| An injury to the elbow such as a dislocation or | | | | entrapment is a matter of refraining from the activity |
| fracture can tear or inflame the ulnar nerve, which | | | | that causes it. However, you may increase the |
| extends down the arm, across the elbow, and into | | | | strength of the forearm and range of motion of the |
| the hand. The inflamed nerve can swell and become | | | | wrist, which speeds up recovery and prevents the |
| trapped, causing a condition called ulnar nerve | | | | injury from recurring. |
| entrapment or cubital tunnel syndrome. | | | | Rehabilitation exercises |
| Diagnosis | | | | The exercises below increase the strength of the |
| Although the problem is in the elbow area, most | | | | forearm muscles. They should be performed to the |
| symptoms occur in the hand and fingers because the | | | | point of initial pain only. You may increase resistance |
| ulnar nerve controls movement and sensation there. | | | | only when the exercise can be performed with no |
| Both sensory and motor skills are affected. | | | | pain, for the designated number of repetitions. |
| Symptoms of an ulnar nerve entrapment include: | | | | # Wrist extensor |
| # tenderness along the inside of the elbow | | | | Sit next to a table with the injured forearm on the |
| # tingling and numbness in little and ring fingers | | | | table surface with the wrist at the end of the table |
| (especially at night) | | | | and the palm down. Hold a two- or three-pound |
| # numbness in your hand when the elbow is bent, | | | | dumbbell in the injured-side hand and raise it as high |
| such as when you drive or hold a telephone | | | | as pain permits or until the back of the hand is level |
| # difficulty with hand coordination (such as when | | | | with the table top. Hold this position for 5 seconds. |
| typing or playing a musical instrument). | | | | Relax the arm and hand for 10 seconds. Perform this |
| # decreased grip and pinch strength, muscle | | | | sequence 10 times, 3 times daily. Increase the range |
| weakness | | | | of the exercise motion as pain permits until the back |
| # pain along the inside border of the shoulder blade | | | | of the hand is level with the table top at each |
| If you experience any of these symptoms, contact a | | | | repetition. When this is possible, increase the amount |
| physician. Early diagnosis and treatment is essential to | | | | of resistance by one-half pound. |
| controlling symptoms. | | | | # Wrist flexor |
| A physician can use several methods to diagnose | | | | Sit next to a table with the injured forearm on the |
| ulnar nerve entrapment. Your own description of the | | | | table surface with the wrist at the end of the table |
| symptoms is a primary source of information. If you | | | | and the palm up. Hold a two- or three-pound dumbbell |
| have experienced a fall, blow, or other injury to the | | | | in the hand and raise it as high as pain permits or until |
| elbow, the physician may request an x-ray. The | | | | the weight is level with the tabletop. Hold this position |
| physician may also apply pressure around the nerve | | | | for 5 seconds. Relax the arm and hand for 10 |
| to see if pain or tingling results, check to see if the | | | | seconds. Perform this sequence 10 times, 3 times |
| hand muscles are weakening, or do an electrical | | | | daily. Increase the range of motion as pain permits |
| stimulation test to see how well the nerve conducts | | | | until the weight is level with the tabletop at each |
| sensory information. | | | | repetition. When this is possible, increase the amount |
| Treatment Options | | | | of resistance by one-half pound. |
| Non-surgical Treatment Options | | | | # Wrist extensor |
| # Keep the elbow as straight as possible. A straight | | | | Assume a hands-and-knees position, with the back of |
| elbow puts less pressure on the ulnar nerve. | | | | the hands on the floor and fingers pointed toward |
| # Avoid crossing your arms across your chest. | | | | the knees. Slowly rock forward, placing weight on |
| # If you frequently use the telephone, consider using | | | | the hands and wrists to the onset of pain. Hold this |
| a headset or cradle attachment, so you do not have | | | | position for 5 seconds. Rock backward, relieving the |
| to hold the telephone to your ear with a bent elbow. | | | | wrists and hands of the body weight, and relax for |
| # Adjust your workspace so that you do not have | | | | 10 seconds. Perform this sequence 10 times, 3 times |
| to bend your elbow more than 30 degrees and you | | | | daily. As pain permits, increase the amount of weight |
| can keep your wrist in a neutral position. | | | | transferred to the hands and wrists. |
| # Consider wearing a splint at night. Something as | | | | # Wrist flexor |
| simple as a towel wrapped around the elbow can | | | | Assume a hands-and-knees posture, with palms on |
