Exercises to Treat Cubital Tunnel Syndrome: Nerve Gliding Exercises

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Cubital tunnel syndrome describes ulnar nerve entrapment. Ulnar nerve entrapment occurs when the ulnar nerve receives too much pressure or compression in this area, irritating the nerve.

This ulnar nerve compression can be effectively treated via cubital tunnel syndrome exercises, including nerve gliding exercises.

Before we get to the exercises though, let’s take a closer look at the nitty gritty details behind cubital tunnel syndrome.

What is the Cubital Tunnel?

cubital tunnel syndrome associated with ulnar nerve entrapment

The cubital tunnel is just one area the ulnar nerve runs through.

If we want to get really specific, the ulnar nerve originates from your C8-T1 nerve roots at the cervical spine in the brachial plexus. The ulnar nerve travels all the way down the arm to the fingers and passes through the cubital tunnel in at the elbow.

The cubital tunnel is bordered by the two heads of the flexor carpi ulnaris muscle and the medial epicondyle, or inner elbow bone. There is an additional ligament, called the arcuate ligament of Osborne, that hovers over the top of the tunnel.

If you stand straight with your arms resting by your side and palms facing forward, you’re in what is known as anatomical alignment. Everything on the pinky side is considered medial.

If you feel around the inside, or medial side, of the elbow, you’ll feel a bony bump. This is your medial epicondyle. From the medial epicondyle, slide your finger in a little bit and you’ll feel a small indentation. That’s the cubital tunnel!

What Happens with Cubital Tunnel Syndrome?

Cubital tunnel syndrome (a.k.a. ulnar nerve entrapment or ulnar tunnel syndrome) is one of the most common nerve entrapment syndromes. As previously mentioned, it occurs when the ulnar nerve becomes entrapped or compressed at the inner elbow.

Have you ever hit your “funny bone?”… Yep, that’s your ulnar nerve. It’s definitely not funny when it happens!

Ultimately, with any nerve compression, symptoms you notice will depend on which nerve is affected.

Ulnar Nerve Motor Function

The ulnar nerve innervates a few important muscles:

  • 2 forearm muscles: flexor carpi ulnaris and the medial half of flexor digitorum profundus.
  • Various intrinsic, or deep, muscles of the hand, including adductor pollicis.

These muscles are ultimately responsible for our grip (particularly the ring and pinky fingers), wrist ulnar deviation or adduction, and flexing of the wrist.

Ulnar Nerve Sensory Function

ulnar nerve sensory function

The ulnar nerve provides sensation to the following areas:

  • Front and back of the pinky finger
  • Front and back of the medial half of the ring finger
  • Medial half of the front and back of the hand in line with the ring and pinky fingers

Symptoms of Cubital Tunnel Syndrome

Before you try any cubital tunnel syndrome exercises… How will you know if you have ulnar nerve entrapment at the elbow to begin with??

There are some pretty common signs and symptoms that will point to it right away. Let’s take a look!

  • Muscle weakness in the hand with gripping objects, especially the ring and pinky fingers
  • Numbness and/or tingling in the ring and pinky fingers
  • Increased numbness/tingling when you bend your elbow
  • An aching pain on the inside of the elbow near or in the cubital tunnel

In very severe cases, you may notice muscle wasting and/or a hand deformity known as claw hand develop. With claw hand, you’ll see the ring and pinky fingers curl up into the palm.

symptoms of cubital tunnel syndrome

Symptoms will usually intensify when you have the elbow bent or are in any type of elbow flexion. This is most common when talking on the phone, sleeping with the arm resting under the head while on your side, or leaning on a hard desk.

Any position or surface that places added pressure to the ulnar nerve will increase your symptoms.

Causes of Cubital Tunnel Syndrome

Now that we know what ulnar nerve entrapment, or ulnar neuropathy, feels like, before we get to the long-awaited cubital tunnel syndrome exercises… What causes or can increase your chances of developing cubital tunnel syndrome?

We mentioned just a moment ago that any sustained position with the elbow bent will increase symptoms, but this can also initially cause your ulnar neuropathy in the first place.

