The ulnar nerve originates in the neck and runs through the shoulder, upper arm and forearm before ending in the ring and little fingers. Injuries most commonly occur at the elbow and wrist but can occur anywhere along the nerve's path. Ulnar nerve injury is the second most common nerve entrapment injury after carpal tunnel syndrome, according to a January 2007 article in "Postgraduate Medical Journal." It can cause mild to intense pain, burning, numbness and weakness in the forearm, hand and 4th and 5th finger. Treatment may include exercises to decrease pain, maintain strength and promote healing.
As with other mild to moderate injuries, conservative treatment is often preferred over surgery. Primary nonoperative treatment includes rest, splinting, activity modification and nonsteroidal antiinflammatory medications, such as ibuprofen (Advil, Motrin) and naproxen (Aleve). Avoiding aggravating movements and postures -- such as bending the elbow or resting it on a hard surface -- may provide relief. Physical therapy and home exercises can also be effective in decreasing pain and improving function, but for severe cases surgery may be warranted.
Ulnar Nerve Glides
Nerve gliding exercises may be beneficial for ulnar nerve injuries. When a nerve is irritated or inflamed, it may not slide through surrounding tissues easily. Nerve gliding exercises may help the nerve move more smoothly, easing pain.
Nerve glides can be performed while sitting or standing. They are often repeated 10 times per session, 3 to 5 times daily. A commonly used glide involves holding the arm in front of you at shoulder level, palm up. Keeping the arm straight, the hand is moved toward the body, flexing at the wrist, and then away from the body. While holding this position, the elbow is then bent, bringing the palm toward the face. Another glide involves extending the arm to the side at shoulder level, palm up. The hand is then brought up to cover the ear with the palm, with the fingers wrapped around the back of the neck.
Isometric Elbow Exercises
Isometric elbow exercises involve tensing the muscle against resistance without moving the joint. They are used to prevent muscle loss due to inactivity and provide the benefits of strength training without aggravating, repetitive movement. Isometric exercises are typically held for 10 seconds for 10 sets, with a 10-second rest between sets.
The biceps muscles at the front of the upper arm are the primary movers when bending the elbow. Isometric exercises that target these muscles can be done by bending the elbow to 90 degrees, palm up. The other hand is used to push the forearm to the ground, creating resistance in the muscle. To create an isometric contraction of the triceps -- the muscles at the back of the upper arm that help straighten the elbow -- the same starting position is assumed, but pushing occurs in the opposite direction. No movement of the elbow should occur during these exercises.
Warnings and Precautions
Talk with your healthcare provider before starting a new exercise routine. A physical therapist can determine the most appropriate exercises for your condition. If you have increased pain, numbness or weakness in the hand or arm during or after any of these activities, stop immediately. Ulnar nerve pain that does not improve or worsens may require surgery. In some cases, ulnar nerve injury symptoms occur because of a serious underlying health problem, so it's important not to ignore them.
- Wheeless' Textbook of Orthopaedics: Ulnar Nerve
- American Family Physicians : Peripheral Nerve Entrapment and Injury in the Upper Extremity
- Postgraduate Medical Journal: Cubital Tunnel Syndrome
- The Cochrane Library: Treatment for Ulnar Neuropathy at the Elbow
- Journal of Manipulative and Physiological Therapeutics: Incorporating Nerve-Gliding Techniques in the Conservative Treatment of Cubital Tunnel Syndrome
- American Academy of Orthopedic Surgeons: Ulnar Nerve Entrapment at the Elbow (Cubital Tunnel Syndrome)
- South Tees Hospitals: Hand Therapy Exercise Videos
- Applied Physiotherapy in Chiropractic: Rehabilitation Methodology