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Ulnar Nerve Entrapment


Two People Cycling Near the Beach

Ulnar nerve entrapment, often called cyclist's neuropathy or handlebar palsy, can cause weakness, numbness, tingling, and pain in the forearm and the fourth and fifth fingers of the hand. In more severe cases, this condition may even lead to muscle atrophy.


Interestingly, about 60% of patients with Golfer's Elbow also experience ulnar nerve compression. Additionally, 70% to 90% of individuals diagnosed with Thoracic Outlet Syndrome face challenges related to the ulnar nerve.


Ulnar nerve entrapment most commonly occurs at the elbow, known as Cubital Tunnel Syndrome, or less frequently at the wrist, known as Guyon's Canal Syndrome. Elbow entrapment often results from keeping the elbow fully flexed or resting it on a hard surface for prolonged periods. In contrast, wrist entrapment typically arises from direct pressure, such as leaning on bicycle handlebars. Understanding these common causes can help in both preventing and effectively managing this condition.


Article Index

 

A Man Extending His Arm

Ulnar Nerve Anatomy


Originating from the medial cord of the brachial plexus, the ulnar nerve has its roots in the C8 and T1 spinal nerves. This mixed nerve, containing motor and sensory fibres, extends down the arm in a posteromedial path. It travels alongside the medial epicondyle of the humerus, passing through the cubital tunnel—a fibro-osseous passage where the medial collateral ligament forms the floor and the aponeurotic arcade of the flexor carpi ulnaris muscle constitutes the roof.


As the ulnar nerve continues down the forearm, it provides motor innervation to the flexor carpi ulnaris and the ulnar portion of the flexor digitorum profundus muscles. Upon entering the hand via Guyon's canal, a fibro-osseous tunnel located between the pisiform and the hook of the hamate, the ulnar nerve divides into its terminal branches. This intricate pathway highlights the importance of understanding the nerve's anatomy to effectively diagnose and treat ulnar nerve entrapment.


 

Physical Examination


In the following videos, we demonstrate a range of procedures used to assess cases of ulnar nerve entrapment. These evaluations include orthopedic, neurological, and vascular examinations, offering a comprehensive approach to identifying and understanding the underlying issues associated with this condition. By showcasing these diverse assessment techniques, we aim to provide a thorough understanding and effective diagnostic pathway for ulnar nerve entrapment.


Mastering Cervical Spine Diagnostics

This guide provides a comprehensive overview of cervical spine anatomy, orthopedic examinations, and tests for accurate diagnosis. (15)







Elbow Examination - Orthopaedic Testing


This video goes through inspection and observation, palpation, Active and Passive Ranges of motion, and orthopedic examination of the Elbow. (15)




Wrist & Hand Examination   

In this video, we demonstrate a comprehensive examination of the wrist and hands, encompassing inspection and observation, palpation, active and passive ranges of motion, and orthopedic assessments. This systematic approach ensures a thorough evaluation of the wrist and hand structures for optimal diagnosis and treatment planning. (15)


Upper Limb Neuro Exam

The upper limb neurological examination is integral to the comprehensive neurological assessment process. It evaluates the motor and sensory neurons responsible for the functioning of the upper limbs. This examination functions as a screening and investigative instrument by detecting potential nervous system impairments, allowing for informed clinical decision-making and appropriate interventions. (15)


Peripheral Vascular Examination - Key Points

A peripheral vascular examination is essential in identifying potential vascular-related pathologies. Early detection and timely intervention for peripheral vascular disease (PVD) can help reduce the risk of cardiovascular and cerebrovascular complications. This video highlights several common procedures routinely performed in daily clinical practice to assess peripheral vascular health effectively. (15)


 

Manual Therapy and Exercise


Dr. Abelson, the Motion Specific Release (MSR) developer, has created several hands-on treatment methods to address Ulnar Nerve Entrapment. These methods are complemented by highly effective exercises that incorporate ulnar nerve gliding, which helps facilitate the movement of new fibres through the surrounding tissues. We frequently recommend these techniques to our patients.


We have included three informative videos below to help you better understand the practices and exercises we suggest for managing Ulnar Nerve Entrapment. These videos showcase a selection of the techniques and exercises we utilize and recommend, offering valuable insights into our comprehensive approach to treating this condition.


Brachial Plexus Release

Welcome to this video on Brachial Plexus Release. The main objective of this video is to demonstrate how to release the nerves connecting the neck to the shoulder, which includes the cervical plexus, brachial plexus, and neurovascular sleeve, using MSR procedures. (15)


Ulnar Nerve Compression Video
Click Image to Watch Video

Ulnar Nerve Compression

In this video, our primary objective is to demonstrate the release of the ulnar nerve utilizing Motion Specific Release (MSR) procedures. These techniques aim to alleviate compression and restore optimal nerve function. Patients suffering from ulnar nerve compression often report sensory alterations, such as numbness, tingling, or pain, predominantly affecting the fourth and fifth fingers. (15)


Ulnar Nerve Flossing Video
Click Image to Watch Video

Ulnar Nerve Flossing

For individuals affected by ulnar nerve entrapment syndrome, these exercises serve to floss, mobilize, and liberate the ulnar nerve from the encircling tissues. The ulnar nerve is susceptible to compression at various locations, including the wrist, beneath the collarbone, or as it emerges from the spinal cord in the neck region. When the ulnar nerve experiences compression at the elbow, this specific condition is termed "cubital tunnel syndrome." The ulnar nerve flossing exercises relieve compression and restore optimal nerve function across these anatomical sites. (15)


 


Conclusion


In conclusion, understanding and effectively managing ulnar nerve entrapment is essential for those affected by this condition. Known commonly as cyclist's neuropathy or handlebar palsy, it can cause significant discomfort and functional impairment in the forearm and the fourth and fifth fingers. Interestingly, about 60% of patients with Golfer's Elbow also experience ulnar nerve compression. Additionally, 70% to 90% of individuals diagnosed with Thoracic Outlet Syndrome face challenges related to the ulnar nerve. We can better prevent and treat this issue by recognizing the common causes, such as Cubital Tunnel Syndrome and Guyon's Canal Syndrome.


