The cubital tunnel is the fibro-osseous tunnel on the medial elbow through which the ulnar nerve passes from the arm into the forearm. It is bounded by the medial epicondyle anteriorly, the olecranon posteriorly, and the Osborne ligament (cubital tunnel retinaculum) as the roof — a fibrous band from the medial epicondyle to the olecranon that compresses the ulnar nerve during elbow flexion. The two heads of the flexor carpi ulnaris form the floor of the more distal tunnel.
Cubital tunnel syndrome (ulnar nerve compression at the elbow) is the second most common peripheral nerve entrapment after carpal tunnel. The ulnar nerve is compressed within the tunnel at elbow flexion, producing medial elbow pain, ring and little finger paresthesiae, intrinsic hand weakness, and clawing of the ring and little finger in advanced cases. Conservative treatment includes extension splinting at night. Surgery involves either simple decompression (Osborne ligament release) or anterior transposition (subcutaneous, intramuscular, or submuscular) of the nerve from behind the medial epicondyle to a position anterior to the elbow axis.
The Osborne ligament (cubital tunnel retinaculum) becomes taught during elbow flexion compressing the ulnar nerve within the cubital tunnel, producing progressive medial elbow pain and ring-little finger paresthesiae worsened by prolonged elbow flexion; cubital tunnel decompression by Osborne ligament division provides relief in mild cases without transposition.
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