Cubital tunnel syndrome is a condition brought on by increased pressure on the ulnar nerve at the elbow, and Dr. Ashruf is one of few doctors on the east coast that can resolve it with a minimally invasive approach that requires little to no downtime.

What is Cubital Tunnel Syndrome?

There is a bump of bone on the inner portion of the elbow under which the ulnar nerve passes; this site is commonly called the “funny bone.” The ulnar nerve runs from the hand to the neck, and it is responsible for hand movement and nerve function. At the site of the inner elbow, the ulnar nerve lies directly next to the bone and is susceptible to pressure.

When the pressure on the nerve becomes great enough to disturb the way the nerve works, numbness, tingling, and pain is felt in the elbow, forearm, hand, or fingers.

Dr. Salman Ashruf is one of the only doctors in Maryland and surrounding areas that performs both endoscopic Cubital Tunnel release and endoscopic Carpal Tunnel release, while the majority of other doctors only perform endoscopic Carpal Tunnel release.

What Causes Cubital Tunnel Syndrome?

Cubital Tunnel Syndrome, also known as Ulnar Nerve Entrapment, occurs when the pressure on the nerve is significant and sustained enough to disturb the way the ulnar nerve works.

Pressure on the ulnar nerve at the elbow can develop in several ways. The nerve is positioned right next to the bone and has very little padding over it, so pressure on this can put pressure on the nerve. For example, if you lean your arm against a table on the inner part of the elbow, your arm may fall asleep and be in pain from sustained pressure on the ulnar nerve. If this occurs repetitively, the numbness and pain may be more persistent and frequent.

In some patients, the ulnar nerve at the elbow begins to click back and forth over the bony bump as the elbow is bent and straightened. If this occurs repetitively, the nerve may be significantly irritated.

Additionally, pressure on the ulnar nerve can occur from holding the elbow in a bent position for a long time, which stretches the nerve across the medial epicondyle. Such sustained bending of the elbow tends to occur during sleep or holding a cell phone. Sometimes the connective tissue over the nerve becomes thicker, or there may be variations in the muscle structure over the nerve at the elbow that put pressure on the nerve.

While some cases may not have a known cause, some of the identifiable causes of Cubital Tunnel Syndrome include:

  • Trauma or injury to the elbow
  • Long pressure on the palm
  • Inflammatory conditions
  • Nerve damaging medical conditions such as diabetes or arthritis
  • Gender – women being more likely to develop the condition than men
  • Pregnancy causing retention of fluid

How Do I Know If I Have Cubital Tunnel Syndrome?

Cubital tunnel syndrome symptoms include:

  • Pain
  • Numbness
  • Tingling
  • Cold temperature sensitivity
  • Loss of hand/finger coordination

The numbness or tingling most often occurs in the ring and little fingers. The symptoms are usually felt when there is pressure on the nerve, such as sitting with the elbow on an armrest, or with repetitive elbow bending and straightening. Often symptoms will be felt when the elbow is held in a bent position for a period of time, such as when holding a phone or sleeping. Some patients may notice weakness while making a pinching motion and occasional clumsiness. Symptoms can onset gradually or rapidly depending on the level of pressure or the extent of the condition.

In order for Dr. Ashruf to diagnose the condition, he may require:

  • A physical examination to check for swelling or tenderness of the palm or elbow, as well as rate finger and hand muscle strength.
  • Laboratory tests to see if the condition is induced by medical conditions such as diabetes.
  • An assessment of medical history and routine activities that involve a lot of elbow movement.
  • X-rays, CT scan, or MRI to view the hand, wrist, and elbow anatomy, as well as identify any fractures, tumors, or presence of arthritis.
  • A nerve conduction study with an electrophysiological test to test the ulnar nerve functionality or see if there are any other issues or dysfunction.

