16 Passive Treatments For The Ulnar Nerve So You Can Sleep Longer

3/20/2019 16 Passive Treatments for the Ulnar Nerve so you can Sleep Longer
Top 5 Ulnar Nerve Entrapment

Locations & Treatments
What’s To Know About Ulnar Nerve

Entrapment
What is the Ulnar Nerve
Causes
Symptoms
Diagnosis
Treatment
2
What is the Ulnar Nerve
The ulnar nerve is one of the 3 major nerves extending from the spine to the far reaches of
the arm, into the hands and ngers. It gets its name from the bone it travels by in the
forearm called the ulna bone.
https://www.p2sportscare.com/ulnar-nerve-entrapment/ 1/16
Other major nerves in the region are the median and radial nerves.
The ulnar nerve is composed of a collection of multiple spinal nerve roots. The ulnar nerve
provides sensory to sections of the hand and motor control of many muscles used to
move the hand and ngers.
Causes
The ulnar nerve can become entrapped for a variety of reasons, yet a common nding
between all of the reasons is the fact that the nerve swells. Swelling of the nerve creates a
sticking point within a bony tunnel or soft tissue tunnel. This is known of the area of
entrapment.
Some common reasons for nerve swelling leading to
ulnar entrapment are:
Compression of the nerve at the neck, shoulder, elbow or wrist
Leading too much on a table or armrest
Swelling in the elbow or wrist from local trauma
Bony arthritis
Joint swelling
Inactivity
Mechanical friction of a subluxing ulnar nerve (at the elbow)
Symptoms
Although the location of ulnar entrapment can vary, the symptoms will reside in the hand
or wrist.
How to nd the exact region of entrapment will come later in this article.
Common symptoms of ulnar nerve entrapment
include:
Intermittent numbness of the pinky and ring nger
Weakness of the hand
Feeling like the pinky and ring nger are falling asleep
Waking up at night with pinky and ring nger numbness
Loss of dexterity of the hand (playing piano, guitar, buttoning shirts) 2
Changes of temperature in the hand
Wasting of the hand
Diagnosis
Proper and timely diagnosis of ulnar nerve entrapment is key in recovery.
Experiencing the above mentioned symptoms for more than two weeks requires medical
examination to ensure return to normal. If you’re experiencing symptoms for more than
two weeks you could experience long-term nerve damage and loss of full ability to use
your hand.
In most cases, a proper diagnosis can be attained with a detailed examination of the neck,
shoulder, elbow, wrist, and hand.
Your doctor should perform test such as: re exes, arm strength, hand strength, skin
sensation, amongst other local stress testing of the local joints to troubleshoot ways to
reduce the entrapment.
In more advanced cases, imaging can be required:

X-rays
MRI (neck)
Nerve Conduction Velocity Test (NCV)
Treatment
Standard care targets a reduction of nerve swelling through immobilization and
decreasing in ammation.
Standard treatment are:

Anti-in ammatory medication
Elbow braces
Wrist brace
Physical therapy
More advanced forms of treatment have been developed in recent years, with can
produce rapid results. Advanced forms of treatment also target a reduction of nerve
swelling via physically removing the pressure from the nerve.
Advanced care uses the muscles of the body to provide a consistent decompression
of the nerve by enhancing sti ness of certain muscles and reducing tightness of other
muscles. This method of treatment is best for most cases who are beyond 3 days of
symptoms. These methods of treatment should always be implemented in the beginning 2
by a medical provider educated in corrective exercise before performing at home.
Some advanced forms of care are:

Static Neurodynamic Openers
Dynamic Neuromuscular Stabilization of the Shoulder
Hand exercises
Nerve ossing/ gliding
Speci c Core Stabilization Exercises
Strength and Conditioning
For severe cases, surgical decompression may be required to preserve the ability to use
the hand in the future. These are used in cases where hand wasting has occurred.
Some surgical options are:

Cubital tunnel release – decompression of the ulnar nerve at the wrist
Ulnar nerve anterior transposition – moving the nerve to the other side of the elbow
Medial epicondylectomy – decompression of the ulnar nerve at the elbow
For step #1 in recovery, keep reading. Finding the location of ulnar entrapment comes
before knowing how to treat it.
I’m Dr. Sebastian Gonzales. I wanted to share this image that I drew (scroll
down) about the 5 most common impingement sites of the ulnar nerve (and
for nerve that contribute to become the ulnar nerve) so you can get a
complete understanding of why I created an a iliated ebook as an addendum
to the massive ulnar nerve article.
Feel free to click around to the location you want to explore rst, but I
strongly suggest reading the entire article. I promise it’s short and to the
point. DISCLAIMER
#1 Ulnar Nerve Entrapment At The Tunnel of Guyon (Handlebar Palsy)
#2 Cubital Tunnel Ulnar Nerve Compression
#3 The Brachial Plexus Entrapment At The Shoulder
#4 C8 or T1 Nerve Root Entrapment At The Intervertebral Foramen (Closing

