Ulnar Nerve Entrapment, informally known as cyclist's neuropathy or handlebar palsy, can present with weakness, numbness, tingling, and pain in the forearm and the 4th and 5th fingers of the hand. In severe cases, this condition may lead to muscle atrophy.
It is noteworthy that around 60% of patients afflicted with Golfer's Elbow also exhibit ulnar nerve compression. Moreover, 70% to 90% of individuals diagnosed with Thoracic Outlet Syndrome encounter issues with the ulnar nerve.
Ulnar nerve entrapment typically takes place at the elbow (Cubital Tunnel Syndrome) or, less frequently, at the wrist (Guyon's Canal Syndrome). Entrapment at the elbow is commonly attributed to maintaining the elbow in a fully flexed position or resting it on a surface for an extended duration. On the other hand, entrapment at the wrist primarily results from direct pressure, such as leaning on bicycle handlebars.
Article Index
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, consisting of both motor and sensory components, extends posteromedially down the arm. It runs alongside the medial epicondyle of the humerus, passing through a fibro-osseous tunnel called the cubital tunnel. The medial collateral ligament forms the floor of the cubital tunnel, while the aponeurotic arcade of the flexor carpi ulnaris muscle constitutes its roof.
As the ulnar nerve progresses down the forearm, it provides motor innervation to the flexor carpi ulnaris and the ulnar portion of the flexor digitorum profundus muscles. The nerve then enters the hand via Guyon's canal, a fibro-osseous tunnel situated between the pisiform and the hook of the hamate, and subsequently divides into its terminal branches.
Physical Examination
In the following videos, we showcase various procedures employed in assessing ulnar nerve entrapment cases. These evaluations encompass orthopedic, neurological, and vascular examinations, providing a comprehensive approach to identifying and understanding the underlying issues related to this condition.
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 orthopaedic 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. By detecting potential nervous system impairments, this examination functions as both a screening and investigative instrument, 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)
RECOMMENDED ORTHOPAEDIC REFERENCE BOOKS
Orthopaedic Physical Assessment – David J. Magee https://amzn.to/3zgu0za
Dutton'sOrthopaedic: Examination, Evaluation and Intervention, Fifth Edition https://amzn.to/3st1AOv
Manual Therapy and Exercise
Dr. Abelson, the Motion Specific Release (MSR) developer, has developed several hands-on treatment methods to address Ulnar Nerve Entrapment, combined with highly effective exercises that incorporate ulnar nerve gliding to encourage the movement of new fibers through surrounding tissues. We often advise our patients to try these techniques.
To offer a better understanding of the practices and exercises we suggest for people experiencing Ulnar Nerve Entrapment, we've included three informative videos below. Please remember that these examples represent only a portion of the techniques and exercises we utilize or recommend for those dealing with this issue.
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. Covering this region thoroughly before addressing the median, radial, and ulnar nerves is essential. (15)
Ulnar Nerve Compression
Ulnar nerve entrapment is a condition that frequently manifests at the inner regions of the elbow and wrist. 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. We strive to alleviate these symptoms by employing MSR techniques and promoting improved nerve health. (15)
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, ulnar nerve entrapment is a condition that can cause significant discomfort and functional impairment in affected individuals. Healthcare professionals can employ targeted assessment and intervention strategies by understanding the anatomy and various entrapment locations. Through manual therapy, such as Motion Specific Release techniques, and ulnar nerve flossing exercises, patients can experience relief from the symptoms associated with ulnar nerve compression. It is essential to approach each case individually and tailor the treatment plan according to the patient's specific needs, ensuring optimal recovery and restoring function.
DR. BRIAN ABELSON DC. - The Author
Dr. Abelson's approach in musculoskeletal health care reflects a deep commitment to evidence-based practices and continuous learning. In his work at Kinetic Health in Calgary, Alberta, he focuses on integrating the latest research with a compassionate understanding of each patient's unique needs. As the developer of the Motion Specific Release (MSR) Treatment Systems, he views his role as both a practitioner and an educator, dedicated to sharing knowledge and techniques that can benefit the wider healthcare community. His ongoing efforts in teaching and practice aim to contribute positively to the field of musculoskeletal health, with a constant emphasis on patient-centered care and the collective advancement of treatment methods.
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References
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.
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.
Beltran, L. S., Bencardino, J., Ghazikhanian, V., & Beltran, J. (2012). Entrapment neuropathies III: lower limb. Seminars in Musculoskeletal Radiology, 16(5), 374-400.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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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