You know that phrase, “I hit my funny bone”? Well, the “funny bone” is actually a nerve, the ulnar nerve to be specific! The ulnar nerve begins at the spinal cord, travels down the neck, through the upper arm all the way down to the ring and small finger tips. A common ulnar nerve compression site is at the elbow resulting in Cubital Tunnel Syndrome. Cubital Tunnel Syndrome symptoms can include numbness or tingling in the 4th and 5th fingers, grip and pinch weakness, loss of fine motor coordination and nerve pain.
Know your anatomy
Common compression sites along the ulnar nerve pathway include:
• At the cubital tunnel
• The arcade of Struthers
• The medial intermuscular septum
• Between the two heads of the flexor carpi ulnaris muscle (FCU)
How these compression sites affect you:
Things that can cause compression at these anatomical sites:
• Resting your elbow on a tabletop
• Sleeping with your hand and wrist flexed
• A blow or force to the elbow
The ulnar nerve innervates muscles that help bend the wrist, 4th and 5th fingers and thumb. If the nerve is compressed severely or for a prolonged period of time, these muscles can begin to atrophy or “waste” resulting in significant weakness and loss of function.
How to treat Cubital Tunnel Syndrome
Conservative hand therapy includes decompression of the ulnar nerve using nerve glides, desensitization and sensory re-education, pain management, range of motion, and strengthening of weak ulnar muscles. Custom orthoses or prefabricated braces are also useful for night time decompression. Another easy option for decreasing nerve compression is sleeping with the affected arm wrapped around a pillow or with a towel around the elbow to prevent bending.
Surgical treatment options, if compression is more severe or recommended by your doctor:
• Cubital tunnel release or decompression
• Nerve transposition (moves the nerve out of the cubital tunnel to pass through musculature)
• Total elbow arthroplasty (for severe cases or nerve injuries with additional bone injury or fractures)
Rehabilitation of the hand and upper extremity. Chapter 3, page 35; ch 7 pg86, ch 40, pg 585