Dysfunction)
#5 C8 or T1 Nerve Root Entrapment from Disc Herniation (Opening

Dysfunction)
2
There are many di erent possible reasons why the ulnar nerve (nerve
contributing sensation feedback to the ring and pinky nger), is going
heywire. Numbness when sleeping often times leads to daytime numbness,
which can leave to hand muscle atrophy if left untreated for years. Sadly I’ve 2
seen this before.
I had a friend I played ball with that lost so much muscle in his hand over
the course of only one year that I wouldn’t doubt he won’t be able to swing a
bat anymore because of decreased hand strength. I can’t handle that
happening to anyone again since it’s very treatable and honestly is just silly
to not start treating this very reversible condition.
On these infographics, I’ve included the 5 most common entrapment sites for
the ulnar nerve and its contributing nerves.
The magic when you nd the correct rehab for you really starts by
identifying the correct site before you implement a treatment strategy for the
problem of hand numbness.
When correctly diagnosed, treatment is very simple and can reduce

numbness tingling and loss of sensation dramatically even over the course a
few weeks.
Proper diagnosis can oftentimes be the hardest portion of implementing care

for even a seasoned clinician, especially if they haven’t had experience with
an upper extremity nerve compression like this.
I personally have had great success reducing people’s symptoms by taking a

through history and exam; by through I mean it sometimes takes hours. If
you’re doc only spent 5 minutes with you and didn’t physically touch you to
exam your condition then his/ her exam was not enough in my experience. I
have requested neurodiagnostics testing but only in very tough cases,
certainly not the majority because they are often times not needed.
You cannot solve a problem unless you know the problem IS.
This led me to create the simple graphic looks and correlates with the book/
eCourse that I created.
Let’s take a look at infographic.
#1 – Ulnar Nerve Entrapment At The Tunnel of

Guyon (Handlebar Palsy)
Number #1 on infographic is an extremely common ulnar nerve entrapment
site for cyclists. As the ulnar nerve passes through wrist it can become
pressured at the Tunnel of Guyon. This is exactly where a cyclist often times
places their wrists onto the handlebars, yielding the slang diagnosis of
Handlebar Palsy.
As you can see in the drawing, there are two circles that form the bony sides
of the tunnel that the ulnar nerve passes through. These bones of the wrist, in
addition to some fascia in the region make up the Tunnel of Guyon.
Excessive compress between the wrist and handlebars, especially with poor
padding, reduces nerve flow into the pinky and ring ngers.
What’s the treatment?
If the problem is too much compression, an obvious solution is to reduce the

amount of compression of the ulnar nerve between the tunnel and the
handlebars. This is possible by adding more padded grip to the handlebars,
wearing gloves, or changing the hand position when riding. This location of
ulnar nerve entrapment can also present in people who work frequently with
2
their hands daily. Day Laborers, factory workers, and other people in the
service industry can be a ected by this location of entrapment.
NOTE: It’s important to consider that nerve entrapments don’t often occur in
isolation.
Nerves slide and when there’s a reduction of normal sliding mechanics,

recovery may take longer. Look at the drawing… see how long the nerve is?
When a nerve is being sensitized in one location (compression site) often

times improving slide mechanics of the rest of the nerve can reduce local
sensitivity. In the case of an ulnar nerve being a ected at the wrist, if we
improve the ability of the ulnar nerve to slide throughout the rest of the arm
then we can accelerate the healing process.
Sounds complicated, but it’s really not. It’s just physics. Forget the location
where the entrapment is just move the shoulder, elbows and body around in
circles. This is a very general way to increase slide contribution to the area
that is “stuck.” Think Tai Chi!
To learn more advanced treatments/ exercises to decompress the ulnar nerve

at the Tunnel of Guyon, buy my eCourse. It includes tons of videos and
information that will greatly assist you in resolving your condition
(DISCLAIMER: With the help of your healthcare provider’s diagnosis). It’s

literally everything I know about the ulnar nerve and how to decompress it.
I created this eCourse because I get soooo many email about the ulnar nerve.
This is the best way I can assist everyone throughout the world
#2 Cubital Tunnel Ulnar Nerve Compression

