Ulnar Nerve Entrapment: Overview

An injury to the elbow such as a dislocation or fracture can tear or inflame the ulnar nerve, which extends down the arm, across the elbow, and into the hand. The inflamed nerve can swell and become trapped, causing a condition called ulnar nerve entrapment or cubital tunnel syndrome.

Diagnosis

Although the problem is in the elbow area, most symptoms occur in the hand and fingers because the ulnar nerve controls movement and sensation there. Both sensory and motor skills are affected.

Symptoms of an ulnar nerve entrapment include:

• tenderness along the inside of the elbow
• tingling and numbness in little and ring fingers (especially at night)
• numbness in your hand when the elbow is bent, such as when you drive or hold a telephone
• difficulty with hand coordination (such as when typing or playing a musical instrument).
• decreased grip and pinch strength, muscle weakness
• pain along the inside border of the shoulder blade

If you experience any of these symptoms, contact a physician. Early diagnosis and treatment is essential to controlling symptoms.

A physician can use several methods to diagnose ulnar nerve entrapment. Your own description of the symptoms is a primary source of information. If you’ve experienced a fall, blow, or other injury to the elbow, the physician may request an x-ray. The physician may also apply pressure around the nerve to see if pain or tingling results, check to see if the hand muscles are weakening, or do an electrical stimulation test to see how well the nerve conducts sensory information.

Treatment Options

Non-surgical Treatment Options

• Keep the elbow as straight as possible. A straight elbow puts less pressure on the ulnar nerve.
• Avoid crossing your arms across your chest.
• If you frequently use the telephone, consider using a headset or cradle attachment, so you don’t have to hold the telephone to your ear with a bent elbow.
• Adjust your workspace so that you don’t have to bend your elbow more than 30 degrees and you can keep your wrist in a neutral position.
• Consider wearing a splint at night. Something as simple as a towel wrapped around the elbow can help keep it straight.
• Use elbow protectors if you play sports to avoid bumping the elbow.
• If muscle atrophy and numbness continues, corticosteroids may be used to reduce swelling and pressure.

Surgery

If conservative treatment is not effective and muscle strength continues to weaken, further evaluation and surgery may be needed. There are several surgical options. The most frequent type of surgery (anterior submuscular transposition) moves the nerve from behind the bone to the front of the elbow. After the surgery, treatment must focus on maximizing the use of the hand and arm through physical therapy. This process can take several months.

How can I prevent ulnar nerve entrapment?

Because ulnar nerve entrapment is caused by overuse, the best way to prevent it is to avoid the activities that caused it. Because this is often impractical, it's recommended that the activity be modified to reduce the likelihood of recurrences.

If you are a bicyclist, you should have your doctor evaluate your position on the bicycle and make adjustments to assure that the weight is not too far forward and supported by the hands on the handlebars. Sometimes it helps to wear padded gloves, or add padding to the handlebars.

Shifting position of your hands from time to time during prolonged rides and generally not staying in "down position" for more than 10 or 15 minutes at a time may also help. Baseball players should make sure that their bat suits them well, and also have the biomechanical analysis of their swing checked to identify correctable form flaws that could lead to ulnar nerve entrapment.

Improving sports performance

The key to improving sports performance after recovering from ulnar nerve entrapment is a proper rehabilitation program, and adhering to some of those same principles after the injury is gone

Ulnar nerve entrapment rehabilitation

As an athlete, your number one concern is getting back to full strength as soon as possible so that you can return to training and competition. That is why appropriate rehabilitation is extremely important.

Unfortunately, rehabilitation for ulnar nerve entrapment is a matter of refraining from the activity that causes it. However, you may increase the strength of the forearm and range of motion of the wrist, which speeds up recovery and prevents the injury from recurring.

Rehabilitation exercises

The exercises below increase the strength of the forearm muscles. They should be performed to the point of initial pain only. You may increase resistance only when the exercise can be performed with no pain, for the designated number of repetitions.

• Wrist extensor
  Sit next to a table with the injured forearm on the table surface with the wrist at the end of the table and the palm down. Hold a two- or three-pound dumbbell in the injured-side hand and raise it as high as pain permits or until the back of the hand is level with the table top. Hold this position for 5 seconds. Relax the arm and hand for 10 seconds. Perform this sequence 10 times, 3 times daily. Increase the range of the exercise motion as pain permits until the back of the hand is level with the table top at each repetition. When this is possible, increase the amount of resistance by one-half pound.
• Wrist flexor
  Sit next to a table with the injured forearm on the table surface with the wrist at the end of the table and the palm up. Hold a two- or three-pound dumbbell in the hand and raise it as high as pain permits or until the weight is level with the tabletop. Hold this position for 5 seconds. Relax the arm and hand for 10 seconds. Perform this sequence 10 times, 3 times daily. Increase the range of motion as pain permits until the weight is level with the tabletop at each repetition. When this is possible, increase the amount of resistance by one-half pound.
• Wrist extensor
  Assume a hands-and-knees position, with the back of the hands on the floor and fingers pointed toward the knees. Slowly rock forward, placing weight on the hands and wrists to the onset of pain. Hold this position for 5 seconds. Rock backward, relieving the wrists and hands of the body weight, and relax for 10 seconds. Perform this sequence 10 times, 3 times daily. As pain permits, increase the amount of weight transferred to the hands and wrists.
• Wrist flexor
  Assume a hands-and-knees posture, with palms on the floor and fingers pointing forward. Slowly rock forward, placing weight on the hands and wrists until the onset of pain. Hold this position for 5 seconds. Rock backward, relieving the wrists and hands of the body weight, and relax for 10 seconds. Perform this sequence 10 times, 3 times daily. As pain permits, increase the amount of weight transferred to the hands and wrists.

Alternative exercises

During the period when normal training should be avoided, alternative exercises may be used. These activities should not require any actions that create or intensify pain at the site of injury. They include:

• swimming
• jogging
• stationary bicycle (without pressure on the handlebars, if pain permits)

How long will the effects of the injury last?

Recovery time from ulnar nerve entrapment varies. Usually, return to full activity depends on how long it takes for the inflammation of the ulnar nerve to remit. In most cases, with appropriate treatment and avoidance of the activity that caused the condition, inflammation and pain disappear within two to four weeks. However, some severe cases may last eight weeks and longer. An early return to your sport before your symptoms are gone may cause a more serious condition that might require surgery.

When can I return to my sport or activity?

Return to full participation in the activity that caused the injury should be avoided until all symptoms are gone. However, it's possible to make a partial return to activity as long as pain permits. For example, a bicyclist suffering from ulnar nerve entrapment may continue to cycle in an upright position that does not require body weight to be supported by the hands, wrists, or forearms. The baseball player may practice fielding skills, the golfer practice putting (if it's not painful), and the tennis player practice ground strokes that do not cause pain.

Remember: The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Return to your activity is determined by how soon your ulnar nerve entrapment recovers and full range of motion is restored, not by how many days or weeks it has been since your injury occurred.