Maybe you’re on the phone regularly, holding it up to your ear. It could also be that you work at a desk and find yourself leaning on it all the time with the elbow bent. Abnormal positioning for sustained periods with elbow flexion creates a high likelihood for developing ulnar nerve entrapment.

Other factors that can increase your risk of developing ulnar neuropathy the following:

  • Elbow arthritis
  • Previous elbow injuries, such as a fracture
  • Abnormal tightness of the flexor carpi ulnaris muscle that surrounds the ulnar nerve
  • Swelling of the elbow
  • Elbow bone spurs

All of these factors and scenarios can create a narrow space in the cubital tunnel and aggravate symptoms.

When to See a Healthcare Professional

If you’re experiencing long periods of the above symptoms for more than a few days, then you should make an appointment to see a doctor. More serious symptoms of muscle wasting, claw hand or sudden onset of dropping objects requires more immediate medical attention.

You should consider seeing a neurologist or a hand surgeon. This doesn’t mean you will necessarily mean surgery, but these specialists are most familiar with your problem and symptoms.

A thorough physical examination will confirm your diagnosis. Part of this exam may include the use of special imaging and testing of the ulnar nerve, such as nerve conduction studies to assess the status and quality of ulnar nerve function.

How to Manage and Improve Symptoms

When considering nonsurgical treatment, initially, you may need to rest the affected arm to help relieve pressure on the ulnar nerve.

If you do have any swelling at the elbow, consider use of ice to help reduce swelling and relieve nerve pressure.

Avoid prolonged periods of elbow flexion and try to keep the elbow in a straight position as often as able.

Check out the video below which demonstrates some of the do’s and don’ts with positioning the arm while experiencing ulnar nerve entrapment.

You may need to consider using a temporary elbow brace of splint at nighttime to avoid sleeping with the elbow bent all night. Try to avoid using a compression elbow sleeve as this will apply direct pressure over the cubital tunnel, which can create more unnecessary pressure on the ulnar nerve.

You could also consider receiving massage therapy from a Licensed Massage Therapist. If the cause behind the ulnar nerve entrapment is swelling or muscle tightness, then a massage may be a great help to relieve these symptoms.

Exercises for Cubital Tunnel Syndrome

Now for the star of the show… the cubital tunnel syndrome exercises!

A common nonsurgical treatment method will involve ulnar nerve entrapment exercises. Many of these incorporate ulnar nerve gliding. Neural glides essentially stretch the nerves. This is a gentle way to relieve the tight pressure surrounding the nerves and help to relieve symptoms.

It’s likely for you to be referred to physical therapy or occupational therapy to help address the ulnar nerve entrapment. A therapist who is also a Certified Hand Therapist would be very well qualified to treat you.

Even if you’re not in therapy, there are many cubital tunnel exercises that can be practiced at home, many of which involve ulnar nerve gliding.

How to Do an Ulnar Nerve Glide

An ulnar nerve glide can be a little tricky at first. We’ll break down each motion step-by-step, but please check out this video demo to follow along!

  • Step 1: Your starting position will be holding your arm out to the side and gently bend the elbow. Make a circle with your thumb and index finger touching as if you’re saying you’re “A-okay.” Your palm should be facing out to the side away from you.

ulnar nerve glide step 1
  • Step 2: Begin to move the hand towards your head while extending the wrist back towards you. Make sure to keep your “A-okay” sign. The fingers should now be pointing towards you with the palm facing the ceiling.

ulnar nerve glide step 2
  • Step 3: From here, bend the neck so that your head moves away from the working arm.

ulnar nerve glide step 3
  • Step 4: To add an extra stretch to the nerve, slightly lift your bent elbow up towards the ceiling.

ulnar nerve glide step 4

Make sure to hold the end of the stretch for up to 5 seconds, then relax back into an upright position with the arm down by your side. Repeat this glide 10 more times.

It’s not uncommon with nerve gliding exercises to initially feel a slight increase in numbness and/or tingling when the nerve is at maximal tension. As you continue the glides, this should gradually decrease as you slowly release the nerve tension.

