Ulnar Nerve Entrapment

Question 1

What is the prevalence of an ulnar nerve entrapment?

Answer 1

2nd most common compression neuropathy seen by hand surgeons

Question 2

What are the locations for ulnar nerve entrapments?

Answer 2

• Cubital tunnel at the elbow
• FCU heads in proximal forearm
• Guyon’s canal in the hand

Question 3

What is the cause(s) of an ulnar nerve entrapment?

Answer 3

• Trauma
• Overuse/ repetitive stress with elbow/ hand
• Age-related joint changes/ RA at elbow/ wrist

Question 4

What are symptoms of cubital tunnel syndrome?

Answer 4

• Medial hand/ finger paresthesia’s
• Weak grip

Question 5

What are the ROM signs of cubital tunnel syndrome?

Answer 5

• Possible limitations with elbow flexion and paresthesia’s
• Possibly limited extension at end range

Question 6

What are the resisted testing signs of cubital tunnel syndrome?

Answer 6

Possible weak wrist and 4th and 5th digit flexion, thumb abduction, and grip

Question 7

What are the neuro signs of cubital tunnel syndrome?

Answer 7

• Possible diminished sensation over the ulnar nerve distribution
• (+) ulnar nerve dural mobility test

Question 8

What are the (+) special test signs of cubital tunnel syndrome?

Answer 8

• Elbow flexion test
• Tinel’s
• Wartenberg’s sign

Question 9

What are the palpation in cubital tunnel signs of cubital tunnel syndrome?

Answer 9

• Provocation with ulnar nerve pressure up to 60 seconds
• May be able to sublux ulnar nerve

Question 10

Ulnar nerve entrapment at the FCU presents with what signs and symptoms?

Answer 10

Same as cubital tunnel syndrome except: ROM at the elbow WNL, only special test is Wartenbergs, palpation causes no provocation or ulnar nerve subluxation in the cubital tunnel but is provoked at the FCU heads

Question 11

Ulnar nerve entrapment at guyon’s canal presents with what signs and symptoms?

Answer 11

Same as cubital tunnel syndrome except: ROM at the elbow WNL, resisted testing shows hand weakness but no wrist weakness, only special test is Wartenbergs, palpation causes no paresthesia’s or ulnar nerve subluxation in the cubital tunnel but causes provocation at guyon’s canal

Question 12

What is the Rx for terminal nerve brach injuries?

Answer 12

• POLI (No C) ED: when compression is the cause
• Bracing/ Splinting to assist with eliminating compression
• MET with optimal stresses to create neural motion/ flossing and the above elimination of compression