Cubital tunnel syndrome in Vienna
The little finger falls asleep, the inner side of the elbow pulls, the hand becomes clumsy: in cubital tunnel syndrome the ulnar nerve is under pressure. In my practice at the Orthozentrum Döbling I find out where the narrow point sits.
In short
In cubital tunnel syndrome the ulnar nerve (nervus ulnaris) is compressed in its groove behind the inner bony prominence of the elbow. Typical are tingling and numbness in the little and ring finger, stronger with the arm bent and at night, later a loss of strength and a clumsy hand. I make the diagnosis from the conversation, the clinical examination and ultrasound; the nerve conduction study arranged through a neurologist shows how badly the nerve is affected. Treatment starts without an operation. If the symptoms remain, or if the nerve is damaged, I release it through an approach on the inner side of the elbow.
What is cubital tunnel syndrome?
The ulnar nerve runs along the inner side of the elbow through a bony groove, the sulcus nervi ulnaris. A firm roof of connective tissue is stretched over it; together the two form the cubital tunnel, which gives the syndrome its name. Here the nerve lies close under the skin, familiar from knocking your funny bone. Further down it supplies the little finger, the ulnar half of the ring finger and the small muscles of the hand.
Bending narrows the groove and stretches the nerve at the same time. If that repeats over a long period, or if pressure from outside is added, the nerve comes under constant strain. Propping the elbow, working with the arm sharply bent, thickened connective tissue, a ganglion and bony spurs after an elbow dislocation or with osteoarthritis all encourage it. Sometimes the nerve jumps out of its groove when the elbow bends.
The nerve is not always the only structure involved. In snapping triceps syndrome an inner portion of the triceps muscle also slips over the bony prominence on the inner side of the elbow. Together this produces a double snap that can be felt when the elbow bends. The distinction matters: if only the nerve is relocated and the muscle portion is overlooked, the snapping continues. That is why, whenever something snaps at the elbow, I check both structures — by feel and with ultrasound during movement.
Typical symptoms
- Tingling and numbness — in the little finger and in the ulnar half of the ring finger.
- Bending as the trigger — being on the phone, driving, sleeping with the arm bent.
- Pain on the inner side of the elbow — radiating into the forearm and hand.
- Loss of strength — spreading the fingers and the grip between thumb and index finger become weaker.
- Clumsiness — keys and cutlery slip, fine movements fail.
- Late signs — the muscle between thumb and index finger sinks in.
How I make the diagnosis
It begins with a detailed conversation: which fingers are affected, when the symptoms appear, how you work and how you sleep. Then I test sensation and strength in the territory the ulnar nerve supplies and use tests in which sustained bending or tapping over the groove provokes the abnormal sensations. I feel whether the nerve jumps out of its groove.
Ultrasound is available in the practice: I see the nerve in cross-section, recognise a swelling in front of the narrow point and assess how it glides during movement. The nerve conduction study (electroneurography) I arrange through a neurologist; it shows at what level the nerve is suffering. Where a bony cause is suspected I arrange an X-ray, and an MRI if needed. If it is mainly the thumb, index and middle finger that fall asleep, that speaks rather for carpal tunnel syndrome; if the picture stays unclear, I work through the causes of elbow pain one by one.
Treatment: conservative first
As long as the nerve has taken no demonstrable damage, I begin without an operation. The largest contribution comes from taking the load off: not propping the elbow on hard edges, interrupting work with the arm sharply bent, using a headset on the phone, resting the arm loosely extended at night. Physiotherapy adds exercises that let the nerve glide again — in the same building at the Orthozentrum Döbling. If the tendon insertion on the inner side is irritated as well, as in golfer's elbow, an ultrasound-guided injection can bring relief.
To be honest about it: these measures take away pressure and irritation, but they do not remove the narrowing itself. My practice is a private practice, in Austria a Wahlarztordination. I do not settle directly with any public health insurer; you receive an invoice and submit it to your insurer — on request I take care of the submission for you. The page on billing in a private practice explains how it works.
When an operation is necessary
The aim is simple: to give the nerve room again. Through an approach on the inner side of the elbow I expose the ulnar nerve and release the roof over the groove as well as the constricting bands of connective tissue — the release of the ulnar nerve. The nerve itself remains untouched. If it jumps out of its groove when the elbow bends, the procedure has to take that into account as well. Afterwards the arm should be moved early, so that the nerve glides.
I carry out necessary procedures at the ATOMOS Klinik Währing, the Privatklinik Döbling or the Rudolfinerhaus, and I accompany you from planning through the procedure to aftercare. Further procedures are shown in the overviews of the elbow and of hand surgery in Vienna. Frankly said: abnormal sensations usually improve earlier than strength and muscle bulk. Whether and when an operation happens depends on the findings — on the nerve conduction study, on the symptoms and on your everyday life. We weigh that up together, and only then is the decision made.
Frequently asked
Common questions about cubital tunnel syndrome
The leading sign is tingling or a feeling of numbness in the little finger and in the ulnar half of the ring finger. It makes itself felt above all when the elbow stays bent for longer — on the phone, while driving or at night. If pain on the inner side of the elbow, loss of strength when spreading the fingers or a clumsy hand are added, the picture fits well.
Bending narrows the groove behind the inner bony prominence, and the ulnar nerve is stretched and pressed at the same time. Its blood supply suffers first, and it reports back with tingling. That is why the symptoms wake many people at night, when the arm lies bent. Straightening the arm and shaking it out usually brings relief at the beginning.
What matters is which fingers are affected. The ulnar nerve supplies the little finger and the ulnar half of the ring finger; if it is compressed, exactly these fall asleep. In carpal tunnel syndrome the narrow point sits at the wrist, and the thumb, index and middle finger are affected. The place where the pain sits also helps.
Usually yes, at the latest before a planned operation. Conversation, clinical examination and ultrasound show me where the narrow point sits. The nerve conduction study adds how badly the conduction of the ulnar nerve is disturbed and at what level. I arrange it through a neurologist and go through the report with you afterwards.
Do not keep the elbow strongly bent all the time and do not prop it on hard edges — desk, car door, armrest. On the phone, a headset takes the load off. For the night, a loose position with the arm extended helps. Which loads matter in your case we go through together.
Through an approach on the inner side of the elbow I expose the nerve and release the roof over the groove as well as constricting bands of connective tissue. Nothing is changed on the nerve itself. If it jumps out of its groove when the elbow bends, the procedure has to take that into account. I discuss the approach and the anaesthetic with you beforehand.
When the numbness no longer goes away, when the hand becomes clumsy in fine grip or when the muscle between thumb and index finger visibly wastes. Such signs speak for a nerve that is already damaged, and muscles recover more slowly than sensation. A nerve that snaps over the inner bony prominence also deserves a look.
Dr. med. Martin Eigenschink
Specialist in Orthopaedics and Traumatology · Specialist in elbow, shoulder and hand surgery
Surgical and conservative treatment of the elbow, shoulder and hand, preferably minimally invasive. Practice at the Orthozentrum Döbling, 1190 Vienna. More about my background
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Medical notice: The contents of this page serve as general information. They do not replace a medical examination, diagnosis or individual advice. Medicine is a constantly evolving field — despite careful research, no guarantee can be given that the content is fully up to date.