What to know about ulnar tunnel syndrome

The ulnar nerve runs from a person’s neck down to their hand. At the wrist, the ulnar nerve enters the hand through Guyon’s canal. If the nerve becomes compressed here, it causes ulnar tunnel syndrome. Compression of this nerve at the elbow is called cubital tunnel syndrome.

Ulnar tunnel syndrome is less common than cubital tunnel syndrome and carpal tunnel syndrome.

While bones and muscles protect many nerves in the human body, the ulnar nerve is not so well protected and is therefore at more risk of injury.

Ulnar tunnel syndrome usually produces symptoms in the hands and wrist, especially the little finger and ring finger. A person with ulnar tunnel syndrome may experience the following:

• numbness or tingling sensations (paresthesia)
• a burning pain
• muscle weakness in the hand
• difficulty gripping with the fingers and thumb
• the hands and fingers bending into a claw shape

These symptoms can affect the hand, wrist, and fingers and may get progressively worse over time, especially if left untreated. The location of the compression will determine the severity of the symptoms.

Ulnar tunnel syndrome occurs when the ulnar nerve becomes compressed in the Guyon’s canal region. This is often due to a ganglion developing in the wrist. A ganglion is a fluid-filled lump also known as a cyst and is benign.

However, anything which places pressure on the ulnar nerve in the wrist can cause ulnar tunnel syndrome, including:

• changes in osteoarthritis that cause pressure on the nerve
• tumors in the wrist tissue
• enlargement of the bursa (fluid-filled sacs) in the wrist
• abnormalities in the muscles or ganglions
• fracture of the hook of the hamate in the wrist, a type of injury that golfers or baseball players might experience

Ulnar tunnel syndrome can also result from repetitive strain or injury due to sports that put a strain on the wrist. Examples include weight lifting and cycling.

The risk of developing ulnar tunnel syndrome is greater if a person:

• has had a previous injury to their wrist
• performs repetitive tasks with the hands, such as typing
• does activities or sports that put the wrist under strain
• uses vibrating tools

Problems in the wrists and hands can get in the way of daily life. Exercises and physical therapy can help speed up recovery, and a doctor should be able to provide advice on how a person can reduce their recovery time.

If the condition is caused by a ganglion or cyst, these should be removed where possible. This surgery should provide relief from pain, numbness, weakness, or tingling. However, recovery from this type of surgery takes time, and it may be several months before the nerve has completely healed.

If a fracture of the hook of the hamate causes the condition, surgery is usually required to remove any bone fragments to take pressure off the nerve.

Alternatively, a surgeon may cut a ligament to relieve the pressure in the wrist.

When repetitive strain causes ulnar tunnel syndrome, a person should reduce repetitive movements where possible to avoid further irritation of the ulnar nerve. A person can also wear a wrist brace to prevent the nerve from moving, allowing it time to heal. Bicyclists often wear padded gloves to take pressure off the nerve.

When ulnar tunnel syndrome is caused by factors that are not treatable with surgery, home exercises may help to relieve symptoms.

Specific exercises designed to stretch, slide, and move the nerve to encourage smooth movement can help reduce pain and weakness in the hand. A systematic review from 2008 suggests that this type of physical therapy, called neural mobilization, may be useful for a range of nerve-related issues.

Before undertaking any exercises to treat ulnar tunnel syndrome a person should first seek advice from their doctor. The following are examples of ulnar gliding exercises:

Forehead touch

The forehead touch is a simple exercise. To do this, use the following steps.

1. stand straight with arms at the sides
2. raise one hand, so the palm is resting on the forehead
3. hold it here for a few seconds then slowly bring the hand down again
4. repeat the exercise

Hand curl

The hand curl is another exerise that stretches the ulnar nerve. To do this, use the following steps:

1. stand or sit upright with the arm held straight in front of the body with the elbow straight
2. curl the wrist and fingers towards the body
3. then, extend the hand away from the body to feel a stretch in the wrist
4. finally, bend the elbow and raise the hand upwards
5. repeat the exercise

Tips while exercising to treat ulnar tunnel syndrome:

• Avoid overstretching the nerve. If exercises are painful, speak to a doctor before continuing.
• Using an ice pack can help to relieve any pain before exercising.
• Build strength slowly by increasing the number of repetitions of each exercise. A physiotherapist will be able to advise on how many repetitions a person should do.
• A person may find that short, frequent sessions of 5–10 minutes are more beneficial than one long session.

While some aching and discomfort are normal, severe pain that lingers may mean that a person is performing the exercises too often or too forcefully. Reduce their frequency and intensity, and if this does not help, make an appointment with a physiotherapist.

There are also some practical home remedies and lifestyle tips that may help a person with ulnar tunnel syndrome.

Some useful tips and home remedies include:

• Avoiding resting the elbow on the arms of chairs or desktops, as this can put pressure on the nerve. Instead, place the hands in the lap when not using them.
• Wearing a wrist brace for additional support, especially when using the hand or wrist.
• Using ergonomic or padded tools to reduce pressure on the wrist
• Avoiding repetitive tasks and taking regular breaks while at work.
• Keeping hands and wrists warm.

If a person suspects they have ulnar tunnel syndrome they should make an appointment with their doctor. A doctor will ask questions about medical history and daily activities as well as any previous injuries that may cause ulnar tunnel syndrome to develop.

A doctor will then perform a physical examination of the elbow, wrist, and hand and may tap specific points on the ulnar nerve to work out where the problem lies.

A doctor may also suggest further imaging tests such as:

• X-rays
• a computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan
• electromyography
• a nerve conduction study

Below is a 3-D model of ulnar tunnel syndrome, which is fully interactive.

Explore the model using your mouse pad or touchscreen to understand more about ulnar tunnel syndrome.

Once a doctor has made an accurate diagnosis they can work out the best treatment plan for an individual.

Ulnar tunnel syndrome can cause pain, weakness, and numbness in the hands and fingers. If left untreated these symptoms may worsen, and in severe cases, a person may be unable to grip with their hand.

Ulnar tunnel syndrome can be treated in a variety of ways depending on the cause. Treating the condition is essential, as if it is left untreated it could cause permanent damage, such as paralysis of a loss of feeling in some regions of the arm or hand.

Often, a cyst or growth in the wrist area causes ulnar tunnel syndrome. This can be corrected through surgery.

Otherwise, this condition can develop from nerve irritation from repetitive movements. In these cases, nonsurgical options can correct the problem, such as a wrist brace and ulnar nerve exercises.