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CUBITAL TUNNEL SYNDROME DIAGNOSIS & TREATMENT · LAS VEGAS, NV
If your ring and pinky fingers go numb, it probably isn't carpal tunnel syndrome
The wrist isn't the only place a nerve gets pinched on its way to your hand. When it's the ring and pinky fingers, the nerve involved is the ulnar nerve, and it's usually being squeezed at your elbow. That's why the wrist brace never helped.
Before anyone talks to you about surgery, you deserve to know which nerve is compressed, and where.
One hour with the doctor
Cash-pay
Leave with a diagnosis and treatment plan
You’re not imagining it
The people we see for this don't look alike: the desk worker whose elbow rests on the arm of a chair all day, the driver whose fingers go dead on the wheel, the person who wakes at 3 AM to shake out a hand. What they share is months or years of numbness in the ring and pinky fingers, an elbow that can't be leaned on, and trouble with anything that keeps the arm bent.
Most were told to brace the elbow straight at night and gave up, because it's close to impossible to sleep that way. Others were handed a wrist brace, which treats a different nerve in a different area. Somewhere in there, the hand went clumsy, the grip quietly weakened, and it all got filed under getting older.
Why "carpal tunnel" is usually the wrong label here
Just as there's a carpal tunnel in your wrist, there's a cubital tunnel in your elbow, where the ulnar nerve wraps around the bony point on the inside. This is your funny bone. It's also a natural point of compression, where the tissue is tighter than along the rest of the nerve's route.
Two things go wrong there, and they compound: first, the tunnel squeezes the nerve; second, bending your elbow stretches it, because the nerve runs around the outside of the bend and has further to travel every time you fold your arm. Being squeezed and pulled at the same time is why your symptoms change with the position of your arm, and why you wake with a dead hand after a night with it curled up.
Numb ring and pinky fingers can also come from the same nerve pinched lower down at the wrist, or from a nerve root in your neck. Same two fingers, three different problems, and only one of them is at your elbow. That's why a label isn't a diagnosis.
Try this. It takes five seconds.
Hold your arm out in front of you, palm up, and bend the elbow to about 90 degrees. With your other hand, tap the inside of that elbow, right over the funny bone.
If that sends shocks, numbness, or tingling down into your ring and pinky fingers, that's a sign the trouble is with the nerve at your elbow. Stronger still if one arm does it and the other doesn't.
It's a sign, not an answer. It can't tell you whether something else is contributing, or how far along it is.
Why waiting costs you more here than elsewhere
This syndrome progresses, and it progresses in an order. Numbness that comes and goes becomes numbness that stays. Then it turns motor; this nerve runs the small muscles that make your hand precise, so weakness sets in and things slip out of your hand. Eventually, the muscle wastes and the fingers begin to claw.
Once a hand is clawing, meaningful motor recovery is unlikely from any treatment, surgery included. Thankfully, the pain and the numbness can still be treated, and they're usually what's making the person miserable. So arriving late doesn't mean there's nothing to do, but it does mean the window for getting the hand back has narrowed.
How we figure out what's actually wrong
The foundation of any honest plan is a proper diagnosis, the part most people tell us was skipped. A consultation at OASIS looks like:
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A real medical interview, covering what's numb, when it started, and what you can no longer do.
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A full physical examination, including the side that doesn't hurt, because comparison is part of the answer.
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Musculoskeletal ultrasound, where we look directly at the ulnar nerve, follow it along its whole course, and often see exactly where it's being compressed.
Two things that scan can tell us that nothing else can, including x-ray and MRI. First, the ulnar nerve can be compressed in more than one place, above and below the tunnel, and a procedure aimed only at the tunnel misses the rest. Second, in some people, fully bending the elbow makes the nerve jump over the bone instead of staying put. Patients feel it as a guitar string twanging; on screen it looks like a circle climbing a mountain and abruptly snapping over the top. You can watch it happen while we move your arm, and it changes the plan, because no nerve-gliding exercise fixes a nerve that won't stay where it belongs.
The ulnar nerve at the elbow, filmed while the arm bends. This is a borderline case: the nerve shifts and rides up as the elbow flexes, but it doesn't come over the top the way a fully unstable one does. Either way, it's only visible while the elbow is moving, which is why a scan taken lying still can miss it.
How this compares to an elbow pad, splinting, therapy, cortisone, and surgery
Regenerative medicine vs. elbow pads and splinting
Dr. Kiok’s philosophy is to take the smallest risks first and find out whether the benefit is enough to stop there. An elbow pad, night splinting, and changing how you sit carry almost no risk, and for symptoms that started recently, they're sometimes the whole answer. What they can't do is settle a nerve that's already caught in the swelling cycle, which is why most people who reach us have done all of it and found it didn't hold.
