Investigation of the Effectiveness of Kinesiological Taping in Cubital Tunnel Syndrome

Overview

This study aims to investigate the effect of kinesiological taping, applied in addition to exercise, on clinical symptoms in patients diagnosed with Cubital Tunnel Syndrome. The patients will be randomized into three groups (exercise, exercise + kinesiological taping, exercise + sham taping) and will be evaluated at the 1st and 3rd months after a 3-week treatment period.

Detailed description

Cubital Tunnel Syndrome (CuTS), characterized by the compression of the ulnar nerve at the elbow, is a condition that causes symptoms such as pain, numbness, paresthesia, and muscle weakness in the affected limb. Ulnar nerve compression is the second most common entrapment neuropathy after median nerve entrapment . The ulnar nerve can become compressed at various locations, including the elbow and wrist. The nerve is formed by the C8 and T1 spinal nerve roots, which make up the lower trunk and medial cord of the brachial plexus. It travels along the medial aspect of the humerus, passes through Struthers' arcade, the retro-epicondylar groove, and enters the cubital tunnel. The roof of the cubital tunnel is known as the cubital tunnel retinaculum. The ulnar nerve then passes beneath the aponeurosis of the flexor carpi ulnaris muscle and its two heads, where the upper edge of the aponeurosis forms the Osborne ligament, which is likely the most commonly affected area in ulnar nerve entrapment. In the forearm, the ulnar nerve is located beneath the flexor carpi ulnaris muscle and innervates this muscle along with the ulnar half of the flexor digitorum profundus muscle. The nerve then proceeds toward Guyon's canal along with the ulnar artery. Distally, the nerve branches into three divisions: the dorsal sensory branch, the volar superficial sensory branch, and the deep motor branch. The deep motor branch descends into the deep part of the hand beneath the edge of the aponeurosis surrounding the hook of the hamate bone, innervating most of the hypothenar and intrinsic muscles. The dorsal sensory branch leaves the main trunk approximately 5-8 cm proximal to Guyon's canal and innervates the dorsal ulnar portion of the hand .

In patients with Cubital Tunnel Syndrome, pain, numbness, paresthesia in the 4th and 5th fingers, and in advanced stages, muscle weakness leading to atrophy of the hypothenar muscles and claw hand deformity may be observed. The diagnosis is made through electrophysiological studies (EMG/NCS).

Treatment options include both conservative and surgical approaches. Surgical options include cubital tunnel decompression, medial epicondylectomy, and ulnar nerve transposition . Surgical treatment is generally preferred for patients with muscle weakness and atrophy, as well as those who do not respond to conservative treatments. Conservative treatment options include avoiding positions of the elbow that may exacerbate symptoms, splinting, exercise, electrotherapy, and local steroid injections .

Kinesiotaping, developed by chiropractor and acupuncturist Kenzo Kase in the late 1970s, is a commonly used conservative treatment option for musculoskeletal pathologies in physical therapy clinics. The tape is made of cotton, stretches longitudinally up to 40%, is water-resistant, and can stay on the skin for up to 7 days.

Kinesiotaping is believed to support muscles, correct joint movement, enhance blood and lymph circulation, provide proprioceptive input, and reduce pain and muscle spasms . Various physical therapy modalities, steroid injections, and dry needling have been studied for their effects on Cubital Tunnel Syndrome. Kinesiotaping has been shown to be effective in patients with Carpal Tunnel Syndrome. However, there is no study available on the use of kinesiotaping in CuTS patients. This simple, cost-effective treatment modality, commonly used in physical therapy practice for various pathologies, will be investigated for its efficacy in patients with Cubital Tunnel Syndrome.