Another common compression location of the ulnar nerve is within the elbow
region. It’s called the Cubital Tunnel. Compression of the ulnar nerve in this
location is called Cubital Tunnel Syndrome.
The Cubital Tunnel is composed of bony borders and a soft tissue roof. The
ulnar nerve travels amongst these tissue to make its way out into the wrist,
but it can become compressed along the way Remember even small amount
of pressure from boarders of the tunnel can create changes of sensation into
the wrist and ngers.
An amazing, but rather unknown, treatment I use is something called Dermal

Traction Method. This style of treatment is “decompressive” in nature. This is
where we grabbed the skin above or below the cubital tunnel in an e ort to
“lift the skin o of the nerve” so it can decompress.
Surprisingly, a simple decompression of the skin from the ulnar nerve

reduces numbness in almost half the people with a con rmed ulnar nerve
compression at the Cubital Tunnel. Credit to Dr. Justin Dean DC and Dr.
Phillips Snell DC for creating this method of care that works so well. Even if
dermal traction therapy works in decompressing the ulnar nerve at the elbow,
I’d consider the strong possibility that we need to restore optimal nerve slide
mechanics to reduce chances of relapse.
You may be wonder why this becoming so complicated?
That’s a valid question but the answer isn’t simple, it’s complicated
sometimes.
When one is able to completely understand how to reduce pressure on the

ulnar nerve throughout its entire pathway, as well as increase slide through
bony/soft tissue tissue tunnels, then the e ectiveness of treatment increases
and the time to resolve the condition decreases. That’s what we all want
right?!
Quick xes are quick xes for reason.
They’re often times incomplete, short-term solutions. Although I’m

mentioning some of the treatments I often use, you should read the entire
eCourse to get as much information as you can. Quick xes are a great start 2
but no place to stay.
#3 The Brachial Plexus Entrapment At The Shoulder

Another common location for the ulnar nerve to become entrapped is at the
shoulder. In this region, the ulnar nerve actually becomes the ulnar nerve. As
we move higher, we are really considering the contributing nerves that form
the ulnar nerve as being the nerves that are compressed. The ulnar nerve is
considered is a mixed nerve, as it doesn’t originate from one single level of
the spine.
In the shoulder region, I oftentimes nd people’s symptoms increased when

anti-shrugging (but not always, sometimes this is relieving), when their arm
is cocked backward (throwing a baseball) or raising their arm (answering a
question in school).
Occult dynamic movement-based instability of the shoulder can place light

pressure on the nerves as they pass into the arm. This light pressure can
trigger a change of sensation in the last two ngers on the hand.
Occult dynamic movement-based instability can happen a few ways

biomechanically. The most common is when the humeral head moves forward
(anteriorly) and creates pressure of the soft tissue aspects of the tunnel where
the nerve bundle travels downward to the arm.
2
My long-term play in these types of cases, is to stabilize the shoulder region
so the soft tissue tunnels in the region no longer places pressure on the
nerves.
However many times, we need to apply rst aid to the nerves in the
beginning of care. This is a great example of how passive and active care for
the ulnar nerve can be applied for di erent cases, at di erent points in their
care. Typically nerve rst aid is passive, yet once the nerve desensitizes we
are onto active care to correct the shoulder instability issue.
Fun right?!
Nerve rst aid can take a week or two oftentimes. The suggestions are kind
of funny though because they’re the exact opposite than you would think for
the shoulder region to heal… but remember we are paying attention to the
nerve, not the shoulder yet. That will come!
Remember this is rehab that is prioritizing the nerve rst.
What’s good for the nerve is not always good for the shoulder.
Rehab of the nerve comes rst and then rehab of the shoulder,
musculoskeletal system comes second. I’ve laid out some more fundamentals
in the ulnar nerve eCourse.
#4 C8 or T1 Nerve Root Entrapment At The 2

Intervertebral Foramen (Closing Dysfunction)
Another location where contributions to the ulnar to become compressed is
within the spine, or just as the nerve roots exits the spine.
Common levels of irritation are at spinal nerve roots C8 and T1. Let’s break
this down into two di erent ways it can become pressure in the area.
A nerve root can very frequently become entrapment was it exits the spine.
The interface that can create pressure is a boney interface called the
intervertebral foramen.
Intervertebral foramen in layman’s terms means “hole.” This hole is narrowed

as you look up towards the sky or tilt your head towards the side of the numb
ngers.
Head movement in the other directions generally dissipates symptoms into

the hand.
Lightly stretching the head downward and away from the numb side typically
will decrease symptoms into the hands, but that’s a very short-term solution.
Just like in the shoulder, nerve rst aid should be applied rst and
musculoskeletal health comes second.
In this case, the “opening of the hole” is the rst add and then we would
tangent care to addressing WHY the hole was closing poorly in the rst
place… normally it is because if the midback or shoulder complex not working
well.
In this case, stretching the neck too far may traumatize other soft tissue in
bony areas within the neck which can’t cause collateral issues.
#5 C8 or T1 Nerve Root Entrapment from Disc

