What is causing my elbow pain?

Do you present with a claw hand? Do you have pain, tingling and numbness in the forearm and hand? Has your grip strength reduced? If so, you may be presenting with Ulnar Nerve Entrapment. Our Physiotherapy specialists in Brisbane, our clinic is focused on individualised care and hands on approach to treatment. Not sure if this applies to you? We will be talking about Ulnar Nerve Entrapment, the common symptoms and how these can be managed.

Ulnar Nerve Entrapment
Ulnar nerve entrapment is a condition that stems from compression of the ulnar nerve. This can cause pain, tingling and numbness in the forearm and hand. Compression of the ulnar nerve occurs mainly at two sites: the elbow or the wrist and each site has different names to help identify the location of the compromise. At the elbow, ulnar nerve entrapment is commonly seen in the cubital tunnel, and therefore is referred to as Cubital Tunnel Syndrome. It is the second most common entrapment of neural tissue. At the wrist, it occurs at Guyon’s canal (subsequently making the condition at the wrist termed Guyon’s Canal Syndrome), which is the second most common compression at the wrist (the first of which is carpal tunnel syndrome).

The Anatomy
Achilles Ulnar Nerve Entrapment 2

Credit: https://www.cedars-sinai.org/health-library/diseases-and-conditions/c/cubital-tunnel-syndrome.html


The ulnar nerve runs through the cubital tunnel on the inside portion of the elbow. The risk factors for ulnar nerve entrapment at the elbow are prolonged flexion (bending) of the elbow and repetitive compression with tasks such as leaning on the elbows. Direct trauma, swelling and fractures can also cause compression in this region.

Achilles Ulnar Nerve Entrapment 3

Credit: https://www.physio-pedia.com/Guyon_Canall


In the wrist, the ulnar nerve passes through Guyon’s Canal, as pictured above. Compression in this area from repetitive extension of the wrist or prolonged weight bearing on the wrist can cause entrapment of the ulnar nerve.

Common Presenting Symptoms
As the ulnar nerve supplies the fourth and fifth fingers in the hand, usually symptoms manifest in the form of tingling into the aforementioned fingers, grip strength weakness and sensitivity on the ulnar aspect of the forearm, wrist and hand. There can also be wasting of the muscles of the hand, specifically around the palm at the base of the fourth and fifth finger.

There are three grades of severity of both cubital tunnel syndrome and Guyon’s canal syndrome.

Cubital Tunnel Syndrome Guyon's Canal Syndrome
Grade I: Mild symptoms:
  • Intermittent numbness and tingling
  • Altered sensation in fourth and fifth fingers
  • No change in strength
Grade I:
  • Muscle wasting primarily in hypothenar muscles and into fourth and fifth digits
  • Weakened finger strength
Grade II: Moderate symptoms which persist:
  • Numbness and tingling
  • Altered sensation in fourth and fifth digits
  • Mild weakness of the hypothenar aspect of the hand (the area of the palm underneath the fourth and fifth digits)
  • Signs of muscle wasting in the hypothenar aspect of the hand
Grade II:
  • Loss of sensation into palm, fourth and fifth digits and backside of respective fingers
  • Associated pain in above mentioned regions
Grade III: Marked symptoms:
  • Numbness and tingling
  • Loss of sensation in the palm and in fourth and fifth fingers
  • Impaired ability to use fingers, loss of dexterity
  • Muscle wasting of the hypothenar aspect of the hand
  • Possible clawing of fourth and fifth digits (ulnar claw pictured below)
Grade III:
  • Ulnar claw can be present (as pictured below)
Ulnar Nerve Entrapment

Credit: https://www.jhandtherapy.org/article/S0894-1130(18)30275-8/abstract


Ulnar claw, or claw hand presentation. Notably there is hyperextension of the knuckles and flexion of the fingers.

Management of Ulnar Nerve Entrapment
Nerve gliding has been shown to improve symptoms of numbness, tingling and pain into the forearm and hand. Nerve gliding protocols state exercises are to be performed regularly (minimum two times daily) and to be done on a daily basis.

Manual therapy by a physiotherapist in the form of joint mobilisations at the elbow, thoracic spine and cervical spine also aid in reduction of symptoms.

DO’s:
  • Cessation of the aggravating activities and positions: repetitive compression and/or prolonged flexion of the wrist and elbow
  • Splinting options that prevent wrist and elbow compromise
  • Seek help from a medical professional: Physiotherapy, specialist hand therapy or surgical intervention if conservative management does not remedy condition

DON’Ts:
  • Continued compressive loading of the wrist and elbow
  • Prolonged periods of holding phone to ear
  • Immobilisation - the compressed structures require pain-free movement
  • Neglect the area in the hopes that symptoms will improve

How Can Physiophi Help?
At Physiophi, we can treat ulnar nerve entrapment with manual therapy. This involves joint mobilisations at the neck, back, elbow and wrist to allow for more mobility of the ulnar nerve. Stiffness of the aforementioned areas can contribute to ulnar nerve compression.

We can also release any soft tissue structures that might be aiding in ulnar nerve compression. This could be done manually by hand, with dry needling techniques or even with our extracorporeal shockwave therapy machine.

Ulnar nerve entrapment is not a condition that is likely to resolve by itself. As a result, if your ulnar nerve entrapment is not getting better you may need to consult your experienced Musculoskeletal Physiotherapists at Physiophi to discuss options for treatment. We accept Private Health Insurance, WorkCover and GP management plans.

PLEASE CONTACT US ON: (07) 3172 4332 TO HAVE A CHAT WITH OUR FRIENDLY STAFF OR SIMPLY BOOK ONLINE AT: https://www.physiophi.com.au/

Reference List
Fadel, M., Lancigu, R., Raimbeau, G., Roquelaure, Y., &Descatha, A. (2017a). Occupational prognosis factors for ulnar nerve entrapment at the elbow: A systematic review. Hand Surg Rehabil, 36(4), 244-249. https://doi.org/10.1016/j.hansur.2017.03.004
Fadel, M., Lancigu, R., Raimbeau, G., Roquelaure, Y., &Descatha, A. (2017b). Occupational prognosis factors for ulnar nerve entrapment at the elbow: A systematic review. Hand Surg Rehabil, 36(4), 244-249. https://doi.org/10.1016/j.hansur.2017.03.004
Lauretti, L., D'Alessandris, Q. G., De Simone, C., Legninda Sop, F. Y., Remore, L. M., Izzo, A., & Fernandez, E. (2017a). Ulnar nerve entrapment at the elbow. A surgical series and a systematic review of the literature. J Clin Neurosci, 46, 99-108.
https://doi.org/10.1016/j.jocn.2017.08.012
Lauretti, L., D'Alessandris, Q. G., De Simone, C., Legninda Sop, F. Y., Remore, L. M., Izzo, A., & Fernandez, E. (2017b). Ulnar nerve entrapment at the elbow. A surgical series and a systematic review of the literature. J Clin Neurosci, 46, 99-108.
https://doi.org/10.1016/j.jocn.2017.08.012
Pearce, C., Feinberg, J., & Wolfe, S. W. (2009). Ulnar neuropathy at the wrist. HSS J, 5(2), 180-183; quiz 184-185.
https://doi.org/10.1007/s11420-009-9110-2

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