Cubital tunnel syndrome occurs when the ulnar nerve is compressed or irritated near the elbow. It can cause elbow or forearm pain, numbness or tingling in the ring and little fingers, hand weakness, and difficulty performing daily activities. This randomized clinical trial will compare two conservative physiotherapy programs for adults with mild to moderate cubital tunnel syndrome. A total of 56 participants will be assigned by computer-generated randomization to one of two groups. Group A will receive soft tissue mobilization combined with ulnar nerve-specific strengthening and nerve-gliding exercises. Group B will receive soft tissue mobilization alone. Both groups will also receive education about activity modification, ergonomic correction, and avoiding prolonged elbow bending. Treatment will be provided three times per week for four weeks, for a total of 12 sessions. Participants will be assessed before treatment and at the end of the fourth week. The main outcomes will be pain intensity, measured using the Numeric Pain Rating Scale, and upper-limb disability, measured using the Disabilities of the Arm, Shoulder and Hand questionnaire. The study aims to determine whether adding ulnar nerve-specific strengthening and nerve-gliding exercises to soft tissue mobilization provides greater improvement in pain and upper-limb function than soft tissue mobilization alone.
Cubital tunnel syndrome, also known as ulnar neuropathy at the elbow, is a peripheral nerve entrapment disorder caused by compression or irritation of the ulnar nerve as it passes through the cubital tunnel. Individuals with this condition may experience pain around the medial elbow, numbness or tingling in the ring and little fingers, reduced grip strength, hand weakness, and limitations in upper-limb activities. Conservative physiotherapy is commonly recommended for mild to moderate cases; however, evidence comparing specific combinations of manual therapy and exercise remains limited. This study is a randomized controlled trial designed to compare soft tissue mobilization combined with ulnar nerve-specific strengthening and nerve-gliding exercises with soft tissue mobilization alone. The study will recruit 56 adults aged 30-55 years with mild to moderate cubital tunnel syndrome. Participants will be recruited from the Physiotherapy Departments of Nawaz Sharif Social Security Hospital, Multan Road, Lahore, and MoveNow Physiotherapy and Rehabilitation Centre, Lahore, Pakistan. Eligible participants will provide written informed consent before enrollment. They will then be allocated in a 1:1 ratio to Group A or Group B using a computer-generated randomization sequence, with 28 participants assigned to each group. Outcome assessment will be conducted at baseline and immediately after completion of the four-week intervention. All participants will receive education regarding activity modification, ergonomic correction, and avoidance of prolonged elbow flexion. Group A will receive soft tissue mobilization together with ulnar nerve-specific strengthening and nerve-gliding exercises. Soft tissue mobilization will be applied to the medial elbow and flexor-pronator muscle region and may include myofascial release, longitudinal soft tissue mobilization, effleurage, and deep transverse friction massage. The strengthening component will target the wrist flexors, forearm stabilizers, intrinsic hand muscles, and grip musculature. Exercises will include resisted wrist flexion, hand-grip exercises, finger abduction and adduction, thumb opposition, and resisted finger flexion. Exercises will generally be completed in two to three sets of 10-15 repetitions. Controlled ulnar nerve-gliding exercises will be performed within a pain-free range. Participants in this group will also be advised to perform the prescribed strengthening and nerve-gliding exercises at home once daily. Group B will receive soft tissue mobilization alone. Manual therapy will be applied to the medial elbow and flexor-pronator region using standardized techniques such as myofascial release, longitudinal mobilization, effleurage, and deep transverse friction massage. Participants in this group will not receive the ulnar nerve-specific strengthening or nerve-gliding program during the intervention period. Both groups will attend three treatment sessions per week for four weeks, resulting in 12 sessions. Sessions will last approximately 30-40 minutes for Group A and 20-30 minutes for Group B. Pain intensity will be assessed using the 11-point Numeric Pain Rating Scale, ranging from 0, indicating no pain, to 10, indicating the worst possible pain. Upper-limb disability will be measured using the 30-item Disabilities of the Arm, Shoulder and Hand questionnaire, with scores ranging from 0, indicating no disability, to 100, indicating the greatest disability. The primary comparison will examine differences in changes in pain and upper-limb disability between baseline and the fourth week.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
56
A physiotherapist will apply standardized manual soft tissue techniques to the medial elbow and flexor-pronator muscle region of the affected upper limb. Techniques will include myofascial release, longitudinal soft tissue mobilization, effleurage, and deep transverse friction massage. The intervention is intended to reduce muscular and fascial restrictions, improve tissue extensibility and local circulation, and decrease mechanical irritation around the cubital tunnel. Treatment will be administered three times per week for four weeks, for a total of 12 sessions. This intervention will be provided to participants in both study arms.
Participants will perform progressive strengthening exercises targeting the wrist flexors, forearm stabilizers, intrinsic hand muscles, and grip musculature. Exercises will include resisted wrist flexion, hand-grip training, finger abduction and adduction, thumb opposition, and resisted finger flexion, generally performed in two to three sets of 10-15 repetitions. Controlled ulnar nerve-gliding exercises will also be performed within a pain-free range. Supervised treatment will be provided three times per week for four weeks, and participants will be instructed to complete the prescribed strengthening and nerve-gliding exercises at home once daily.
Physiotherapy Departments of Nawaz Sharif Social Security Hospital, Multan Road, Lahore, and MoveNow Physiotherapy and Rehabilitation Centre, Lahore.
Lahore, Pakistan
Change in Pain Intensity Measured by the Numeric Pain Rating Scale
Pain intensity will be assessed using the 11-point Numeric Pain Rating Scale (NPRS). Participants will rate their average pain during the previous 24 hours on a scale from 0 to 10, where 0 indicates "no pain" and 10 indicates the "worst possible pain." Lower scores represent less pain. Change will be calculated by comparing the baseline score with the score recorded after the four-week intervention.
Time frame: Baseline and immediately after the 4-week intervention
Change in Upper-Limb Disability Measured by the Disabilities of the Arm, Shoulder and Hand Questionnaire
Upper-limb disability will be assessed using the 30-item Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Items evaluate difficulty performing daily activities, symptom severity, and the effect of the condition on social and functional participation. The total score ranges from 0 to 100, where 0 indicates no disability and 100 indicates the greatest disability. Lower scores represent better upper-limb function. Change will be calculated by comparing baseline and post-intervention scores.
Time frame: Baseline and immediately after the 4-week intervention
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