CUBITAL TUNNEL SYNDROME: CURRENT DIAGNOSTIC AND TREATMENT STRATEGIES FROM SOCIOECONOMIC AND HEALTHCARE PERSPECTIVES — A NARRATIVE REVIEW

Paweł Budzik; Karolina Kornatowska; Mateusz Wiekiera; Adrianna Wiekiera; Szymon  Kopciał; Jonatan Rataj; Justyna Jankowska; Mateusz Michał Pysiewicz; Szymon Marciszuk

doi:10.31435/ijitss.2(50).2026.5624

Authors

Paweł Budzik Norbert Barlicki Memorial Teaching Hospital No. 1 of the Medical University of Lodz, Łódź, Poland https://orcid.org/0009-0003-3177-5634
Karolina Kornatowska Dr. Tytus Chałubiński Specialist Hospital, Radom, Poland https://orcid.org/0009-0008-4622-8285
Mateusz Wiekiera The Nicolaus Copernicus Provincial Multispecialty Center for Oncology and Traumatology, Łódź, Poland https://orcid.org/0009-0003-9236-2913
Adrianna Wiekiera The Nicolaus Copernicus Provincial Multispecialty Center for Oncology and Traumatology, Łódź, Poland https://orcid.org/0009-0001-4829-3768
Szymon Kopciał The Nicolaus Copernicus Provincial Multispecialty Center for Oncology and Traumatology, Łódź, Poland https://orcid.org/0009-0008-6647-247X
Jonatan Rataj Medical University of Lodz, Łódź, Poland https://orcid.org/0009-0006-4670-0100
Justyna Jankowska Independent Public Healthcare Institution MSWiA in Lodz, Łódź, Poland https://orcid.org/0009-0006-0225-2668
Mateusz Michał Pysiewicz Norbert Barlicki Memorial Teaching Hospital No. 1 of the Medical University of Lodz, Łódź, Poland https://orcid.org/0009-0007-0094-2857
Szymon Marciszuk Medical University of Lodz, Łódź, Poland https://orcid.org/0009-0003-9917-0762

DOI:

https://doi.org/10.31435/ijitss.2(50).2026.5624

Keywords:

Cubital Tunnel Syndrome, Ulnar Neuropathy, Diagnosis, Management, Healthcare Systems, Socio-Economic Factors

Abstract

Background: Cubital tunnel syndrome (CuTS) is the second most common compressive neuropathy of the upper extremity, with an estimated prevalence of 1.8–5.9% in the general population. It represents a significant clinical and socio-economic problem, contributing to pain, functional impairment, and reduced work productivity.

Aim: This narrative review aims to summarize current evidence on the pathophysiology, diagnostic approaches, and treatment strategies for CuTS, with particular emphasis on clinical outcomes and implications for healthcare systems.

Methods: A narrative review was conducted using the PubMed database, including systematic reviews, meta-analyses, and clinical studies published between 2017 and 2026.

Results: CuTS pathophysiology involves mechanical compression, traction, and ischemia of the ulnar nerve. Diagnosis is based on clinical examination supported by electrodiagnostic testing and ultrasound. Conservative treatment is effective in mild cases, while surgical techniques, including decompression and anterior transposition, show favorable outcomes. No single surgical method has demonstrated clear superiority. Treatment outcomes are influenced by disease severity and duration. From a healthcare perspective, delayed diagnosis is associated with increased costs and higher rates of surgical intervention.

Conclusion: CuTS requires an individualized, evidence-based approach. Early diagnosis and optimized treatment strategies may improve clinical outcomes while reducing healthcare costs and socio-economic burden. Future approaches should focus on improving diagnostic pathways and access to cost-effective interventions.