Regenerative medicine vs. physical therapy
Nerve glides are the therapy most often prescribed for this, and Dr. Kiok isn't convinced you can glide your way out of an established cubital tunnel syndrome. When the nerve is slipping out of its groove rather than failing to move, they're aimed at the wrong problem entirely.
Regenerative medicine vs. cortisone
Dr. Kiok's answer on cortisone here is no. It's a powerful anti-inflammatory, and this isn't primarily an inflammatory problem. Even placed perfectly, which means under ultrasound at the exact point of compression rather than by feel, it still wouldn't do the thing that needs doing: lifting the nerve away from what's binding it, the whole way around.
Regenerative medicine vs. surgery
Surgery releases the pressure on the nerve, and for some people it's the right call. The question is what it asks of you to get there. Recovery can mean weeks of bracing where you can't fully straighten your arm, and not everyone gets that last bit of extension back. Count how many times a day you straighten your arm all the way, to put on a shirt or reach a high shelf, then picture not being able to. There are nerves running through the surgical field that can be injured on the way in. There's a course of therapy afterward. And any release leaves scar tissue behind, which can tether the nerve and bring the symptoms back, the way it already does after carpal tunnel release.
There's a precise, non-surgical option that works on the compression directly instead of managing around it. Whether it fits your case depends entirely on the diagnosis, which is what the consultation is for.
If a nerve conduction study came back normal while your hand plainly isn't, that doesn't settle it. Those studies read positive in people with no problem and negative in people with an obvious one, which is why we look at the nerve directly.
What ultrasound-guided hydrodissection actually involves
If the ulnar nerve at your elbow is confirmed as the source, you may be a candidate for hydrodissection. It uses a controlled stream of fluid to lift the nerve away from the tissue compressing it, and leave a cushion around it so it can move freely again.
Unlike surgery, it's done in the office with no fasting, no sedation, and no driver, and it takes minutes. We scan the whole nerve, mark every point where it's compressed, and choose the approach that lets us get all the way around it with a safe margin. Then a fine needle goes in alongside the nerve without touching it, and we inject slowly while you watch the nerve separate from the surrounding tissue on screen. What goes in is roughly 10 mL of 5% dextrose (a.k.a. sugar water), not cortisone.
A cubital tunnel hydrodissection as it happens. The dark pocket opening across the middle of the screen is the fluid going in, lifting the ulnar nerve away from the tissue binding it. Patients watch this on the monitor while we do it, and the whole thing takes minutes.
Afterward, you get a small bandage and no restrictions. You drive yourself home and use the arm normally. Relief often arrives within days, sometimes the same day, and builds over the following weeks. If the nerve is unstable, we add a brace at night and reassess the need for it about every three weeks.
Most people need one injection. Unlike the wrist, where partial responders sometimes need a second, the cubital tunnel procedure hasn't required a repeat in this practice so far. How long it lasts is the question we get at nearly every consultation, and the honest answer is that the technique is new enough that nobody has long-term data yet. What we can tell you is that Dr. Kiok's first cubital tunnel patients are a year on and still reporting benefit.
Where this is unlikely to help: a nerve cut through by trauma, which needs a surgeon, and numbness that turns out to be coming from your neck. Both are things the examination is built to find first.
Learn more about hydrodissection, or about carpal tunnel syndrome if the numbness is in your thumb and first two fingers instead.
Our consultation isn't your typical doctor's appointment
One hour with Dr. Kiok. $500, credited toward your treatment plan if you decide to move forward. You leave with:
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A specific diagnosis, not a label.
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A treatment plan, not a referral or “let’s follow up in six weeks.”
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A clear answer on whether you’re a candidate for regenerative medicine.
Do you take insurance?
No, we’re a cash-pay clinic. We don’t take insurance because we don’t believe a coverage desk should shape your care. Treatment plans are made in person, with you and Dr. Kiok, on a timeline that fits your goals. No delays, no denials.
Learn more about why regenerative medicine isn't covered by insurance.
Outcomes vary by patient, condition, and stage of disease. Whether regenerative medicine is right for your hand or elbow is determined during the consultation, based on the diagnosis and your individual goals.
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Clark DM, Piscoya AS, Dunn JC, Nesti LJ. The impact of pre-existing ulnar nerve instability on the surgical treatment of cubital tunnel syndrome: a systematic review. Journal of Shoulder and Elbow Surgery. 2020;29(11):2339-2346.
Ready for an actual answer?
If your ring and pinky fingers have been numb for a year, if the brace you were given was for the wrong part of your arm, or if you're booked for surgery and want to know what else exists, request a consultation.
If you're not sure whether you'd be a candidate, that's exactly what the consultation is set up to figure out.