Cubital Tunnel Syndrome: Therapy Treatment

If you are considering occupational or physical therapy as a treatment for cubital tunnel syndrome, we want you to be as informed as possible – so we, as therapists, can truly partner to create the best course of treatment for YOU.

In occupational therapy and physical therapy, we tend to work from “menus” of evidence-based assessments and treatments. This gives us the flexibility to meet the specific needs of each patient. Below, you’ll find the assessment and treatment options your therapist may use, along with the evidence supporting them. 

Members of the OT Potential Club can login for detailed clinical decision support on this diagnosis, including a comprehensive assessment search, goal bank, treatment info, handouts, a community forum and more.

If your cubital tunnel syndrome symptoms are new (i.e., they began within the last two weeks) and mild enough that they are not occurring every day, you may want to first try some nerve gliding at home. 

We’ve also included self-assessments to help you determine how much your cubital tunnel syndrome is impacting your quality of life, and whether it’s time to seek therapy.

Please note that this page is for educational purposes and does not substitute advice from your medical provider. At the bottom of this page, you’ll find therapists near you who can support you in your cubital tunnel syndrome treatment.

A Quick Note on Why to Pursue Therapy First

This article focuses on therapy treatment for cubital tunnel syndrome. As with most conditions, conservative treatment like therapy is typically the first course of care. That is because therapy is safer and much more cost-effective compared to invasive options like surgery (which come with a host of risks and potential complications – not to mention long recovery times).

Surgery for cubital tunnel syndrome costs approximately $5,522 per patient, whereas therapy typically costs $75-$150 per session. 

One study demonstrated that nearly 90% of patients who received cubital tunnel surgery were satisfied with the results. 31 After surgery, it can take between 12 and 18 months to see final outcomes regarding strength and symptom recovery. Long-term outcomes after cubital tunnel surgery are typically good, especially in milder cases. The amount of recovered hand strength will vary from person to person, depending on how severe the condition was prior to surgery.32 Participating in therapy after surgery is recommended to improve strength and mobility in your arm.33

The number and frequency of therapy sessions needed to treat cubital tunnel syndrome conservatively will vary based on your initial evaluation. In general, the higher your initial disability score, the more frequent your sessions. Ultimately, our goal as OTs is to move you toward self-management with a personalized prescribed program. (Read more about this in the discharge section below).

Therapist-Recommended Assessments for Cubital Tunnel Syndrome

Although your symptoms might be localized to your hand or elbow, it is important to evaluate other parts of the arm. This is because all of these structures are connected and influence each other. The other benefit of a thorough examination is that it can help discern whether other diagnoses are contributing to your symptoms.

Assessments also serve as a point of comparison for tracking your progress and response to treatment over time. An accurate and thorough baseline allows your therapist (and you!) to determine how much the interventions are helping. Your therapist may perform certain assessments at various intervals throughout therapy.

Core Occupational Therapy Outcome Measures

Here are two metrics that many OTs collect with every patient. Our most-used assessment measures your quality of life. At the end of the day, this is the most important outcome for us. We want our treatments to have a significant impact on your day-to-day life. 

Patient Rated Outcome Measures

Administered at evaluation, re-evaluation, and discharge. 

Observations 5-8 

Upper Quarter Screen 

  • Dermatomes, Myotomes, and Reflexes

Neurological Assessment

  • Nerve Tension
  • Semmes West Monofilaments to assess light touch 6, 9
  • Static 2-Point Discrimination 6, 8 

Range of Motion 8

  • Cervical ROM 10
  • Shoulder ROM all planes
  • Elbow ROM all planes
  • Forearm ROM all planes
  • Wrist ROM all planes
  • Screen thumb ROM
  • Finger ROM (flexion/extension/adduction/abduction)

Strength

  • Grip strength bilaterally 6, 8
  • Pinch strength, assessing the variety of functional pinch patterns used, bilaterally 6-7
  • Manual Muscle Testing 5-6
    • Muscles of the hand and forearm that are innervated by the ulnar nerve
    • Wrist flex/extend
    • Elbow flex/extend
    • Shoulder flex/abduct/ER/IR

Differential Diagnoses 5-7

  • Ulnar nerve compression in Guyon’s canal
  • Thoracic outlet syndrome
  • Cervical radiculopathy
  • Medial epicondylitis
  • Medial epicondyle osteophytes
  • Pancoast tumor
  • Brachial plexopathy
  • Martin-Gruber anastomosis considerations 16

Setting Goals for Cubital Tunnel Syndrome Therapy

Therapy only works when there is buy-in from the patient. It is important that you work with your therapist to set treatment goals that truly reflect what’s important to you.