| help keep it straight. | | | | the floor and fingers pointing forward. Slowly rock |
| # Use elbow protectors if you play sports to avoid | | | | forward, placing weight on the hands and wrists until |
| bumping the elbow. | | | | the onset of pain. Hold this position for 5 seconds. |
| # If muscle atrophy and numbness continues, | | | | Rock backward, relieving the wrists and hands of the |
| corticosteroids may be used to reduce swelling and | | | | body weight, and relax for 10 seconds. Perform this |
| pressure. | | | | sequence 10 times, 3 times daily. As pain permits, |
| Surgery | | | | increase the amount of weight transferred to the |
| If conservative treatment is not effective and | | | | hands and wrists. |
| muscle strength continues to weaken, further | | | | Alternative exercises |
| evaluation and surgery may be needed. There are | | | | During the period when normal training should be |
| several surgical options. The most frequent type of | | | | avoided, alternative exercises may be used. These |
| surgery (anterior submuscular transposition) moves | | | | activities should not require any actions that create |
| the nerve from behind the bone to the front of the | | | | or intensify pain at the site of injury. They include: |
| elbow. After the surgery, treatment must focus on | | | | # swimming |
| maximizing the use of the hand and arm through | | | | # jogging |
| physical therapy. This process can take several | | | | # stationary bicycle (without pressure on the |
| months. | | | | handlebars, if pain permits) |
| How can I prevent ulnar nerve entrapment? | | | | How long will the effects of the injury last? |
| Because ulnar nerve entrapment is caused by | | | | Recovery time from ulnar nerve entrapment varies. |
| overuse, the best way to prevent it is to avoid the | | | | Usually, return to full activity depends on how long it |
| activities that caused it. Because this is often | | | | takes for the inflammation of the ulnar nerve to |
| impractical, it is recommended that the activity be | | | | remit. In most cases, with appropriate treatment and |
| modified to reduce the likelihood of recurrences. | | | | avoidance of the activity that caused the condition, |
| If you are a bicyclist, you should have your doctor | | | | inflammation and pain disappear within two to four |
| evaluate your position on the bicycle and make | | | | weeks. However, some severe cases may last eight |
| adjustments to assure that the weight is not too far | | | | weeks and longer. An early return to your sport |
| forward and supported by the hands on the | | | | before your symptoms are gone may cause a more |
| handlebars. Sometimes it helps to wear padded | | | | serious condition that might require surgery. |
| gloves, or add padding to the handlebars. | | | | When can I return to my sport or activity? |
| Shifting position of your hands from time to time | | | | Return to full participation in the activity that caused |
| during prolonged rides and generally not staying in | | | | the injury should be avoided until all symptoms are |
| "down position" for more than 10 or 15 minutes at a | | | | gone. However, it is possible to make a partial return |
| time may also help. Baseball players should make sure | | | | to activity as long as pain permits. For example, a |
| that their bat suits them well, and also have the | | | | bicyclist suffering from ulnar nerve entrapment may |
| biomechanical analysis of their swing checked to | | | | continue to cycle in an upright position that does not |
| identify correctable form flaws that could lead to | | | | require body weight to be supported by the hands, |
| ulnar nerve entrapment. | | | | wrists, or forearms. The baseball player may practice |
| Improving sports performance | | | | fielding skills, the golfer practice putting (if it is not |
| The key to improving sports performance after | | | | painful), and the tennis player practice ground strokes |
| recovering from ulnar nerve entrapment is a proper | | | | that do not cause pain. |
| rehabilitation program, and adhering to some of those | | | | Remember: The goal of rehabilitation is to return you |
| same principles after the injury is gone | | | | to your sport or activity as soon as is safely possible. |
| Ulnar nerve entrapment rehabilitation | | | | If you return too soon you may worsen your injury, |
| As an athlete, your number one concern is getting | | | | which could lead to permanent damage. Return to |
| back to full strength as soon as possible so that you | | | | your activity is determined by how soon your ulnar |
| can return to training and competition. That is why | | | | nerve entrapment recovers and full range of motion |
| appropriate rehabilitation is extremely important. | | | | is restored, not by how many days or weeks it has |
| Unfortunately, rehabilitation for ulnar nerve | | | | been since your injury occurred. |