Wrist Extension Stretch

wrist extension stretch step 1
wrist extension stretch step 2

Although this is called a wrist extension stretch because the wrist is positioned anatomically in wrist extension, it’s actually stretching the flexors in the forearm.

  • You’ll have the arm stretched out in front of you with the palm facing down towards the floor.
  • Extend the wrist so that now the palm is facing forward. Place the other hand on the palm and gently bend the wrist back until a stretch is felt in the forearm muscles.
  • You can try to hold this stretch anywhere from 30-60 seconds. If, however, this stretch is very intense at first, then you can hold for a shorter duration, such as 5 seconds, relax then repeat 10-15x.

Grip Squeeze

grip squeeze step 1
grip squeeze step 2
  • Using a soft object, such as a towel or stress ball, hold it in the affected hand. Position the arm in front or next to you, with the elbow in a more extended versus flexed position.
  • Practice gently squeezing the ball up to 15x, holding for about 2 seconds each repetition.
  • You can practice this in sitting or standing.

Resisted Wrist Flexion

resisted wrist flexion step 1
resisted wrist flexion step 2

While the image demonstrates use of a light resistance band, you can also utilize a light 1-2# free weight for this exercise.

  • While you can perform this in standing or sitting, we’ll key in on a standing position for this one.
  • Stand tall with the working arm by your side and the palm facing forward.
  • If using a light resistance band, hold one end in your hand and the other end will be anchored under a foot.
  • Repeat 10x for 2 sets.

Resisted Wrist Ulnar Deviation

resisted wrist ulnar deviation step 1
resisted wrist ulnar deviation step 2
  • For this cubital tunnel syndrome exercise, you’ll stand with the arm by your side and the palm facing your thigh. You can use a light resistance band, such as in the above image, or a light 1-2# free weight.
  • If using a light resistance band, hold one end in your hand and the other end will be anchored under a foot.
  • Slowly bend the wrist back in the direction of the pinky finger. Don’t bend so far that you feel your symptoms increasing.
  • Repeat 10x for 2 sets.

Generally speaking, it’s better to initiate nerve gliding exercises prior to strengthening exercises. As you practice your nerve glides, and you notice your symptoms improving, then you can gradually begin incorporating strengthening exercises.

The purpose of this is so that enough healing time is allowed for the nerve before trying to strengthen weakened areas.

More Severe Cases of Ulnar Nerve Entrapment

cases of ulnar nerve entrapment

With more severe symptoms or if you haven’t responded to nonsurgical treatments such as cubital tunnel syndrome exercises, your doctor may recommend surgery.

The specific surgery recommended will depend on your particular case and cause behind the ulnar nerve compression. The overall aim though is to release whatever is pressing and entrapping the ulnar nerve.

It’s not uncommon to still need a rehab referral after surgery to regain full use of the affected arm.

Depending on your surgeon’s instructions, you may need to rest for a few weeks to heal prior to initiating rehab. The rehab process itself may take a few months, depending on how severe your limitations are with using that arm.

Key Takeaways

Cubital tunnel syndrome is a very manageable condition. One of the most important things to remember is not to wait too long to see a healthcare professional.

If your symptoms are continuing for more than a few days, make an appointment to see your doctor. If you’ve noticed more severe and sudden symptoms, then seek medical attention right away.

Relief is on its way!

FAQ:

Is cubital tunnel syndrome permanent?

There is no reason for cubital tunnel syndrome to be permanent as long as you address your symptoms right away.

Can I lift weights with cubital tunnel syndrome?

In the early stages of this problem, you may want to take a break from upper body weight training until the symptoms begin to calm down.

As they calm down, you can gradually re-introduce light weight training. Try to avoid positions that have the elbow maximally bent > 90 degrees.

Can I do a push-up with cubital tunnel syndrome?

Similar to weight training, take a break from most upper body strength training, including push-ups, until your symptoms begin to calm down. Then you can start push-ups gradually. You may need to modify the depth of your push up and overall position as you begin this exercise again.

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