Ulnar Nerve Entrapment

A common type of ulnar nerve entrapment at the elbow is cubital tunnel syndrome, which can be caused by elbow injuries (such as fractures and dislocations), bone and joint disease (such as arthritis and bone spurs), repeated bending of the elbow (which is common in some occupational settings requiring heavier work), or excessive leaning on it (especially on hard surfaces). Moreover, some conditions can increase susceptibility to nerve compression, such as diabetes and hereditary neuropathy with pressure palsies. Occasionally, there is no clear cause leading to ulnar nerve entrapment at the elbow. Ulnar nerve entrapment at the wrist can be caused by direct trauma, laceration, and ulnar tunnel syndrome.

Additionally, distal vascular anomalies or some joint conditions (such as rheumatoid arthritis and other disorders) may also contribute to nerve compression. Lastly, cycling and doing excessive push-ups, as well as any other usual cases of chronic and repeated external pressure by hand tools, may also contribute to ulnar nerve entrapment at the wrist. Symptoms of ulnar nerve entrapment can vary depending on the location, extent, and severity of the pressure on the nerve, as well as the ulnar nerve branches that are involved. Typical symptoms can include muscle weakness, decreased grip strength, and clumsiness. Some cases could also lead to muscle wasting. Moreover, ulnar nerve entrapment can lead to numbness, tingling, and pain involving the little finger, ring finger, and the palmar aspect of the hand. Severe cases of ulnar nerve damage at the elbow could result in clawing of the fourth and fifth fingers. Over time, in more severe cases, ulnar nerve damage may potentially worsen to the point of permanent disability.

Many patients often experience a characteristic tingling sensation when hitting their funny bone. The funny bone, known as the medial epicondyle of the elbow, is a protuberance in the lower inner part of the humerus. Striking the funny bone can cause pain in some instances, as the ulnar nerve is exposed in that area and vulnerable to transient trauma. Other symptoms linked to ulnar nerve entrapment can affect either at the elbow or the wrist; therefore, being considered entrapments. These causes include:

• Driving with a bent elbow resting on a resting place, like an open window.

• Leaning on your elbows at a table for a long period of time.

• Carrying a phone up to your ear for a long period of time.

• Holding a tool in a constant position.

• A cyst on your elbow.

• Injury to your elbow.

• A certain fluid build-up and swelling after an injury.

• Arthritis in your elbow.

Symptoms at the wrist include repetitive activity at work, such as using a jackhammer or a hammer, and repetitive activity in sports, such as pressing your hand against bicycle handlebars or swinging a golf club.

Ulnar nerve entrapment can happen to anyone, however, people who lean on their elbows, such as office workers (who lean on one elbow at their desk), or truck drivers (who rest their arms on the open window of their truck as they drive), are at a higher risk of developing compression around the nerve. Other risk factors include repeatedly bending and stretching your arms; keeping your arms out straight for long periods; participating in activities that put stress on your elbow or wrist; and prior fractures to the wrist or elbow. Several other things can increase your risk of ulnar nerve entrapment in either your elbow or wrist including:

• Diabetes
• Obesity
• Autoimmune conditions
• Thyroid conditions
• High blood pressure
• Pregnancy

Most cases of ulnar nerve entrapment are successfully treated, and the symptoms go away. If treatment for ulnar nerve entrapment does not relieve the symptoms, they may become worse with time. If you have surgery, it may take several weeks for you to regain strength and proper feeling in your arm, especially if the condition has been present for a long time.

Since ulnar nerve entrapment is associated with cubital tunnel syndrome, in most cases, cubital tunnel syndrome may be mistaken with another condition known as proximal nerve compression. Proximal nerve compression is a type of compression that can occur not only at the wrist within the carpal tunnel, but also in the proximal forearm. Therefore, it can be in the same area as where the ulnar nerve entrapment can cause in an individual.