References

Abourisha, E., Srinivasan, A. S., Barakat, A., Chong, H. H., & Singh, H. P. (2024). Surgical management of cubital tunnel syndrome: A systematic review and meta-analysis of randomised trials. Journal of Orthopaedics, 53, 41–48. https://doi.org/10.1016/j.jor.2024.02.041

An, T. W., Evanoff, B. A., Boyer, M. I., & Osei, D. A. (2017). The prevalence of cubital tunnel syndrome: A cross-sectional study in a U.S. metropolitan cohort. The Journal of Bone and Joint Surgery. American Volume, 99(5), 408–416. https://doi.org/10.2106/JBJS.15.01162

Andrews, K., Rowland, A., Pranjal, A., & Ebraheim, N. (2018). Cubital tunnel syndrome: Anatomy, clinical presentation, and management. Journal of Orthopaedics, 15(3), 832–836. https://doi.org/10.1016/j.jor.2018.08.010

Bateman, M., Swaile, H., & Tambe, A. (2025). Effectiveness of night splints for cubital tunnel syndrome: A systematic review. Hand Therapy, 30(3), 105–112. https://doi.org/10.1177/17589983251336157

Brogan, D. M., Landau, A. J., Olsen, M. A., Nickel, K. B., Buss, J. L., & Dy, C. J. (2025). Direct economic burden of cubital tunnel surgery in the United States: Total payments and components of cost. The Journal of Hand Surgery, 50(8), 938–947. https://doi.org/10.1016/j.jhsa.2024.07.011

Burahee, A. S., Sanders, A. D., Shirley, C., & Power, D. M. (2021). Cubital tunnel syndrome. EFORT Open Reviews, 6(9), 743–750. https://doi.org/10.1302/2058-5241.6.200129

Cambon-Binder, A. (2021). Ulnar neuropathy at the elbow. Orthopaedics & Traumatology: Surgery & Research, 107(1 Suppl), 102754. https://doi.org/10.1016/j.otsr.2020.102754

Carlton, A., & Khalid, S. I. (2018). Surgical approaches and their outcomes in the treatment of cubital tunnel syndrome. Frontiers in Surgery, 5, 48. https://doi.org/10.3389/fsurg.2018.00048

Chang, K.-V., Mezian, K., Naňka, O., Wu, W.-T., Lou, Y.-M., Wang, J.-C., Martinoli, C., & Özçakar, L. (2018). Ultrasound imaging for the cutaneous nerves of the extremities and relevant entrapment syndromes: From anatomy to clinical implications. Journal of Clinical Medicine, 7(11), 457. https://doi.org/10.3390/jcm7110457

Córdoba-Mosqueda, M. E., Rasulić, L., Savić, A., Grujić, J., Vitošević, F., Lepić, M., Mićić, A., Radojević, S., Mandić-Rajčević, S., Jovanović, I., & Rodríguez-Aceves, C. A. (2023). Quality of life and satisfaction in patients surgically treated for cubital tunnel syndrome. Neurological Research, 45(2), 138–151. https://doi.org/10.1080/01616412.2022.2126163

Fowler, J. R. (2025). The use of musculoskeletal ultrasound for diagnosis of peripheral nerve compression syndromes. The Journal of Hand Surgery, 50(4), 481–490. https://doi.org/10.1016/j.jhsa.2024.11.009

Fok, M. W. M., Cobb, T., & Bain, G. I. (2021). Endoscopic cubital tunnel decompression: Review of the literature. Journal of Orthopaedic Surgery, 29(1), 2309499020982084. https://doi.org/10.1177/2309499020982084

Graf, A., Ahmed, A. S., Roundy, R., Gottschalk, M. B., & Dempsey, A. (2023). Modern treatment of cubital tunnel syndrome: Evidence and controversy. Journal of Hand Surgery Global Online, 5(4), 547–560. https://doi.org/10.1016/j.jhsg.2022.07.008

Grisdela, P., Liu, C., Model, Z., Steele, A., Liu, D., Earp, B., Blazar, P., & Zhang, D. (2025). Do socioeconomic factors affect symptom duration and disease severity at presentation for cubital tunnel syndrome? Hand, 20(2), 179–187. https://doi.org/10.1177/15589447231213386

Gu, A. S., Bingi, P., Ginder, J., Flynn, J., Khak, M., & Ilyas, A. M. (2025). A systematic review of retrospective evidence on patient and surgical factors in recurrent cubital tunnel syndrome. Archives of Bone and Joint Surgery, 13(10), 611–621. https://doi.org/10.22038/ABJS.2025.89107.4040

