Carpal tunnel syndrome (CTS) and cubital tunnel syndrome (CuTS) are both common conditions that involve nerve compression, but they affect different nerves and parts of the arm.
CTS affects the median nerve and is more common in people who engage in repetitive wrist motions. CuTS affects the ulnar nerve and is more common in people who have had past elbow fractures or dislocations.
This article discusses the differences between carpal tunnel and cubital tunnel syndromes and how treatment options may vary.
While there are some similarities between these two conditions, a distinctive factor is that cubital tunnel affects your pinky and ring finger, while carpal tunnel affects your thumb, index, middle, and ring fingers.
Some additional differences between CTS and CuTS syndromes include:
Carpal tunnel syndrome
Carpal tunnel syndrome affects the median nerve, with nerve compression happening at the wrist.
Its main symptoms include:
- numbness and tingling of the thumb, index, middle, and ring fingers
- pain that extends from the wrist to the forearm, and occasionally to the shoulder
- weakened grip strength and difficulty holding objects
- thumb muscle atrophy (in severe cases)
- a positive Durkan’s test, a physical examination performed by a doctor
- a positive Tinel’s sign, which looks for a nerve reaction in response to tapping
- a positive Phalen’s maneuver, where wrist flexion provokes symptoms
Cubital tunnel syndrome
Cubital tunnel syndrome affects the ulnar nerve, with nerve compression happening at the elbow.
Its main symptoms include:
- numbness and tingling in the ring and middle fingers
- pain on the inside of the elbow, forearm, and hand
- difficulty with finger coordination and grip strength
- muscle atrophy in the little finger (in severe cases)
- positive elbow flexion test, where flexion initiates symptoms
- positive Tinel’s sign at the elbow
- positive
Froment’s sign , where there’s difficulty holding a sheet of paper between the thumb and forefinger
Chart of symptoms
| Carpal tunnel | Cubital tunnel | |
|---|---|---|
| elbow pain | pain mainly in the wrist, but may radiate to the elbow | numbness, tingling, weakness, or shock-like feelings in the wrist, hand, and forearm |
| feelings | numbness, tingling, weakness, or shock-like feelings in the wrist, hand, and forearm | numbness, tingling, pain, and weakness, closer to the elbow |
| fingers | thumb, index, middle, and ring fingers | ring and little finger |
| pain timing | weak grip that may cause people to drop things | often at night, or when elbows are bent |
| grip | weakness in the hand or fingers may make coordination difficult | weakness in hand or fingers that may make coordination difficult |
It’s possible to have both carpal tunnel and cubital tunnel syndromes at the same time. In fact, many people who receive treatment for carpal tunnel syndrome also need treatment for cubital tunnel syndrome.
This is known as double crush syndrome, which is when nerve compression occurs at two or more points along the same nerve pathway.
Once a nerve is compressed in one area (such as the wrist in CTS), it becomes more vulnerable to compression at another site.
Yes, carpal tunnel and cubital tunnel syndromes receive different treatments because they involve different nerves and compression locations. Here’s a look at their treatment differences:
Carpal tunnel treatments
These include:
- wrist splints to maintain a neutral median nerve position
- physical therapy to strengthen hand and wrist muscles
- activity modification to reduce nerve pressure
- medications, such as NSAIDs and corticosteroid injections
- carpal tunnel release surgery
Cubital tunnel treatments
These include:
- elbow bracing or padding to reduce ulnar nerve pressure
- activity changes to reduce nerve pressure and avoid elbow flexion
- physical therapy, including nerve gliding exercises, focused on the ulnar nerve
- medications, such as NSAIDs and corticosteroid injections
- cubital tunnel release surgery
When treatment for carpal and cubital tunnel syndromes is medically necessary, most insurers will cover treatment. This can include surgery if your healthcare team decides it’s your best option.
Treatment for carpal tunnel and cubital tunnel syndromes can include physical therapy, medications, and surgery. If you have Medicare, your coverage and out-of-pocket costs will vary depending on your state, and your specific plan.
If you’re a veteran, your costs will likely be covered if your disability rating is greater than 50%. While the carpal tunnel VA disability rating usually begins at 10%, it can go as high as 70%, depending on the severity of your condition.
Healthcare coverage can be confusing. If you have questions about specific costs and coverage, it’s always a good idea to check with your individual insurance provider.
Carpal tunnel syndrome (CTS) and cubital tunnel syndrome (CuTS) are both nerve compression conditions that can cause numbness and tingling in different parts of the arm.
CTS is related to the median nerve and causes issues in the forearm, hand, and fingers. CuTS is related to the ulnar nerve and causes issues closer to the elbow.
In both cases, early intervention and treatment can prevent complications and improve symptoms. While doctors may sometimes suggest surgery, physical therapy exercises and medications are often effective treatment options.