Goals may focus on areas such as activities of daily living, strength and coordination, and pain and fatigue management, among others.

Therapy Treatment Interventions for Cubital Tunnel Syndrome

After a thorough evaluation and goal-setting process, it is time to start making progress. Below are treatment interventions that can be implemented as part of a holistic therapy program.

Aerobic Warm-up

Supports endorphin release and axonal growth.18

Nighttime Orthosis 

Prevents tight elbow flexion (as in a tightly bent elbow). 5,17,19-20

  • Your therapist will evaluate your individual presentation and determine which orthotic approach best supports your symptoms. Depending on your needs, this may include a custom‑fabricated orthosis or a well‑fitted prefabricated option designed to improve comfort, function, and nerve protection.

Manual Therapy

Improves space, movement, and blood flow for the nerve.21 

  • Instrument Assisted Soft Tissue Mobilization (IASTM) 22
  • Joint mobilizations
    • Recommended to use the Mechanical Interface Approach following the nerve pathway. 23-24

Neuromuscular Re-education

Addresses coordination, proprioception, and motor planning. Proprioception refers to knowing where your body is in space.

  • Neurodynamic techniques to mobilize the ulnar nerve and surrounding tissues. 25-26
    • Stable C Posture
    • FDI Strengthening
    • Place and Hold Tip Pinch
    • Isometrics of Stabalizers
  • Coordination challenges
    • Tendon glides → Correct any compensations that may be present
    • In-hand manipulation tasks
  • Sensory re-education
    • Stereognosis challenges
    • Exposure to/identification of various textures
  • Proprioception
    • Incorporate putty exercises while paying attention to the amount of force required to manipulate the putty.
    • Isolate and resist the muscles innervated by the ulnar nerve

Functional Strengthening

  • Scapular stabilization and postural control
  • Core exercises

Self-Care Home Management

  • Education on ergonomic positioning
  • Work with the patient to modify activities and employ adaptive equipment to prevent sustained or repetitive elbow flexion. The goal is to reduce tension placed on the ulnar nerve.5,17,19,28

Incorporating Functional Tasks and Occupation-based Interventions Based on Patient Goals

  • Practice activity modifications for patient-identified I/ADLs in the clinic to promote carry-over at home.
  • Engage ulnar-innervated muscles to improve participation/activity tolerance in functional activities.

Pain Management Tools

  • Modalities: Pulsed signal therapy,5 ultrasound, and low-level laser therapy.29
  • Elbow pads to reduce compression.
  • Kinesiotape along the nerve pathway.

Home Exercise Program

  • Prioritize 1-3 exercises to enhance patient adherence to the home program.

Discharge Suggestions

Every person is unique, so your individual response to therapy will also be unique. For some, it is not appropriate to continue therapy until the condition completely resolves. For others, pain may resolve before the entire rehabilitation program is established. In the latter case, it is important to remember that pain is a symptom—not a diagnosis—and that deficits in strength and endurance must be addressed to prevent recurrence. We also recommend that you: 

  • Follow your therapist’s discharge recommendations to maintain progress made in therapy. 
  • Continue to use self-management and empowerment strategies to control any remaining symptoms.
  • Follow a home exercise program with a posture component for an additional 3 months to help establish good habits for body mechanics, even if you feel like you’re back to 100% function.
  • Consult your therapist if your condition worsens or if you continue to have difficulty with your daily activities after 3 months.

Choosing a Therapist for Cubital Tunnel Syndrome

Both occupational therapists and physical therapists can treat cubital tunnel syndrome. In less severe cases, a generalist therapist from either discipline should be able to help.

It is important to note that both OTs and PTs can pursue advanced certification as a Certified Hand Therapist. To achieve this rigorous specialization of the hand, wrist, elbow, and shoulder, therapists must log 4,000 hours of experience treating the upper extremity and pass a formal examination. They must also complete various recertification requirements every 5 years.

Below, you can find occupational therapy professionals who have tagged “hand therapy” as a focus area. The ones with a “CHT” in their credentials are Certified Hand Therapists.

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Conclusion

Hopefully this article helped you understand what therapy for cubital tunnel syndrome entails – and whether you’re a good candidate for this type of treatment.

This article is updated regularly based on newly released research. If you have any research you would like us to consider, please drop it in the comments.

Therapists who would like more detailed information on cubital tunnel syndrome treatment best practices can join us as members of the OT Potential Club.

