How To Fix Ulnar Nerve Entrapment | Causes & Symptoms

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Why do our hands fall asleep? More specifically, why is it that sometimes only certain fingers fall asleep?

There are a few answers to these questions, but the most likely answer is because you have something called Peripheral Neuropathy.

This is a fancy term for saying that your nerves are having trouble transporting signals from your brain to your muscles and tissues, potentially causing you pain, weakness, numbness, or tingling in different parts of your body. 

At its worst, it can cause muscle wasting, complete sensory loss, and decreased or absent deep tendon reflexes.

Scary stuff.

Most likely however, you clicked on this article because you have some numbness and tingling in your fingers, and it’s annoying the heck out of you.

Trust me, I understand. I’ve been there. 

But let’s quickly go back to my second question, why is it that sometimes only CERTAIN fingers fall asleep?

Now, if you have this numbness and/or tingling in your ring and pinky finger, it’s probably because of something called Ulnar Nerve Entrapment.

This is a type of peripheral neuropathy, one that is the second most common behind carpal tunnel syndrome — you have most likely heard of somebody with that one.

“Ulnar nerve entrapment” basically means that your ulnar nerve — more on that later — is compressed, usually either at your elbow or at your wrist.

This causes those sensation changes we talked about, and can also cause weakness in your grip strength. 

There are many reasons as to why this nerve compression happens, including fractures, swelling, trauma, blood-flow issues, repetitive elbow/wrist compression, and more. 

The good news is, despite the large amount of symptoms and causes, there are some simple fixes — in most cases, but we’ll get into that. 

First, to really understand how to fix ulnar nerve entrapment, we have to understand what it is, and why it happens.

Let’s take a closer look.

Anatomy 101

Have you ever hit your “funny bone?” You’re not actually hitting a bone, but your ulnar nerve! If you really want (and I don’t know why you would) you can actually touch the nerve at will by grabbing around the inside of your elbow, right at the “funny bone” spot.

The ulnar nerve is one of the three main branches of the brachial plexus, which is a bunch of nerves that come together from your spinal cord at your neck and then travel down your arm as the ulnar nerve, the median nerve, and the radial nerve.

The ulnar nerve essentially starts in your armpit, and runs down the inside of your arm and forearm into your wrist and hand. 

This means that the nerve can get “trapped” at any of these points, causing some of those symptoms we talked about. 

Also, our nerves live inside “sheaths.” These sheaths act as a kind of sleeve around the nerve, keeping it all bundled together.

The nerve “glides” or “flosses” back and forth within that sheath as we move our limbs. 

But what does the ulnar nerve actually do (besides cause us grief)?

It has a couple of important functions. One, it supplies the muscles at the inside of our forearms and in the majority of our hand, allowing those muscles to be connected to our brain and, well, move when we want them to.

Two, it also provides sensation to the inside of our forearm, hand, and our ring and pinky fingers. This makes sense, as that “nerve distribution” is important when we connect the dots as to why only our ring and pinky fingers get numbness or tingling in them.

Landmarks

Now, there are two specific landmarks in the arm that we need to go over. The first one is the elbow

I’m sure you’re very capable of finding your elbow, but I want you to note that the ulnar nerve runs along the inside of it, by what’s called the “medial epicondyle.”

This bony prominence is where the ulnar nerve is exposed, and creates the “funny bone.” 

Although, there’s never really anything funny about hitting that part, is there? 

The elbow is where ulnar nerve entrapment is the most common. This is also called “Cubital Tunnel Syndrome,” which, like mentioned before, is the second most common form of entrapment neuropathy behind “Carpal Tunnel Syndrome,” which affects the median nerve at the wrist. 

The second landmark we need to talk about is “Guyon’s Canal,” which is located at the wrist. It’s also called the “ulnar canal” or “ulnar tunnel.” When the ulnar nerve is entrapped here, it’s called “Guyon’s Canal Syndrome.”

We don’t have to worry too much about what structures actually make up Guyon’s Canal, but it is important to note that it is located in your wrist below your pinky finger, and house’s the ulnar nerve, ulnar artery, and some veins and lymphatic vessels. 

