Nerve Entrapments in Arm
Nerve entrapment occurs when a nerve is compressed by surrounding joints, muscles and tendons and results in irritation or injury to the nerve. Common upper extremity nerve entrapments seen in physical therapy include ulnar nerve entrapment (Cubital Tunnel Syndrome; Guyon’s Syndrome) and median nerve entrapment (Carpal Tunnel Syndrome).
Ulnar Nerve Entrapment (Cubital Tunnel Syndrome)
Ulnar nerve entrapment at the elbow, also known as Cubital Tunnel Syndrome, is the second most common nerve entrapment treated in physical therapy. It occurs when the ulnar nerve is compressed as it passes the elbow through the Cubital Tunnel.
Cubital Tunnel Syndrome can occur from trauma (such as elbow dislocations or radial/humeral fractures), excessive swelling or bony abnormalities. It may also occur after extended periods with the elbow bent, such as prolonged sling use.
Signs and symptoms of Cubital Tunnel Syndrome:
- Pain and sensitivity to the inside (ulnar side) of the forearm, wrist or hand
- Numbness and tingling to the pinky and/or ring fingers
- Pain and weakness with gripping
- Severe cases may present with clawing of the pinky and ring fingers (sign of Benediction; when trying to make a fist, the ring and little finger flex but the index and middle finger cannot flex at the metacarpal-phalangeal joint or interphalangeal joint.)
Physical therapy examination of upper extremity nerve entrapments include:
- Extensive history of symptom onset and progression
- Range of motion of the elbow, wrist and fingers
- Strength assessment of affected muscles
- Sensation testing
- Special tests including: Froment’s Sign, Phalen Maneuver, Tinnel’s sign and neurodynamic assessment
The neck and shoulder are also screened to rule out other diagnoses that can refer symptoms to the wrist or elbow.
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- Han HH, Kang HW, Lee JL, Jung S. Fascia Wrapping Technique: A Modified Method for the Treatment of Cubital Tunnel Syndrome. The Scientific World Journal. 2014; Article ID 482702, 6 pages. doi:10.1155/2014/482702
- Miller, Theodore T., and William R. Reinus. “Nerve entrapment syndromes of the elbow, forearm, and wrist.” American Journal of Roentgenology 195.3 (2010): 585-594.
- Neuropathy of Ulnar Nerve (Entrapment). MD Guidelines. http://www.mdguidelines.com/neuropathy-of-ulnar-nerve-entrapment/differential-diagnosis. Accessed September 29, 2022.
- Palmer BA, Hughes TB. Cubital Tunnel Syndrome. J Hand Surg. 2010; 35(1): 153–163.
- Ulnar Nerve Entrapment. Physiopedia. https://www.physio-pedia.com/Ulnar_Nerve_Entrapment. Accessed September 29, 2022.
- Lawrence RC, Felson DT, Helmick CG, et al.; National Arthritis Data Workgroup. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum 2008; 58:26–35 49.
It is common for the neck to refer pain into one’s arm. Patients commonly report a feeling of numbness and tingling that can extend to and even past the elbow joint. We call this cervical radiculopathy or referred pain.
There are several types of fractures that can occur at the elbow. The most common elbow fractures occur at the olecranon, radial head and distal humerus bone.
Physical Therapy Treatment for Nerve Entrapments at Elbow Many cases of...