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Nerve Entrapments in Wrist

Nerve entrapment occurs when a nerve is compressed by surrounding joints, muscles or tendons and results in injury or irritation to the nerve. Two common nerve entrapments affecting the wrist are ulnar nerve entrapment (Guyon’s Canal Syndrome) and median nerve entrapment (Carpal Tunnel Syndrome).

Ulnar Nerve Entrapment (Guyon’s Canal Syndrome)
Ulnar nerve entrapment occurs when the ulnar nerve is compressed at the wrist as it passes through the Guyon’s canal. It is also known as “handlebar palsy” as it frequently occurs following repetitive compression of the wrist against an object such as in cycling, weight lifting or use of heavy power tools.

Signs and symptoms of Guyon’s Canal Syndrome:

  • Muscle loss of the hand (hypothenar and interossei muscles)
  • Weakness of the hand, especially with fine motor skills
  • Loss of sensation and/or pain to the pinky and part of the ring finger
  • Severe cases may present with clawing of the pinky and ring fingers (sign of Benediction)

Median Nerve Entrapment (Carpal Tunnel Syndrome)

Carpal tunnel syndrome is the most common nerve entrapment affecting 4-10 million patients in the US. It occurs when the median nerve is compressed as it passes through the carpal tunnel. Carpal Tunnel Syndrome is more common in women compared to men, usually impacting women aged 30 to 60 and men aged 35 to 40. Carpal Tunnel Syndrome can occur from overuse of the hand or wrist, osteoarthritis, trauma or bony abnormalities.

Clinical signs and symptoms of Carpal Tunnel Syndrome include:

  • Pain in the underside of the wrist, palm and/or the first three fingers
  • Weakness and clumsiness of the hand
  • Numbness and tingling to the palm and/or first three fingers.
  • Muscle loss of the hand (muscles of the thumb)

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

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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