Diagnosis of ulnar nerve entrapment begins by taking a medical history, followed by a physical examination of the arm, elbow, and hand to test for motor or sensory performance, as well as to find the source of injury. An Additional test, including ultrasound, electromyography, and nerve conduction studies can be performed to confirm a diagnosis and help determine the location and extent of nerve damage. The two latter techniques are non-invasive electrodiagnostic methods that can be performed to evaluate the electrical activity of muscles or neurons, respectively. Therefore, for the most part, ulnar nerve entrapment treatment is successful without surgery. Once you identify the cause, such as leaning on your elbow or repeated bending and stretching, your doctor may recommend:

• Pain medications to reduce inflammation and pain. These can include aspirin or non-steroidal anti-inflammatories (NSAIDs), such as ibuprofen.

• Immobilizing your arm. A brace or splint that can keep your arm from moving will give your arm a chance to heal and prevent you from moving your elbow, especially while you sleep.

• Physiotherapy / occupational therapy for the hand and arm may help you regain strength in your hand. In some cases, the therapist may recommend nerve-gliding exercises, which encourage the nerves to slide or glide as they should. Heat packs to heal the tissues may also be effective.

If the treatments mentioned above do not help ease the ulnar nerve entrapment symptoms, your doctor may recommend ulnar nerve surgery. The procedures for ulnar nerve entrapment treatment include:

• Cubital tunnel release surgery – This minor surgical procedure is done on an outpatient basis with a local anesthetic to freeze the area around your elbow. A surgeon cuts the tissue that is pressing on the nerve. You will need a brace or splint for a few weeks to allow the incision to heal and the inflammation to subside.

• Ulnar nerve anterior surgery – For situations where the ulnar nerve is seriously compressed or the nerve has moved out of position, a surgeon must relocate the nerve to a less vulnerable position. Although this surgical procedure is more involved than cubital tunnel release surgery, it is also done on an outpatient basis with a local anesthetic.

• Joint repair – If nerve compression is the result of trauma to the elbow, wrist, or any other area of the arm, the surgeon may have to surgically repair the joint and remove tissue or bone parts pressing on the nerve.

Many nerve injuries and disorders are first recognized and treated by neurologists, neuromuscular specialists, orthopedists, or physiotherapists. If surgery is needed for treatment, it is generally performed by a neurosurgeon who specializes in peripheral nerve surgery.

Regarding exercises, there are always different methods that can help relieve many types of conditions, therefore these are a few great exercises anyone can perform to help lessen any symptoms linked to ulnar nerve entrapment:

Elbow straightening

You first begin with your arm extended straight and your palm up. Secondly, curl your fingers inwards. Finally, bend your elbow, bringing your curled fist up towards your shoulder. Return to your starting position; then repeat the exercise 3-5 times for 2-3 times a day.

Forehead touch

The forehead touch is a common exercise method for the elbow and wrist. You start by standing straight with your arms at the sides. Raise one hand, so the palm is resting on the forehead. Lastly, hold the position for a few seconds then slowly bring the hand down again. Repeat the same method 3-5 times for 2-3 times a day.

Hand curl

The hand curl is another good exercise that stretches the ulnar nerve. To perform this, you must first stand or sit upright with the arm held straight in front of the body with the elbow straight. Afterwards, curl the wrist and fingers towards the body. Then, extend the hand away from the body to feel a stretch in the wrist. Finally, bend the elbow and raise the hand upwards. Repeat the exercise 2-3 times for 2-3 times a day.

Wrist exercise

Stand or sit tall with your arm held straight out to the front of you and your palm facing up. Then you curl your wrist and fingers towards your body. Bend your hand away from the body to gently stretch your wrist. Afterwards, bend your elbow and raise your hand upwards. Repeat the exercise a few times a day; gradually increasing the number of repetitions you do in each session.

There are many things you can do at home to help relieve symptoms – if your symptoms interfere with normal activities or last more than a few weeks, be sure to schedule an appointment with your doctor…

• Avoid activities that may require you to keep your arm bent for a long period of time.

• If you often use a computer, make sure that your chair is not too low. Do not rest your elbow on the armrest.

• Avoid leaning on your elbow or putting pressure on the inside of your arm. For example, do not drive with your arm resting on an open window.

• Keep your elbows straight at night when you are sleeping. This can be done by wrapping a towel around your straight elbows or wearing an elbow pad backwards.

• Using an ice pack may also help relieve any inflammation and swelling.