Progressive clinical symptoms of cubital tunnel syndrome include numbness and paresthesias or pain in the ulnar nerve distribution of the hand, primarily the little finger and ring finger. Sensory symptoms are usually exacerbated by activities that require prolonged elbow flexion, such as holding a telephone or prolonged pressure on the elbow. There may be weakness, stiffness, or clumsiness of the hand with difficulty writing or removing the lid from a jar.

Clinical signs include dulled sensation or mixed hypoesthesia and hyperesthesia in the little finger or ring finger or both. Weakness of the hand intrinsic muscles, including the lumbricals to the little finger and ring finger and the abductor digiti minimi muscle, usually precedes flexor digitorum profundus weakness. Subacute ulnar neuropathy may produce marked atrophy of the hypothenar and first dorsal interosseus muscles. Chronic ulnar neuropathy results in a claw deformity. A Tinel sign is usually present in the distribution of the ulnar nerve with tapping of the olecranon notch.

Nerve conduction slowing at the elbow should be confirmed with electrodiagnostic studies.

A positive magnetic resonance neurogram showing increased intensity of the ulnar nerve at the level of the cubital tunnel and distally provides further diagnostic evidence.

Patients with mild or intermittent symptoms may benefit from a 6- to 12-week course of nonoperative therapies, including nonsteroidal antiinflammatory drugs, corticosteroid injections, education, and activity modification.

Contraindications include other causes for the neurologic symptoms, including lower cervical radiculopathy, thoracic outlet syndrome, proximal ulnar nerve compression by the arcade of Struthers, or compression at the wrist in the Guyon canal. Amyotrophic lateral sclerosis may manifest initially with unilateral hand weakness. Spinal cord syringomyelia may produce hand symptoms but usually has a characteristic dissociated sensory loss.

Neurolysis should not be performed if the ulnar nerve is chronically partially dislocated from the epicondylar groove or has been displaced by a soft tissue mass. Anterior subluxation is favored for revision surgery or if there is a significant posttraumatic deformity.

Patients with mild or intermittent symptoms may benefit from a 6- to 12-week course of nonoperative therapies, including nonsteroidal antiinflammatory drugs, corticosteroid injections, education, and activity modification.

Contraindications include other causes for the neurologic symptoms, including lower cervical radiculopathy, thoracic outlet syndrome, proximal ulnar nerve compression by the arcade of Struthers, or compression at the wrist in the Guyon canal. Amyotrophic lateral sclerosis may manifest initially with unilateral hand weakness. Spinal cord syringomyelia may produce hand symptoms but usually has a characteristic dissociated sensory loss.

Neurolysis should not be performed if the ulnar nerve is chronically partially dislocated from the epicondylar groove or has been displaced by a soft tissue mass. Anterior subluxation is favored for revision surgery or if there is a significant posttraumatic deformity.