Hu, T., & Zhou, H. (2026). Geometric and biomechanical perspectives on ulnar nerve compression in cubital tunnel syndrome: Pathomechanics and surgical strategies. Annals of Medicine and Surgery, 88(1), 422–435. https://doi.org/10.1097/MS9.0000000000004348

Hubbard, M. E., AlMasri, A., & Huq, N. S. (2025). Cubital tunnel release under local and regional anesthesia: A scoping review. Plastic Surgery. https://doi.org/10.1177/22925503251404418

Kazmers, N. H., Lazaris, E. L., Allen, C., Presson, A., & Tyser, A. R. (2019). Comparison of surgical encounter direct costs for three methods of cubital tunnel decompression. Plastic and Reconstructive Surgery, 143(2), 503–510. https://doi.org/10.1097/PRS.0000000000005196

Kooner, S., Cinats, D., Kwong, C., Matthewson, G., & Dhaliwal, G. (2019). Conservative treatment of cubital tunnel syndrome: A systematic review. Orthopedic Reviews, 11(2), 7955. https://doi.org/10.4081/or.2019.7955

Law, T. Y., Hubbard, Z. S., Chieng, L. O., & Chim, H. W. (2017). Trends in open and endoscopic cubital tunnel release in the Medicare patient population. Hand, 12(4), 408–412. https://doi.org/10.1177/1558944716679610

McGurk, K., Tracey, J. A., Daley, D. N., & Daly, C. A. (2023). Diagnostic considerations in compressive neuropathies. Journal of Hand Surgery Global Online, 5(4), 525–535. https://doi.org/10.1016/j.jhsg.2022.10.010

Nyman, E., & Dahlin, L. B. (2024). The unpredictable ulnar nerve—Ulnar nerve entrapment from anatomical, pathophysiological, and biopsychosocial aspects. Diagnostics, 14(5), 489. https://doi.org/10.3390/diagnostics14050489

Pokharel, B., Fossati, C., Bhattarai, S., Vaja, F., Kemetse, A., Traverso, A., & Randelli, P. S. (2025). Simple decompression vs. subcutaneous anterior transposition of the ulnar nerve: The 2025 update on the optimal treatment for cubital tunnel syndrome. JSES Reviews, Reports, and Techniques, 6(2), 100630. https://doi.org/10.1016/j.xrrt.2025.100630

Reichenbach, R., Chartrand, N. A., Stecher, C., Renfree, S. P., Stickels, M., & Hustedt, J. W. (2024). Higher revision rates with in situ decompression as compared to ulnar nerve transposition for cubital tunnel syndrome: A meta-regression analysis. Cureus, 16(8), e68116. https://doi.org/10.7759/cureus.68116

Toirac, A., Giugale, J. M., & Fowler, J. R. (2017). Open versus endoscopic cubital tunnel in situ decompression: A systematic review of outcomes and complications. Hand, 12(3), 229–235. https://doi.org/10.1177/1558944716662018

Vij, N., Traube, B., Bisht, R., Singleton, I., Cornett, E. M., Kaye, A. D., Imani, F., Mohammadian Erdi, A., Varrassi, G., Viswanath, O., & Urits, I. (2020). An update on treatment modalities for ulnar nerve entrapment: A literature review. Anesthesiology and Pain Medicine, 10(6), e112070. https://doi.org/10.5812/aapm.112070

Wade, R. G., Griffiths, T. T., Flather, R., Burr, N. E., Teo, M., & Bourke, G. (2020). Safety and outcomes of different surgical techniques for cubital tunnel decompression: A systematic review and network meta-analysis. JAMA Network Open, 3(11), e2024352. https://doi.org/10.1001/jamanetworkopen.2020.24352

Wolny, T., Fernández-de-las-Peñas, C., Buczek, T., Domin, M., Granek, A., & Linek, P. (2022). The effects of physiotherapy in the treatment of cubital tunnel syndrome: A systematic review. Journal of Clinical Medicine, 11(14), 4247. https://doi.org/10.3390/jcm11144247