Ulnar Nerve Entrapment

• Ulnar Nerve Entrapment:

  • aka cubital tunnel syndrome
  • the ulnar nerve is superficial at the elbow
  • it runs through a narrow channel enclosed in a tunnel of fascia which can contribute to compression, increasing the likelihood of ulnar nerve entrapment along its course
• Ulnar Nerve Entrapment / Cubital Tunnel Syndrome:

  • what
  • compression (or traction) neuropathy of the ulnar nerve
  • where
  • cubital tunnel - most common site
  • can occur at other sites along the course of the nerve
  • how
  • direct compression when leaning on the elbow
  • traction injury when throwing, especially when a valgus force is applied
  • direct nerve compression from the 2 heads of flexor carpi ulnaris
  • a subluxing ulnar nerve
  • irregularities in the ulnar groove
• Ulnar Nerve Entrapment / Cubital Tunnel Syndrome - Subjective Features:

  • diffuse medial elbow pain radiating into the forearm
  • paraesthesia/anaesthesia into hand/forearm
  • paraesthesia into 4th and 5th digits
  • loss of dexterity/motor weakness
  • the feeling of the nerve moving as the elbow goes through flexion/extension
• Ulnar Nerve Entrapment / Cubital Tunnel Syndrome - Objective Features:

  • observations
  • elbow may be in full extension to reduce compression of nerve
  • palpation
  • possible tenderness/reproduction of symptoms over the medial epicondyle and directly over the nerve where it runs superficially at the elbow
  • ROM
  • full active ROM of elbow, wrist and hand
• Ulnar Nerve Entrapment / Cubital Tunnel Syndrome - Special/Clearing Tests:

  • upper limb neurological examination - dermatome:
  • reduced sensation to light touch, sharp blunt etc. in ulnar nerve distribution
  • upper limb neurological examination - myotomes:
  • reduced flexor strength in 4th and 5th digits and reduced strength into ulnar deviation
  • neural provocation testing:
  • upper limb neural provocation test 3 (ulnar nerve)
  • clearing tests
  • must clear spine and shoulder
• Ulnar Nerve Entrapment / Cubital Tunnel Syndrome - Management:

  • education
  • activity modification
  • neural tissue mobilisations
  • address muscle strength deficits/functional weakness
  • refer to a neurosurgeon if symptoms persist, recur, worsen