Ulnar nerve entrapment, often called cyclist's neuropathy or handlebar palsy, can cause weakness, numbness, tingling, and pain in the forearm and the fourth and fifth fingers of the hand. In more severe cases, this condition may even lead to muscle atrophy.
Interestingly, about 60% of patients with Golfer's Elbow also experience ulnar nerve compression. Additionally, 70% to 90% of individuals diagnosed with Thoracic Outlet Syndrome face challenges related to the ulnar nerve.
Ulnar nerve entrapment most commonly occurs at the elbow, known as Cubital Tunnel Syndrome, or less frequently at the wrist, known as Guyon's Canal Syndrome. Elbow entrapment often results from keeping the elbow fully flexed or resting it on a hard surface for prolonged periods. In contrast, wrist entrapment typically arises from direct pressure, such as leaning on bicycle handlebars. Understanding these common causes can help in both preventing and effectively managing this condition.
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, containing motor and sensory fibres, extends down the arm in a posteromedial path. It travels alongside the medial epicondyle of the humerus, passing through the cubital tunnel—a fibro-osseous passage where the medial collateral ligament forms the floor and the aponeurotic arcade of the flexor carpi ulnaris muscle constitutes the roof.
As the ulnar nerve continues down the forearm, it provides motor innervation to the flexor carpi ulnaris and the ulnar portion of the flexor digitorum profundus muscles. Upon entering the hand via Guyon's canal, a fibro-osseous tunnel located between the pisiform and the hook of the hamate, the ulnar nerve divides into its terminal branches. This intricate pathway highlights the importance of understanding the nerve's anatomy to effectively diagnose and treat ulnar nerve entrapment.
Physical Examination
In the following videos, we demonstrate a range of procedures used to assess cases of ulnar nerve entrapment. These evaluations include orthopedic, neurological, and vascular examinations, offering a comprehensive approach to identifying and understanding the underlying issues associated with this condition. By showcasing these diverse assessment techniques, we aim to provide a thorough understanding and effective diagnostic pathway for ulnar nerve entrapment.
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 orthopedic 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. This examination functions as a screening and investigative instrument by detecting potential nervous system impairments, 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)
Manual Therapy and Exercise
Dr. Abelson, the Motion Specific Release (MSR) developer, has created several hands-on treatment methods to address Ulnar Nerve Entrapment. These methods are complemented by highly effective exercises that incorporate ulnar nerve gliding, which helps facilitate the movement of new fibres through the surrounding tissues. We frequently recommend these techniques to our patients.
We have included three informative videos below to help you better understand the practices and exercises we suggest for managing Ulnar Nerve Entrapment. These videos showcase a selection of the techniques and exercises we utilize and recommend, offering valuable insights into our comprehensive approach to treating this condition.
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. (15)
Ulnar Nerve Compression
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. (15)
MSR Fascial Expansion:
Many patients do not realize that elbow pain, such as Golfer's Elbow, is often associated with ulnar nerve entrapment. In fact, approximately 60% of individuals with Golfer's Elbow also experience ulnar nerve compression, frequently reporting numbness or tingling in their ring and little fingers. By using fascial expansions, we can often expedite the treatment process, effectively addressing not only the primary pain but also the related ulnar nerve entrapment.
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, understanding and effectively managing ulnar nerve entrapment is essential for those affected by this condition. Known commonly as cyclist's neuropathy or handlebar palsy, it can cause significant discomfort and functional impairment in the forearm and the fourth and fifth fingers. Interestingly, about 60% of patients with Golfer's Elbow also experience ulnar nerve compression. Additionally, 70% to 90% of individuals diagnosed with Thoracic Outlet Syndrome face challenges related to the ulnar nerve. We can better prevent and treat this issue by recognizing the common causes, such as Cubital Tunnel Syndrome and Guyon's Canal Syndrome.
Healthcare professionals can significantly alleviate symptoms and improve patient outcomes by utilizing a comprehensive approach that includes detailed anatomical knowledge, thorough physical examinations, and targeted manual therapy and exercises. Our video demonstrations provide valuable insights and practical guidance on these techniques. Embracing these methods can lead to successful management and a better quality of life for those suffering from ulnar nerve entrapment.
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.
Disclaimer:
The content on the MSR website, including articles and embedded videos, serves educational and informational purposes only. It is not a substitute for professional medical advice; only certified MSR practitioners should practice these techniques. By accessing this content, you assume full responsibility for your use of the information, acknowledging that the authors and contributors are not liable for any damages or claims that may arise.
This website does not establish a physician-patient relationship. If you have a medical concern, consult an appropriately licensed healthcare provider. Users under the age of 18 are not permitted to use the site. The MSR website may also feature links to third-party sites; however, we bear no responsibility for the content or practices of these external websites.
By using the MSR website, you agree to indemnify and hold the authors and contributors harmless from any claims, including legal fees, arising from your use of the site or violating these terms. This disclaimer constitutes part of the understanding between you and the website's authors regarding the use of the MSR website. For more information, read the full disclaimer and policies on this website.
DR. BRIAN ABELSON, DC. - The Author
With over 30 years of clinical practice and experience in treating over 25,000 patients with a success rate of over 90%, Dr. Abelson created the powerful and effective Motion Specific Release (MSR) Treatment Systems.
As an internationally best-selling author, he aims to educate and share techniques to benefit the broader healthcare community.
A perpetual student himself, Dr. Abelson continually integrates leading-edge techniques into the MSR programs, with a strong emphasis on multidisciplinary care. His work constantly emphasizes patient-centred care and advancing treatment methods. His practice, Kinetic Health, is located in Calgary, Alberta, Canada.
Join Us at Motion Specific Release
Enroll in our courses to master innovative soft-tissue and osseous techniques that seamlessly fit into your current clinical practice, providing your patients with substantial relief from pain and a renewed sense of functionality. Our curriculum masterfully integrates rigorous medical science with creative therapeutic paradigms, comprehensively understanding musculoskeletal diagnosis and treatment protocols.
Join MSR Pro and start tapping into the power of Motion Specific Release. Have access to:
Protocols: Over 250 clinical procedures with detailed video productions.
Examination Procedures: Over 70 orthopedic and neurological assessment videos and downloadable PDF examination forms for use in your clinical practice are coming soon.
Exercises: You can prescribe hundreds of Functional Exercises Videos to your patients through our downloadable prescription pads.
Article Library: Our Article Index Library with over 45+ of the most common MSK conditions we all see in clinical practice. This is a great opportunity to educate your patients on our processes. Each article covers basic condition information, diagnostic procedures, treatment methodologies, timelines, and exercise recommendations. All of this is in an easy-to-prescribe PDF format you can directly send to your patients.
Discounts: MSR Pro yearly memberships entitle you to a significant discount on our online and live courses.
Integrating MSR into your practice can significantly enhance your clinical practice. The benefits we mentioned are only a few reasons for joining our MSR team.
Comments