Massage & Bodywork

MAY | JUNE 2016

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98 m a s s a g e & b o d y w o r k m a y / j u n e 2 0 1 6 technique SCIENCE OF NERVES Cubital Tunnel Syndrome Addressing Compressed Nerves By Whitney Lowe Nerve pain in the hand is a common complaint for clients, but it can also be an occupational challenge for massage practitioners. The most common cause of nerve compression symptoms in the upper extremity is carpal tunnel syndrome. However, other upper extremity nerve compression problems exist and are frequently overshadowed by it. One such problem that warrants more attention is compression of the ulnar nerve in the posterior elbow region. This is a condition known as cubital tunnel syndrome. Surprisingly, this condition is not discussed very often in massage therapy literature, yet it is the second most common upper extremity entrapment neuropathy—second only to carpal tunnel syndrome. If you or one of your clients are experiencing neurological sensations in the hand, it's crucial to not make assumptions and explore the symptoms more thoroughly. BACKGROUND The cubital tunnel is located where the ulnar nerve passes between the medial epicondyle of the humerus and the olecranon process of the ulna (Image 1). There is a small groove or sulcus created between these two prominent bony landmarks, and this depression makes up the floor of the cubital tunnel. There is a ligament connecting the medial epicondyle to the olecranon, which forms the roof of the tunnel. As the nerve exits this space between these two bony prominences, it passes through another narrow canal between the two heads of the flexor carpi ulnaris (FCU) muscle. One head of the FCU blends with the flexor tendon attachments at the medial epicondyle of the humerus, while the other head originates on the medial aspect of the olecranon process (Image 2). The description of cubital tunnel syndrome can include nerve compression in the tunnel between the two bony 1 2 Posterior view of the left elbow showing the path of the ulnar nerve through the cubital tunnel between the humerus and ulna. Image is from 3D4Medical's Essential Anatomy 5 application. Posterior view of the left elbow showing the ulnar nerve coursing under the flexor carpi ulnaris muscle. Image is from 3D4Medical's Essential Anatomy 5 application. Olecranon process Medial epicondyle Ulnar nerve Ulnar nerve Flexor carpi ulnaris

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