulnar nerve in cubital tunnel syndrome. Handchir Mik-rochir Plast Chir 2009; 41 ((1)) 28-34
  • 30 Heinen CP et al The endoscopic management of the cubital tunnel syndrome - an anatomical study and first clinical results. Handchir Mikrochir Plast Chir 2009; 41 ((1)) 23-27
  • 31 Yamaguchi K, Sweet FA, Bindra R, Gelberman RH. The extraneural and intraneural arterial anatomy of the ulnar nerve at the elbow. J Shoulder Elbow Surg 1999; 8 ((1)) 17-21
  • 32 Bimmler D, Meyer VE. Surgical treatment of the ulnar nerve entrapment neuropathy: Submuscular anterior transposition or simple decompression of the ulnar nerve? Long-term results in 79 cases. Ann Chir Main Memb Super 1996; 15 ((3)) 148-157
  • 33 Keiner D et al Comparison of the long-term results of anterior transposition of the ulnar nerve or simple decompression in the treatment of the cubital tunnel syndrome - a prospective study. Acta Neurochir 2009; 151 ((4)) 311-315
  • 34 Goldberg BJ, Light TR, Blair SJ. Ulnar neuropathy at the elbow: results of medial epicondylectomy. J Hand Surg [Am] 1989; 14: 182-188