Comparative Efficacy of Soft Tissue Mobilization and Ulnar Nerve-Specific Strengthening Exercises in Patients With Cubital Tunnel Syndrome

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.

Inclusion criteria

• Patients diagnosed with mild to moderate cubital tunnel syndrome (ulnar neuropathy at the elbow)
• Patients having symptoms for more than one month
• Patients who are willing to participate and provide informed consent.
• Patients who are able to follow instructions and complete the treatment protocol.

Exclusion criteria

• Patients with a history of elbow surgery
• Patients with severe neurological deficits (e.g., advanced muscle atrophy or complete nerve palsy)
• Patients with fracture or dislocation of the elbow joint
• Patients with systemic neurological disorders (e.g., stroke, multiple sclerosis)
• Patients with rheumatoid arthritis or other inflammatory joint diseases
• Patients currently receiving other physiotherapy or invasive treatments for the same condition.