What clinical signs and symptoms should I assess to confirm a diagnosis of cubital tunnel syndrome?

To confirm a diagnosis of cubital tunnel syndrome, assess for sensory symptoms such as numbness, tingling, or paraesthesia in the ulnar nerve distribution, particularly affecting the little finger and the ulnar half of the ring finger.

Evaluate for motor symptoms including weakness or clumsiness in hand grip and finger abduction/adduction, which may manifest as difficulty with fine motor tasks.

On physical examination, look for muscle wasting of the hypothenar eminence and first dorsal interosseous muscle, indicating chronic ulnar nerve compression.

Perform provocative tests such as the elbow flexion test (reproducing symptoms with sustained elbow flexion) and Tinel’s sign over the cubital tunnel to elicit tingling in the ulnar nerve distribution.

Assess for decreased sensation to light touch or pinprick in the ulnar nerve territory and reduced strength in ulnar-innervated muscles.

Additionally, observe for a positive Froment’s sign, which indicates weakness of the adductor pollicis muscle due to ulnar nerve dysfunction.

These clinical features combined support the diagnosis of cubital tunnel syndrome and guide further neurophysiological testing or referral ¹ (Palmer and Hughes, 2010; Andrews et al., 2018; Hannaford and Simon, 2024).