Herniation (Opening Dysfunction)
The fth location is again a location within the spine region. This fth
location can compress one or two of the contributing nerves to the ulnar,
thereby a ecting the pinky and ring ngers
(on both or one hand at a time).
A cervical disc herniation can project posteriorly (backwards) creating

pressure on the spinal cord itself or the exiting nerve roots.
Often times bending the neck forward, or tucking the chin towards the chest,
increases symptoms to the hand or hands. Looking towards the sky
oftentimes decreases symptoms but is not 100% comfortable either.
This is the polar opposite from the nerve entrapment at the intervertebral
foramen. Although a disc herniation may present in this fashion other types
spinal-based conditions can also present this way such as: space occupying
lesions and tumors.
This is a reason why you should always be examined by an educated

healthcare professional who can guide you to correct diagnosis and treatment.
If you want to learn more about treatments for the ulnar nerve check out the
eCourse I created. Hand numbness is not a urgent issue for most people who
experience it a few night a week, but it should be something to investigate.
Some of the most painful conditions you can imagine, actually are less
urgent than nerve compression that alters sensations.
I tell new patients in my o ice all the time, “If you decide to not come back
and see me that’s ne, but I want you to know that you MUST get rid of this
numbness within the next few weeks. This is considered a neurological
condition and is actually pretty serious if it progresses beyond the stage of
only numbness.
So if you don’t treat it with me PLEASE treat it with someone who can get
you some serious results within a few weeks. You should KNOW for sure that
you are getting better. You will feel less numbness if you’re getting better. 2
You need to resolve this.”
I hope the graphic was helpful and if you’d like to see me in Southern CA,
I’m located in Huntington Beach. Use the “Book Now” button on the
homepage of the site.
Dr. Sebastian Gonzales DC, DACBSP®, CSCS
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Huntington Beach CA 92647
Phone:
714-502-4243
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16 Passive Treatments For The Ulnar Nerve So You Can Sleep Longer

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3/20/2019 16 Passive Treatments for the Ulnar Nerve so you can Sleep Longer

Top 5 Ulnar Nerve Entrapment

What’s To Know About Ulnar Nerve

Proper and timely diagnosis of ulnar nerve entrapment is key in recovery.

In more advanced cases, imaging can be required:

Standard treatment are:

Some advanced forms of care are:

Some surgical options are:

#1 Ulnar Nerve Entrapment At The Tunnel of Guyon (Handlebar Palsy)

#2 Cubital Tunnel Ulnar Nerve Compression

#3 The Brachial Plexus Entrapment At The Shoulder

#4 C8 or T1 Nerve Root Entrapment At The Intervertebral Foramen (Closing

#5 C8 or T1 Nerve Root Entrapment from Disc Herniation (Opening

When correctly diagnosed, treatment is very simple and can reduce

Proper diagnosis can oftentimes be the hardest portion of implementing care

I personally have had great success reducing people’s symptoms by taking a

Let’s take a look at infographic.

#1 – Ulnar Nerve Entrapment At The Tunnel of

What’s the treatment?

If the problem is too much compression, an obvious solution is to reduce the

Nerves slide and when there’s a reduction of normal sliding mechanics,

When a nerve is being sensitized in one location (compression site) often

To learn more advanced treatments/ exercises to decompress the ulnar nerve

(DISCLAIMER: With the help of your healthcare provider’s diagnosis). It’s

#2 Cubital Tunnel Ulnar Nerve Compression

An amazing, but rather unknown, treatment I use is something called Dermal

Surprisingly, a simple decompression of the skin from the ulnar nerve

You may be wonder why this becoming so complicated?

When one is able to completely understand how to reduce pressure on the

Quick xes are quick xes for reason.

They’re often times incomplete, short-term solutions. Although I’m

#3 The Brachial Plexus Entrapment At The Shoulder

In the shoulder region, I oftentimes nd people’s symptoms increased when

Occult dynamic movement-based instability of the shoulder can place light

Occult dynamic movement-based instability can happen a few ways

Remember this is rehab that is prioritizing the nerve rst.

#4 C8 or T1 Nerve Root Entrapment At The 2

Intervertebral foramen in layman’s terms means “hole.” This hole is narrowed

Head movement in the other directions generally dissipates symptoms into

#5 C8 or T1 Nerve Root Entrapment from Disc

A cervical disc herniation can project posteriorly (backwards) creating

This is a reason why you should always be examined by an educated

Dr. Sebastian Gonzales DC, DACBSP®, CSCS

Performance Place Sports Care & Chiropractic

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