Healthcare professionals can significantly alleviate symptoms and improve patient outcomes by utilizing a comprehensive approach that includes detailed anatomical knowledge, thorough physical examinations, and targeted manual therapy and exercises. Our video demonstrations provide valuable insights and practical guidance on these techniques. Embracing these methods can lead to successful management and a better quality of life for those suffering from ulnar nerve entrapment.

 

References


  1. Akkoc, Y., Kilic, E., & Erdogan, S. (2021). The effectiveness of nerve mobilization techniques in the management of neurogenic cervicobrachial pain: A randomized clinical trial. Journal of Back and Musculoskeletal Rehabilitation, 34(2), 229-236.

  2. Ballestero-Pérez, R., Plaza-Manzano, G., Urraca-Gesto, A., Romo-Romo, F., Atín-Arratibel, M. Á., Pecos-Martín, D., & Gallego-Izquierdo, T. (2020). Effectiveness of nerve gliding exercises on carpal tunnel syndrome: a systematic review. Journal of Manipulative and Physiological Therapeutics, 43(1), 9-18.

  3. Beltran, L. S., Bencardino, J., Ghazikhanian, V., & Beltran, J. (2012). Entrapment neuropathies III: lower limb. Seminars in Musculoskeletal Radiology, 16(5), 374-400.

  4. Broudy, A. S., Leffert, R. D., & Smith, R. J. (1998). Cubital tunnel surgery: an outcomes study of 52 patients. Journal of Hand Surgery, 23(1), 60-66.

  5. Chan, A. K., Youssef, A., & Chau, J. (2020). The effectiveness of neurodynamic techniques in the management of carpal tunnel syndrome: A systematic review. Journal of Hand Therapy, 33(2), 190-197.

  6. Descatha, A., Leclerc, A., Chastang, J. F., & Roquelaure, Y. (2004). Medial epicondylitis in occupational settings: prevalence, incidence and associated risk factors. Journal of Occupational and Environmental Medicine, 46(9), 954-964.

  7. Ellis, R., & Hing, W. (2020). Neural mobilization: a systematic review of randomized controlled trials with an analysis of therapeutic efficacy. Journal of Manual and Manipulative Therapy, 14(1), 23-34.

  8. Gervasio, O., Gambardella, G., Zaccone, C., & Branca, D. (2005). Simple decompression versus anterior submuscular transposition of the ulnar nerve in severe cubital tunnel syndrome: a prospective randomized study. Neurosurgery, 56(1), 108-117.

  9. Passigli, S., Rossi, A., & Spidalieri, R. (2020). Sensory nerve mobilization for ulnar neuropathy at the elbow: a randomized, placebo-controlled clinical trial. Clinical Rehabilitation, 34(6), 767-774.

  10. Rempel, D., Evanoff, B., & Amadio, P. C. (1998). Consensus criteria for the classification of carpal tunnel syndrome in epidemiologic studies. American Journal of Public Health, 88(10), 1447-1451.

  11. Tadjalli, H. E., Yoosefinejad, A. K., & Vahdatpour, B. (2018). Effect of neurodynamic treatment on nerve conduction in patients with ulnar neuropathy at the elbow: a randomized clinical trial. Journal of Hand Therapy, 31(4), 433-439.

  12. Wang, Q., & Zhu, Z. (2019). Efficacy of neural gliding for patients with ulnar nerve entrapment at the elbow: a systematic review and meta-analysis of randomized controlled trials. Journal of Hand Surgery (European Volume), 44(9), 949-956.

  13. Abelson, B., & Abelson, K. Release Your Kinetic Chain: Exercises For the Shoulder to Hand: Activating Your Arm's Kinetic Chain! Calgary, Canada : Rowan Tree Books, 2010.

  14. DM, Donahue. Cervical ribs and NTOS. [book auth.] Thompson RW, Freischlag JA, Donahue DM, Jordan SE, Edgelow PI (Eds) Illig KA. Thoracic Outlet Syndrom, 1st edition. London : Spinger, 2013, pp. 85-8.

  15. Abelson, B., Abelson, K., & Mylonas, E. (2018, February). A Practitioner's Guide to Motion Specific Release, Functional, Successful, Easy to Implement Techniques for Musculoskeletal Injuries (1st edition). Rowan Tree Books.


 
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DR. BRIAN ABELSON DC. - The Author


Photo of Dr. Brian Abelson

Dr. Abelson is dedicated to using evidence-based practices to improve musculoskeletal health. At Kinetic Health in Calgary, Alberta, he combines the latest research with a compassionate, patient-focused approach. As the creator of the Motion Specific Release (MSR) Treatment Systems, he aims to educate and share techniques to benefit the broader healthcare community. His work continually emphasizes patient-centred care and advancing treatment methods.



 


MSR Instructor Mike Burton Smiling

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