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 peripheralnerve entrapment disorder caused by compression or irritation of the ulnar nerve as itpasses through the cubital tunnel. Individuals with this condition may experience painaround the medial elbow, numbness or tingling in the ring and little fingers, reducedgrip strength, hand weakness, and limitations in upper‐limb activities. Conservativephysiotherapy is commonly recommended for mild to moderate cases; however, evidencecomparing specific combinations of manual therapy and exercise remains limited.This study is a randomized controlled trial designed to compare soft tissue mobilizationcombined with ulnar nerve‐specific strengthening and nerve‐gliding exercises with softtissue mobilization alone. The study will recruit 56 adults aged 30‐55 years with mild tomoderate cubital tunnel syndrome. Participants will be recruited from the PhysiotherapyDepartments of Nawaz Sharif Social Security Hospital, Multan Road, Lahore, and MoveNowPhysiotherapy and Rehabilitation Centre, Lahore, Pakistan.Eligible participants will provide written informed consent before enrollment. They willthen be allocated in a 1:1 ratio to Group A or Group B using a computer‐generatedrandomization sequence, with 28 participants assigned to each group. Outcome assessmentwill be conducted at baseline and immediately after completion of the four‐weekintervention.All participants will receive education regarding activity modification, ergonomiccorrection, and avoidance of prolonged elbow flexion. Group A will receive soft tissuemobilization together with ulnar nerve‐specific strengthening and nerve‐glidingexercises. Soft tissue mobilization will be applied to the medial elbow andflexor‐pronator muscle region and may include myofascial release, longitudinal softtissue mobilization, effleurage, and deep transverse friction massage. The strengtheningcomponent will target the wrist flexors, forearm stabilizers, intrinsic hand muscles, andgrip musculature. Exercises will include resisted wrist flexion, hand‐grip exercises,finger abduction and adduction, thumb opposition, and resisted finger flexion. Exerciseswill generally be completed in two to three sets of 10‐15 repetitions. Controlled ulnarnerve‐gliding exercises will be performed within a pain‐free range. Participants in thisgroup will also be advised to perform the prescribed strengthening and nerve‐glidingexercises at home once daily.Group B will receive soft tissue mobilization alone. Manual therapy will be applied tothe medial elbow and flexor‐pronator region using standardized techniques such asmyofascial release, longitudinal mobilization, effleurage, and deep transverse frictionmassage. Participants in this group will not receive the ulnar nerve‐specificstrengthening or nerve‐gliding program during the intervention period.Both groups will attend three treatment sessions per week for four weeks, resulting in 12sessions. Sessions will last approximately 30‐40 minutes for Group A and 20‐30 minutesfor Group B.Pain intensity will be assessed using the 11‐point Numeric Pain Rating Scale, rangingfrom 0, indicating no pain, to 10, indicating the worst possible pain. Upper‐limbdisability will be measured using the 30‐item Disabilities of the Arm, Shoulder and Handquestionnaire, with scores ranging from 0, indicating no disability, to 100, indicatingthe greatest disability. The primary comparison will examine differences in changes inpain and upper‐limb disability between baseline and the fourth week.