Interventions

• Other kinesio taping
  Kinesio taping at the level of the cubital tunnel on the elbow
• Other Ulnar nerve mobilization exercise
  All patients will be provided with information and an exercise sheet containing pictures on ulnar nerve gliding exercises. To monitor whether patients are performing the exercises correctly, they will be asked to come to the hospital once a week, where they will perform the exercises under the supervision of a physiotherapist. In the exercise program, different positions will be held for 30 seconds, with a 1-minute rest between them, and the exercises will be performed twice a day .
• Other Sham (No Treatment)
  It will be applied in the same way as kinesiological taping with adhesive tape.
• Diagnostic test Numeric Rating Scale (NRS)
  Description: To demonstrate that kinesiological taping will result in a reduction of pain intensity associated with Cubital Tunnel Syndrome, as measured by the Numeric Rating Scale (NRS) ranging from 0 to 10.
• Diagnostic test the ulnar nerve cross-sectional area measured by ultrasound
  The measurements will be taken with the patient in a supine position, the affected arm in shoulder abduction and external rotation, and the elbow flexed at 70°-90°. After applying a generous amount of gel, the lateral edge of the ultrasound probe will be placed on the medial epicondyle, and the medial edge of the probe will be positioned on the olecranon; the ulnar nerve will be directly examined in the retroepicondylar groove. Once the nerve is visualized, the widest point will be identified, a
• Diagnostic test Neuropathic pain scale (measured using the DN-4 scale)
  The DN4 questionnaire consists of two main sections and a total of ten questions. The first section includes seven questions related to pain characteristics and sensory information obtained through patient interview. These questions are about burning, electric shocks, coldness, tingling, pricking, numbness, and itching. The second section contains three statements related to physical examination (touch hypoesthesia, pinprick hypoesthesia, and allodynia). For each statement, "yes" or "no" respons
• Diagnostic test SF-12 Quality of Life Scale
  The SF-12 Quality of Life Scale is a short form of the SF-36 Quality of Life Scale. While the SF-36 is used for chronic conditions (states), the SF-12 is used for short-term assessments (clinical findings). Similarly, it is also used to gather information about the patient's general health status. The SF-12 provides the same summary component scores as the SF-36, but with fewer items, making it a significant advantage due to its shorter application time. The scale asks the patient about their he
• Diagnostic test QUICK-DASH
  QUICK-DASH (Shoulder, Arm, and Hand Problems Questionnaire): This questionnaire assesses both the ability to perform certain physical activities as well as the symptoms of the disease. Each question is answered based on the condition of the past week, and the appropriate score is marked. The answer is given based solely on the ability to perform the physical activity, without considering which hand or arm is injured. Scoring: 1. = No difficulty 2. = Mild difficulty 3. = Moderate difficulty 4.
• Diagnostic test Grip strength measured with a hand dynamometer
  Grip strength will be measured using a hand dynamometer, with the average of three measurements taken, each followed by a 30-second rest period.

Primary outcome measures

• Numeric Rating Scale (NRS) [Time frame: 3 months]

Secondary outcome measures (5)

• the ulnar nerve cross-sectional area measured by ultrasound [Time frame: 3 months]
• Neuropathic pain scale (measured using the DN-4 scale [Time frame: 3 months]
• SF-12 Quality of Life Scale [Time frame: 3 months]
• QUICK-DASH [Time frame: 3 months]
• Grip strength measured with a hand dynamometer [Time frame: 3 months]

Eligibility criteria

Inclusion criteria

• Aged between 18 and 65 years
• Patients with at least 3 points of pain according to the Numeric Rating Scale (NRS)
• Patients diagnosed with Cubital Tunnel Syndrome via Electroneuromyography (ENMG)
• Literate
• Willing to consent to participate in the study

Exclusion criteria

• Having any secondary entrapment neuropathy such as diabetes, inflammatory arthritis, or hypothyroidism
• Pregnancy
• Active cancer presence
• Skin infection, burns, wounds, or scars on the forearm
• History of elbow trauma
• Cervical radiculopathy or brachial plexopathy
• Polyneuropathy
• Having previously undergone Cubital Tunnel decompression surgery
• Having received a corticosteroid injection into the Cubital Tunnel within the last 3 months
• Illiterate
• Not consenting to participate in the study

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Treatment

Study locations

Turkey (Türkiye) · 2 centers

• Health Sciences University — Istanbul
• Sultan 2. Abdülhamid Han Eğitim ve Araştırma Hastanesi — Istanbul

Publications

• Stewart JD. The variable clinical manifestations of ulnar neuropathies at the elbow. J Neurol Neurosurg Psychiatry. 1987 Mar;50(3):252-8. doi: 10.1136/jnnp.50.3.252. PMID 3031220

Identifiers

NCT: NCT07001111 · 25-17

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