What causes ulnar nerve pain? Ulnar nerve entrapment and treatment.Dec 13, 2022
The ulnar nerve is the nerve runs behind your elbow, through the funny bone groove, down into the pinkie and ring fingers. It has bother a sensory / feeling component, and a motor control muscle control component to it. Pain in this area is relatively common. We look at three places for potential entrapment of the ulnar nerve. *This blog post is intended for general information only, it is not intended to diagnosis or treat any specific condition, no patient client relationship is established.
1. Where it's component branches exit the spine.
2. Where it runs through the thoracic outlet under the collar bone.
3. At the back of the elbow in the ulnar groove / funny bone.
1. Where it exits the spine.
We have a rule, It is spine until it isn't. The the first place we always look is where the nerve comes out of the spine. For the ulnar nerve the main component branches exit the spine right where the neck meets the mid back. Primarily C7-C8-T1 nerve roots. Stiffness in the lower neck, upper thoracic are a common entrapment area.
2. Where it runs through the thoracic outlet area.
This is one I see most commonly when there isn't a specific injury and there isn't significant neck pain with the elbow issue. As the spinal nerves exit the neck they come together in the brachial plexus and run under the collar bone, over the first few ribs as they make their way down the inside of the arm. If you have tightness in the front of the shoulder/chest area, elevation of the first rib, tightness in the pec minor, accessory breathing issues, or other forward shoulder issues it is a potential area of irritation for the ulnar nerve. In this situation, normalizing diaphragmatic breathing patterns at rest, reducing pectoral tightness, and first rib mobilizations, are often a key component in relieving the nerve tension down the arm.
3. Irritation at the elbow in the ulnar groove.
When the cause of the pain is at the elbow we typically see some type of mechanism to the pain. This is common in overhead athletes like pitchers, someone taking on a new sports or weightlifting program, or in the case of a fall or compression injury. There is still usually a regional component to treating ulnar pain stemming from the elbow by improving either grip strength or shoulder mobility/stability to reduce pressure and abnormal movement at the elbow.
Treatment of Ulnar Nerve Entrapment and Pain.
The most important part of resolving the pain at the ulnar nerve is determining where the irritation is coming from based on the three above common entrapment points. Once you know where it's coming from you can take steps to resolve it.
Dry needling is one of our favorite ways to reduce irritation and inflammation along the ulnar nerve pathway. In the view above is a common treatment pattern we may use in our clinic for Dry needling of the ulnar nerve. We would also treat the spinal segments and pectoral area if appropriate for you.
The common exercises we use for ulnar nerve entrapment include reducing pressure on the pectorals and thoracic area, first rib mobilization, and nerve glides. Here are YouTube Links to some of our most commonly prescribed exercises.
Pectoral Release. https://www.youtube.com/watch?v=TrqaWwpVKAU
First Rib Mobilization. https://www.youtube.com/watch?v=OW7t_pG7RlI&t=54s
Ulnar Nerve Glides. https://youtu.be/PyS8vt4-q8g
If you have any other questions about ulnar nerve entrapment let us know or schedule a session for a custom evaluation at https://phyt.janeapp.com
Written by Nick Sanders
Written by Dr. Nicholas Sanders PT, DPT, CSCS, CIDN. Dr. Sanders is the founder and owner of PHYT For Function where we provide a convenient and simple solution for people to continue to do the activities they love without muscle, joint, or nerve pain. He is a national instructor for Integrative Dry Needling and Co-Creator of a Neuro-Inflammatory Manual Therapy course.
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