Therapists who would like more detailed information on Cubital Tunnel Syndrome rehabilitation best practices can join us as members of the OT Potential Club.

References

Here’s the science that backs the assessment and treatment outlined above.

  1. Dabbagh, A., Saeidi, S., & MacDermid, J. C. (2022). Psychometric Properties of the Patient-Reported Outcome Measures for People With Ulnar Nerve Entrapment at the Elbow: A Systematic Review. Physical Therapy, 102(10).
  2. Shafiee, E., MacDermid, J., Farzad, M., & Karbalaei, M. (2022). A systematic review and meta-analysis of Patient-Rated Wrist (and Hand) Evaluation (PRWE/PRWHE) measurement properties, translation, and/ or cross-cultural adaptation, 44(2), 6551-6565.
  3. Polson, K., Reid, D., McNair, P. J., & Larmer, P. (2010). Responsiveness, minimal importance difference and minimal detectable change scores of the shortened disability arm shoulder hand (QuickDASH) questionnaire. Manual Therapy, 15(4), 404–407.
  4. Dwivedi, N., Goldfarb, C. A., & Calfee, R. P. (2023). The Responsiveness of the Patient-Reported Outcomes Measurement Information System Upper Extremity and Physical Function in Patients With Cubital Tunnel Syndrome. The Journal of Hand Surgery, 48(2), 134–140.
  5. Andrews, K., Rowland, A., Pranjal, A., & Ebraheim, N. (2018). Cubital tunnel syndrome: Anatomy, clinical presentation, and management. Journal of Orthopaedics, 15(3), 832–836.
  6. Collins, D. W., Rehak, D., Dawes, A., Collins, D. P., Daly, C., Wagner, E. R., & Gottschalk, M. B. (2025). Cubital Tunnel Syndrome: Does a Consensus Exist for Diagnosis? The Journal of Hand Surgery, 50(2).
  7. Cambon-Binder, A. (2021). Ulnar neuropathy at the elbow. Orthopaedics & Traumatology: Surgery & Research, 107(1).
  8. Corkery-Hayward, M., & MacFarlane, R. J. (2023). Clinical examination of the hand. Orthopaedics and Trauma, 37(2), 98–103.
  9. Burke, S. L., Higgins, J. P., Mclinton, M. A., Saunders, R. J., & Valdata, L. Hand and upper extremity rehabilitation: A practical guide, 4th Edition. pp. 58-60. Elsevier. 2015
  10. Sukari, A. A. A., Singh, S., Bohari, M. H., Idris, Z., Ghani, A. R. I., & Abdullah, J. M. (2021). Examining the range of motion of the cervical spine: Utilising different bedside instruments. Malaysian Journal of Medical Sciences, 28(2), 100-105.
  11. Anantavorasakul, N., Duangmee, I., Honglertkawin, S., Siripoonyothai, S., Kittithamvongs, P., Malungpaishrope, K., & Leechavengvongs, S. (2026). Objective Evaluation of the “Scratch Collapse Test” for the Diagnosis of Cubital Tunnel Syndrome Using Dynamometer. The Journal of Hand Surgery, 51(1), 61.e1-61.e5.
  12. Jain, N. S., Zukotynski, B., Barr, M. L., Cortez, A., & Benhaim, P. (2024). The Scratch-Collapse Test: A Systematic Review and Statistical Analysis. HAND, 19(7), 1054–1061.
  13. Woon, C. (2016, October 21). Ulnar nerve. Orthobullets.
  14. Calfee, R. P., Manske, P. R., Gelberman, R. H., Van Steyn, M. O., Steffen, J., & Goldfarb, C. A. (2010). Clinical assessment of the ulnar nerve at the elbow: Reliability of instability testing and the association of hypermobility with clinical symptoms. Journal of Bone & Joint Surgery, 92(17), 2801-2808.
  15. Ochi, K., Horiuchi, Y., Tanabe, A., Morita, K., Takeda, K., & Ninomiya, K. (2011). Comparison of Shoulder Internal Rotation Test With the Elbow Flexion Test in the Diagnosis of Cubital Tunnel Syndrome. The Journal of Hand Surgery, 36(5), 782–787.
  16. Cavalheiro, C. S., Filho, M. R., Pedro, G., Caetano, M. F., Vieira, L. A., & Caetano, E. B. (2016). Clinical repercussions of Martin-Gruber anastomosis: Anatomical study. Revista Brasileira de Ortopedia, 51(2), 214-223.
  17. Kooner, S., Cinats, D., Kwong, C., Matthewson, G. D., & Dhaliwal, G. (2019). Conservative treatment of cubital tunnel syndrome: A systematic review. Orthopedic Reviews, 11(2).