Here, the ulnar nerve exits into the hand, and splits off into its motor and sensory branches, giving you control and feeling in the outside part of your hand. 

Entrapment at the wrist is less common than at the elbow, and can present with some different symptoms as well — let’s cover those!

Symptoms

So, we’ve already talked a bit about how symptoms of ulnar nerve entrapment can include tingling and numbness in the 4th and 5th fingers, decreased grip strength, pain on the inside of the forearm and hand, and muscle wasting. 

However, Cubital Tunnel Syndrome (which means ulnar nerve entrapment at the elbow) presents in different grades, and can have different symptoms than Guyon’s Canal Syndrome. 

This is important to understand, because this will help us determine where the entrapment is happening, which will help us fix the issue more efficiently.

Let’s break down the grades of Cubital Tunnel Syndrome symptoms:

Grade 1: Mild Symptoms

  • Occasional paresthesia (tingling, burning, prickly sensations) 
  • Some light numbness in the ring and pinky fingers
  • No weakness in the hand

Grade 2: Moderate and Persistent Symptoms

  • Consistent paresthesia
  • Numbness in the ring and pinky fingers
  • Some weakness in grip strength, some wrist movements, and use of the ring and pinky fingers
  • Early signs of muscle decrease in the forearm and hand

Grade 3: Severe Symptoms

  • Consistent paresthesia
  • Loss of sensation in ring and pinky fingers
  • Significant weakness in grip strength, wrist movements, and hand movements that impact your function
  • Muscle decrease in your hand
  • Possible “clawing” of your ring and pinky fingers

The higher the grade you’re at, the more severe the entrapment and the more time and effort it will take to get back to normal. 

Now, let’s look at the main symptoms of Guyon’s Canal Syndrome:

  1. Muscular decrease in the meaty part of your hand underneath your pinky and ring fingers. This area is really important in hand function and grip strength, and is often one of the first things affected with Guyon’s Canal Syndrome.
  2. Decreased sensation and pain in the ring and pinky fingers
  3. Possible “clawing” of your ring and pinky fingers (more likely than with Cubital Tunnel Syndrome)

Now that we’ve covered the symptoms, let’s take a closer look at some of the causes.

Causes

When looking at the causes of Cubital Tunnel Syndrome, we see that there are many different reasons for ulnar nerve entrapment at the elbow. They include:

  • elbow fractures and dislocations
  • repeated bending at the elbow (for example, when you’re doing a lot of work that involves hammering or when working out)
  • bone diseases or joint issues (such as arthritis, bone spurs, etc.)
  • and leaning on elbows a lot (the harder the surface, the more likely this can be a cause)

Working our way down to the wrist, causes of Guyon’s Canal Syndrome may be:

  • ganglion cysts
  • direct trauma (like an accident)
  • doing excessive amounts of pushups and activities such as biking
  • deep cuts
  • and repeated impact on the wrist such as when using heavier tools

These are the most common causes for the two syndromes, however there is one more thing that can cause numbness and tingling in this nerve distribution… 

Remember how we talked about the nerves “gliding” inside sheaths? Well, sometimes the nerves get “stuck” to those sheaths from the inside, causing them to stick a little (or a lot) when they try to move. 

This can also cause those sensation issues like numbness and tingling, but is usually something that comes on randomly — it can affect pretty much anyone with no apparent cause. 

One other thing to note is that if you have diabetes or rheumatoid arthritis, you may be at more risk for developing either of these syndromes.

How To Fix It

Finally, we’re done talking about all the negative stuff and can focus on the good part: how do we actually fix ulnar nerve entrapment. 

Depending on if you have a fracture or some sort of condition that needs medical help, many people experiencing tingling and numbness in their ring and pinky fingers can take care of the problem with conservative treatment, usually through the form of exercises.

One reason for the exercises is to address any functional issues, like weakness in the muscles. This can be done by following a workout routine, such as following our bicep workout to strengthen your arms, or by incorporating a strength routine for your wrists — any sort of strengthening done in a tolerable way (meaning we don’t further increase the symptoms) is going to have benefits!

