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
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.
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 |
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Grade I: Mild symptoms:
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Grade I:
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Grade II: Moderate symptoms which persist:
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Grade II:
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Grade III: Marked symptoms:
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Grade III:
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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
- 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