Ulnar nerve entrapment – symptoms and treatment

Is surgery always needed?

Second only to carpal tunnel syndrome, ulnar nerve entrapment is one of the most common nerve injuries of the upper extremity.

The ulnar nerve can be compressed at several sites, including the brachial plexus, Guyon’s canal and the cubital tunnel. Patients with ulnar nerve entrapment often present with sensory deficits over the 4th and 5th finger, loss of strength in the hand with tasks (such as opening a bottle) and pain that intensifies with positions of flexed elbows (buttoning a shirt, etc).

The authors of this review performed a literature search to explore diagnostic and treatment options for suspected ulnar nerve entrapment.

The authors found that appropriate diagnosis is one of the most important steps. If needed, CT and MRI can be helpful in ruling out boney pathology (such as a fracture to the hook of the hamate bone) or soft tissue entrapment. However, nerve conduction studies may be most helpful in establishing a diagnosis.

While conservative management has a limited scope, further minimally invasive pain management techniques may be a viable option for management. When physiotherapy, activity modification and exercise are not enough to resolve symptoms, surgical intervention remains the gold standard for management.

> From: Vij et al., Anesth Pain Med 10 (2020) e112070 (Epub ahead of print). All rights reserved to The Author(s). Click here for the online summary.

Expert opinion

Ulnar nerve entrapment is often overlooked when considering upper extremity nerve injuries, and it is important to distinguish between the different pathological presentations of sensory and motor loss of the hand (such as comparing carpal tunnel syndrome and ulnar nerve entrapment).

Even though physiotherapy is not the gold standard for treatment, education and positional changes are a good starting point for symptom management. If soft tissue is a contributing factor to the ulnar nerve symptoms, physiotherapeutic intervention may be used to optimise tissue length and muscular imbalances.

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