However, we also want to do some exercises specific to the ulnar nerve. This will help it glide back and forth smoothly again, and combat the effects of the entrapment. 

Before I show you these exercises, I want to make a note that it is important to not aggravate the nerve more. It’s similar to a scab — if we keep picking the scab open over and over again, it will have a tough time healing. 

This means that all of these exercises are to be done in a controlled and tolerable way. You may feel a strong stretch with these, and that’s ok, but we don’t want to cause pain or more sensation changes — that’s a sign that you’re pushing a bit too hard.

That being said, let’s jump into the first exercise.

Exercise 1: The Waitress Stretch

This first exercise begins with your arm stretched out straight beside you, palm down, with your wrist bent up as if you were telling someone to “stop.”

From here, bend your elbow, keeping your wrist bent, bringing your hand closer to your head. 

You may already be feeling a stretch in your elbow/wrist/fingers, but you can increase this by continuing to bend your elbow and bringing the palm of your hand closer to your cheek. 

To finish the movement, slowly straighten your elbow while still keeping your wrist bent up, so that you get back to the starting position. 

With this exercise, it’s important to keep your wrist bent back at a comfortable level — the more you bend it, the more “stretch” you may feel. Again, find a level that doesn’t cause pain or tingling into your fingers.

You want to do this one 1-2 times per day, for 5-7 repetitions.

Exercise 2: Wrist Flexor Stretch

This second exercise will be targeting the underside of your forearm and wrist, AKA the “wrist flexors.”

If these muscles are short and tight, they can cause compression in the elbow or in Guyon’s Canal, which are two things we want to try and avoid.

To begin with this one, hold the arm that you’re feeling symptoms in straight in front of you, and bend your wrist up. 

Using your other hand, pull your bent wrist backwards towards you, giving you a nice stretch underneath your forearm. 

Again, we don’t want to reproduce symptoms. Only pull as far as you can to feel a stretch. 

Do this one 1-2 times per day, holding the stretch for 3 sets of 20 seconds.

Exercise 3: A-OK

This exercise is named after the message of this post: you will be “a-ok,” the pain will go away. 

To do this one, start with your arm straight out beside you, palm facing up. 

Make a circle, or an “ok” sign with your pointer finger and thumb.

Next, slowly bend your elbow while rotating your wrist upside down, so that you can wrap your fingers around your ears and jaw to make a circle around your eye, kind-of like a mask.

Hold for about 2 seconds, lower back to the starting position, and repeat for 5 reps, 1-2 times per day.

Some Notes

It’s important to remember that one of the best ways to help out with ulnar nerve entrapment is to avoid recreating the symptoms you feel.

This includes movements at work, at the gym, at home, or when doing the above exercises — we don’t want to keep aggravating that nerve. 

Now, this doesn’t mean you should stop moving completely. Just respect movement ranges where you feel the numbness and/or tingling come on stronger. 

If these exercises don’t feel good to do, try a more general approach to stretching. Our article on calisthenics stretches is a great place to find stretches that will help release your nerves and muscles. 

Finally, we want to optimize our recovery. This means that after a hard day of work using your elbow and wrist, or a hard session at the gym or practice, we want to put our body into a state where it can optimally recover. 

Our article on maximizing recovery after a workout will help put your body into that state, and applies to any sort of activity, not just working out. 

Recap

Let’s quickly summarize what we learned today:

  • Ulnar Nerve Entrapment can happen anywhere along the arm, but mainly happens at the elbow or wrist, and creates numbness or tingling in our ring and pinky fingers
  • As it worsens, there can be an increase in pain, muscle wasting, and weakness in our forearm and hand muscles
  • Staying out of aggravating movements and doing controlled, tolerable exercises 1-2 times per day with low repetitions will help give relief and combat the effects of ulnar nerve entrapment
  • Recovery is important, and should be optimized daily

Nerves are stubborn, they can take a while to improve significantly. The earlier you start, the faster you will get better. 

Keep at it, and don’t give up! The road to recovery is a challenging one, but there are many valuable lessons along the way, and your future-self will thank you.

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