Cubital Tunnel Syndrome vs Carpal Tunnel Syndrome

Cubital Tunnel Syndrome (UNE – Ulnar Nerve Entrapment) and Carpal Tunnel Syndrome (CTS) are both categorized as cumulative trauma disorders, or conditions caused by fast, repetitive motion and wear and tear of upper extremities. These two conditions are similar sounding, but they are in fact different. Cubital Tunnel Syndrome is caused by a pinched or irritated ulnar nerve, affecting the ring finger and the pinky.

Carpal Tunnel Syndrome on the other hand, figuratively speaking, is caused by a pinch of the median nerve which is responsible for gripping and fine motor skills. This greatly affects the thumb and first two fingers. The specific syndrome for a given case can only be determined after a consultation examination by Dr. Ashruf. It is possible to experience both Cubital Tunnel Syndrome and Carpal Tunnel Syndrome at the same time, meaning all fingers are affected.

Endoscopic Cubital Tunnel Release vs Open Surgery

Cubital Tunnel Syndrome can be performed with either an endoscopic or open approach, but Dr. Salman Ashruf finds endoscopic to be much more effective. The open Cubital Tunnel release technique requires a large exterior incision that may destroy nerves and vessels. And the release itself is only between 8cm and 12cm long. An endoscopic cubital tunnel release technique is performed internally with camera guidance and HD viewing. The nerve release with this internal technique can be between 18cm and 30cm long without tissue, vessel, or nerve damage. The ulnar nerve also recovers much quicker with the endoscopic technique, a matter of a couple days. Recovery time after the open technique can take upwards of 2 weeks.

The Procedure Process

After the consultation, Dr. Ashruf will be able to determine the cause of a patient’s Cubital Tunnel Syndrome. If it is caused by a medical condition or repetitive motion from a sport, non-surgical remedies may be prescribed to first try and rule out the need for surgical intervention. This may include rest of the elbow with a sling, cold compresses, or corticosteroid injections. If symptoms do not go away or progress, he will recommend an endoscopic Cubital Tunnel release. Medications can be prescribed in the meantime before surgery to help reduce inflammation and discomfort.

An endoscopic Cubital Tunnel release is a straightforward, minimally invasive procedure.

A small incision will be made on the inside of the elbow for the insertion of the endoscope. Dr. Ashruf can see the ulnar nerve during the release process with camera guidance which is attached to a thin clear endoscope. A 4-5 cm proximal workspace is created near the cubital tunnel. The now visible compressive fibrous bands and tissue that surrounds the ulnar nerve will carefully be cut with a specialized dissection instrument. Any resulting bleeding will be stopped immediately with a bipolar cautery. Once all appropriate dissection has been made and release has been achieved, the incision will then be closed.

Recovering from Cubital Tunnel Syndrome

A small, soft bandage will be placed on the incision site to keep it sterile after the procedure, and then patients are free to return home. There is little to no downtime necessary after an endoscopic Cubital Tunnel release. The hand and arm can be used the very next day with minimal discomfort felt. Over-the-counter pain medication can be taken for added comfort.

The ligaments and tissue will overtime heal in such a way that produces more space around the cubital tunnel, and patients can begin to enjoy more mobilized results after surgery.


The cost of endoscopic Cubital Tunnel release is dependent on the extent of the individual case. Please consult with your insurance provider before scheduling a consultation to see if treatment may be covered. If you have any questions do not hesitate to contact our Hanover office and we’d be more than happy to assist you.

Schedule Your Consultation

Cubital Tunnel Syndrome consultations take place with Dr. Ashruf at our Hanover, Maryland location. The consultation will consist of a preliminary conversation in regards to the pain you experience and when/where it is experienced, as well as a complete physical examination of the neck down to the fingers. Tests may be conducted to further assess your candidacy and determine if the condition is solely Cubital Tunnel Syndrome or a combination of the aforementioned and Carpal Tunnel Syndrome, in which case a specialized surgical technique will be used. It is important to Dr. Ashruf that you are comfortable and confident in your decision to undergo endoscopic Cubital Tunnel release, so any questions you may have please feel free to ask. This can be in regards to the procedure itself, or preparatory and recovery inquiries.