  18. Chiaramonte, R., Pavone, V., Testa, G., Pesce, I., Scaturro, D., Musumeci, G., Mauro, G. L., & Vecchio, M. (2023). The role of physical exercise and rehabilitative implications in the process of nerve repair in peripheral neuropathies: A systematic review. Diagnostics, 13(3).
  19. Ho, E. S., Zuccaro, J., Davidge, K., Borschel, G., & Wright, V. (2018). Effectiveness of Conservative Treatment for Cubital Tunnel Syndrome: A Systematic Review. Journal of Hand Therapy, 31(1), 145.
  20. Shah, C. M., Calfee, R. P., Gelberman, R. H., & Goldfarb, C. A. (2013). Outcomes of Rigid Night Splinting and Activity Modification in the Treatment of Cubital Tunnel Syndrome. The Journal of Hand Surgery, 38(6).
  21. Cook, C. E., Rhon, D. I., Bialosky, J., Donaldson, M., George, S. Z., Hall, T., Kawchuk, G., Lane, E., Lavazza, C., Lluch, E., Louw, A., Mazzieri, A. M., McDevitt, A., Reed, W. R., Schmid, A. B., Silva, A. G., Smart, K. M., & Puentedura, E. J. (2023). Developing manual therapy frameworks for dedicated pain mechanism. JOSPT Open, 1(1), 48–62.
  22. Jiménez-del-Barrio, S., Cadellans-Arróniz, A., Ceballos-Laita, L., Estébanez-de-Miguel, E., López-de-Celis, C., Bueno-Gracia, E., & Pérez-Bellmunt, A. (2022). The effectiveness of manual therapy on pain, physical function, and nerve conduction studies in carpal tunnel syndrome patients: A systematic review and meta-analysis. International Orthopaedics, 46(2), 301–312.
  23. Fernández-de-las-Peñas, C., Cleland, J., Palacios-Ceña, M., Fuensalida-Novo, S., Pareja, J. A., & Alonso-Blanco, C. (2017). The effectiveness of manual therapy versus surgery on self-reported function, cervical range of motion, and pinch grip force in carpal tunnel syndrome: A randomized clinical trial. Journal of Orthopaedic & Sports Physical Therapy, 47(3), 151–161.
  24. Dutton, M. (2023). Dutton’s orthopaedic: Examination, evaluation and intervention (6th ed.). McGraw Hill.
  25. Papacharalambous, C., Savva, C., Karagiannis, C., & Giannakou, K. (2022). The effectiveness of slider and tensioner neural mobilization techniques in the management of upper quadrant pain: A systematic review of randomized controlled trials. Journal of Bodywork and Movement Therapies, 31, 102–112.
  26. Wolny, T., & Wieczorek, M. (2025). Real Versus Sham-Based Neurodynamic Techniques in the Treatment of Cubital Tunnel Syndrome: A Randomized Placebo-Controlled Trial. Journal of Clinical Medicine, 14(6).
  27. Coppieters, M. W., Hough, A. D., & Dilley, A. (2009). Different nerve-gliding exercises induce different magnitudes of median nerve longitudinal excursion: An in vivo study using dynamic ultrasound imaging. Journal of Orthopaedic & Sports Physical Therapy, 39(3), 164-171.
  28. Caliandro, P., La Torre, G., Padua, R., Giannini, F., & Padua, L. (2016). Treatment for ulnar neuropathy at the elbow. Cochrane Database of Systematic Reviews, 2016(11).
  29. Wieczorek, M., & Wolny, T. (2025). Efficacy of manual therapy and electrophysical modalities for treatment of cubital tunnel syndrome: A randomized interventional trial. Life, 15(7).
  30. Goodman, C. C. (2010). Screening for medical problems in patients with upper extremity signs and symptoms. Journal of Hand Therapy, 23(2), 105–126.
  31. Harder, K., Lukschu, S., Dunda, S. E., & Krapohl, B. D. (2015). Results after simple decompression of the ulnar nerve in cubital tunnel syndrome. GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW, 4(19).
  32. Pidgeon, T. S. (n.d.). Cubital tunnel release. OrthoInfo.
  33. Ignite Healthwise, LLC Staff. (2024, July 31). Ulnar nerve decompression: What to expect at home. Alberta.

OT Potential does not endorse any treatments, procedures, products, or therapists referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking medical advice should consult their medical provider.

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