The elbow joint connects the forearm to the upper arm. The three bones of the elbow (humerus, radius and ulna) allow for bending and straightening of the elbow and rotation of the forearm. Three major nerves cross the elbow: the median nerve, ulnar nerve, and radial nerve. These nerves originate at the brachial plexus, a network of nerves that begins in the neck and innervates the muscles and skin of the arm. Each of these nerves is responsible for providing sensory and motor function to a different portion of the arm and hand.

PINCHED NERVES IN THE ELBOW

Any of these three nerves can experience compression or “pinching” which can affect both the muscles and skin innervated by that nerve. Below you will find information on the signs and symptoms of a pinched ulnar, radial and median nerve: Ulnar nerve compression (cubital tunnel syndrome): Cubital tunnel syndrome or entrapment of the ulnar nerve 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 as it passes through the cubital tunnel, a narrow passageway in the elbow created by bone, muscles and ligaments.

Common symptoms of ulnar nerve entrapment include:

• 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

Radial nerve entrapment: The radial nerve can be compressed or irritated where it crosses the anterior side of the elbow. Overuse of the muscles of the upper arm, direct trauma to the elbow or hematoma can compress the radial nerve above the elbow. Below the elbow, the nerve can get entrapped just above the supinator muscle or in the radial tunnel leading to a condition called posterior interosseous nerve syndrome or radial tunnel syndrome.

Common symptoms of radial nerve entrapment include:

• Gradual sensory loss or alteration over the back of the forearm, fingers and hand
• Weakness of the wrist or finger extensors
• Wrist drop
• Burning over the lateral aspect of the forearm
• Tenderness over the radial nerve
• Aching sensation with fine motor activities like writing
• Pain with resisted supination (turning palm up) or resisted middle finger extension

Median nerve entrapment: Compression of the median nerve at the elbow can lead to a condition called pronator syndrome and a condition called anterior interosseous nerve syndrome.

Symptoms of these conditions can range from mild to severe and include the following:

• Pain and abnormal sensation over the flexors of the elbow and forearm
• Reduced sensation in the thumb, index, middle and ring fingers
• Pain with resisted pronation (turning palm down), elbow flexion with supination, resisted middle finger flexion
• Weakness in the thumb and fingers
• Inability or weakness when making the ‘OK’ sign
• Decreased finger coordination
• Deep forearm discomfort

If you decide to work with a physical therapist to help correct the pinched nerve in your elbow, 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 NERVE COMPRESSION IN THE ARM?

The goal of physical therapy is to reduce irritation or compression in the affected nerve which can relieve your symptoms. Conservative treatments such as physical therapy and sometimes anti-inflammatories or corticosteroid injections are often recommended by doctors first and can be very successful. If conservative treatment does not fully address the nerve compression, surgery may be recommended by your doctor.

While physical therapy for a pinched nerve will always be individualized to your specific needs, below are some common goals and treatments of physical therapy to manage nerve compression in the elbow:

TREATMENT TO REDUCE INFLAMMATION: Modalities like ice, ultrasound, contrast baths or iontophoresis may be used to reduce inflammation. Additionally, splinting or bracing may be recommended to reduce nerve irritation.

NERVE AND TISSUE MOBILITY EXERCISES: Nerve mobilization 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 more optimally.

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

STRENGTHENING: Strengthening of muscles affected by the pinched nerve or contributing to the pinched nerve are often prescribed in the mid and late stages of healing

While nerve compression in the elbow can significantly impact your function and quality of life, physical therapy is a first-line treatment to reduce compression and alleviate symptoms. If you are experiencing pain, weakness or paresthesias in the forearm or hand, call Evolve Physical Therapy today to schedule an initial evaluation.

Resources-

Naik AA, Bawa A, Arya A, Gulihar A. Nerve entrapment around elbow. J Clin Orthop Trauma. 2021 May 27;19:209-215. doi: 10.1016/j.jcot.2021.05.031. Erratum in: J Clin Orthop Trauma. 2021 Jul 30;20:101539. doi: 10.1016/j.jcot.2021.101539. PMID: 34150493; PMCID: PMC8190494.