The ulnar nerve is located in the arm. It is supplied by the eighth cervical spinal nerve and the first thoracic spinal nerve meaning it arises from the spinal cord near the bottom of the neck and top of the upper back. It splits from the brachial plexus, a bundle of nerves that supply the arm, near the shoulder, courses down the arm and supplies sensation to half of the palm and back of the hand along with the pinky finger and half the ring finger. It supplies motor function to some of the muscles that help you flex your wrist and fingers as well as intrinsic muscles of the hand that help you grasp. While theoretically the ulnar nerve can become entrapped or compressed anywhere along its course, the two most common locations of ulnar nerve entrapment are at the elbow and wrist.

CUBITAL TUNNEL SYNDROME

Entrapment of the ulnar nerve at the elbow is the second most common type of nerve compression in the arm. It is caused by compression, irritation or decreased blood flow to the ulnar nerve. The two most common locations for entrapment are the cubital tunnel, a narrow passageway in the elbow created by bone, muscles and ligaments (most common), and at the wrist (less common). Ulnar nerve entrapment at the elbow is called cubital tunnel syndrome.

Cubital tunnel syndrome can be caused by prolonged leaning on the elbows such as on a desk while working or due to prolonged elbow flexion such as sleeping with your arms overhead. Trauma, swelling, fractures and bony or vascular abnormalities can also cause ulnar nerve entrapment as they narrow the space for the nerve to travel through the cubital tunnel or impact blood flow to the nerve.

Because nerves supply sensory and motor functions to specific areas, compression or irritation of any nerve results in a predictable pattern of symptoms. If you have any of the symptoms listed below, you may be experiencing cubital tunnel syndrome:

• Pain or aching along the inside of the elbow or forearm
• Numbness and tingling in the pinky and ½ the ring finger and the palm or back of the hand beneath those fingers
• A non-painful popping or snapping on the inside of the elbow when you move it
• Difficulty moving the pinky finger outward
• Inability to strongly hold a piece of paper between the index finger and thumb (Froment’s Sign)
• Atrophy of the intrinsic hand muscles and an abnormal claw posture of the 4th and 5th fingers
• Tenderness of the ulnar nerve in the cubital tunnel

If you decide to work with a physical therapist to help correct your cubital tunnel syndrome issues, your entire treatment plan could consist of around 8-20+ different physical therapy sessions that will each last 60-90 minutes. Once you complete your customized physical therapy treatment plan, you will be able to continue to do the prescribed stretches and exercises utilized during your PT sessions yet in the comfort of your own home.

WHAT PHYSICAL THERAPY TREATMENTS ARE BEST FOR CUBITAL TUNNEL SYNDROME?

After identifying ulnar nerve compression or cubital tunnel syndrome, the goal is to reduce irritation or compression in the nerve which can relieve your symptoms. Conservative treatments such as physical therapy or even corticosteroid injections are often recommended first and can be very successful. In the case where conservative therapy does not fully address the nerve compression, surgery may be recommended by your doctor to relieve the remaining compression on the nerve.

While physical therapy for cubital tunnel syndrome will always be individualized to your specific needs, below are some common goals and treatments of physical therapy to manage ulnar nerve entrapment:

TREATMENT TO REDUCE INFLAMMATION: modalities like ice, ultrasound, contrast baths or iontophoresis may be used to reduce inflammation in the earliest stages of healing. Additionally, recommendations such as limiting weight bearing on the elbow or modifying static arm positions may be provided to reduce nerve compression and irritation.

SPLINTING: The use of an elbow night splint to limit elbow flexion may be recommended for a period of time to allow the nerve to heal

NERVE AND TISSUE MOBILITY EXERCISES: nerve gliding and tensioning mobilizations and soft tissue mobilization techniques are often used to ensure good tissue health and proper nerve mobility

BIOMECHANICS AND MOVEMENT TRAINING: In cases where mechanical compression or irritation of a nerve occurs due to faulty or non-optimal movement patterns, your physical therapist can teach you to move better or sometimes use supports like taping or bracing to help lessen the stress on your nerves

STRETCHING: Muscle stretching is often prescribed to improve muscle length if this is a factor contributing to your symptoms

STRENGTHENING: Strengthening or muscles affected by the pinched nerve or contributing to the pinched nerve are often prescribed in the mid and late stages of healing which can help you return to your prior activities

As you can see, physical therapists have many tools in their treatment toolbox to address cubital tunnel syndrome and physical therapy is a first-line treatment to reduce compression and alleviate symptoms. If you are experiencing pain, weakness or paresthesias in the arm or hand, call Evolve Physical Therapy today to schedule an initial evaluation and begin working with our skilled team of PTs.