What happens when we hit our ‘funny bone’? What causes that immense pain to shoot down from our elbow to our hand? Well, when we hit our ‘funny bone’, we’re not actually hitting a bone. We are in fact, directly hitting a nerve. The ulnar nerve to be specific. The ulnar nerve is one of three main nerves that run from our neck to our hand. Specifically, the ulnar nerve runs down the inside of our forearm and all the way into our ring and pinkie fingers. You may be wondering why you don’t you get similar symptoms when you knock other parts of your arm. It’s because the ulnar nerve travels through a space in our elbow called the cubital fossa. The nerve is most vulnerable in this space because there is only a thin layer of skin and fat to protect the nerve, so even the smallest knock or tap can produce pain. Generally, when we knock our ‘funny bone’, we feel severe pain shoot down into our fingers which is often accompanied by tingling. After a short time, the pain dissipates, and you can move on with your day. But sometimes these symptoms can become more constant and can occur without a knock to the funny bone. When this happens, we term it Ulnar Nerve Entrapment.
Ulnar Nerve Entrapment is the most common problem associated with the ulnar nerve and occurs when the nerve becomes compressed. Ulnar Nerve Entrapment can occur either in the elbow or in the wrist. Compression at elbow level is termed Cubital Tunnel Syndrome, while compression in the wrist is referred to as Guyon’s Canal Syndrome. Cubital Tunnel Syndrome is one of the most common peripheral neuropathies that occur in the arm, second to Carpal Tunnel Syndrome (which affects the median nerve in our upper limb). Guyon’s Canal Syndrome, on the other hand, is quite rare.
So what causes Ulnar Nerve Entrapment? Activities that continually stretch the ulnar nerve at the elbow joint, such as sustained bent elbow positions, or activities that put a lot of direct pressure through your elbow, can increase the risk of Cubital Tunnel Syndrome. Activities that put direct pressure through your wrists, such as leaning on handlebars, can increase the risk of Guyon’s Canal Syndrome. Populations that commonly complain of Ulnar Nerve Entrapment include baseball, tennis and golf players, cyclists, weightlifters and those who use a keyboard frequently.
Ulnar Nerve Entrapment can result in pain, tingling and numbness through the forearm, hand and ring and pinky fingers, as well as tenderness in the elbow region. In severe cases, compression on the ulnar nerve can lead to weakness in the hand and muscle mass loss.
Non-surgical management has been shown to effectively treat Ulnar Nerve Entrapment. Physiotherapy can provide appropriate activity modifications and positional advice, manual therapy for symptom relief and prescribe an individualised exercises to increase strength and mobility of the muscles, joints, and nerves. Splinting the elbow at night may also be indicated for some patients.
If you have persistent pain or other issues in your elbow, forearm or hand that are affecting your daily routine, book an appointment with one of our physiotherapists to get you back on track.