• Postural Correction: Addressing poor posture, especially upper back rounding and forward head posture, which can contribute to nerve tension.
• Avoidance of Aggravating Activities: Teaching patients to avoid prolonged elbow flexion (e.g., talking on the phone, sleeping with a bent elbow), direct pressure on the elbow, and repetitive wrist/finger movements that irritate the nerve. Night splinting to keep the elbow extended at around 30-45 degrees of flexion is often recommended.
• Nerve Gliding Exercises (Nerve Flossing): These are gentle, controlled movements designed to improve the mobility of the ulnar nerve as it passes through its various anatomical tunnels. The goal is to encourage the nerve to slide and glide smoothly, reducing adhesions and impingement, without stretching or irritating it further.
  • Elbow Flexion with Wrist Extension: Start with the arm outstretched, palm up. Slowly bend the elbow, bringing the hand towards the shoulder while simultaneously extending the wrist and fingers.
  • Head Tilt with Arm Extension: Extend the affected arm out to the side with the palm up. Slowly tilt the head away from the arm, feeling a gentle stretch. To increase the stretch, extend the fingers towards the floor.

Manual Therapy

• Joint Mobilization:
  • Elbow Joint Mobilizations: Gentle mobilization of the humeroulnar and humeroradial joints to restore normal elbow motion and reduce any mechanical restrictions contributing to nerve compression.
  • Wrist and Hand Mobilizations: Addressing any stiffness or restrictions in the wrist and hand joints, as the ulnar nerve supplies these areas.
  • First Rib Mobilization: Although less direct than in thoracic outlet syndrome, tension in the neck and shoulder girdle can indirectly affect the ulnar nerve path. Mobilizing the first rib can help release overall tension.
• Soft Tissue Mobilization:
  • Trigger Point Release: Identifying and treating trigger points in the forearm, triceps, or shoulder muscles that can refer pain to the elbow or hand.
• Myofascial Release (MFR):
  • MFR techniques involve applying sustained pressure to release fascial restrictions, which are connective tissue “webs” that can become tight and restrict movement or compress nerves.
  • In CuTS, MFR can target the fascia surrounding the ulnar nerve path, particularly in the forearm flexor compartment, triceps, and around the medial epicondyle. This helps improve tissue mobility and reduce nerve impingement.
• Instrument-Assisted Soft Tissue Mobilization (IASTM)
  • Techniques like Graston Technique or similar IASTM tools use stainless steel instruments to detect and treat soft tissue restrictions, adhesions, and scar tissue.
  • For CuTS, IASTM can be applied along the forearm musculature, around the elbow, and even into the triceps to break down fibrotic tissue and improve blood flow, facilitating tissue healing and nerve mobility.
• Taping
  • Kinesiology Taping: Can be used to support muscles, reduce swelling, or subtly influence posture and movement patterns without restricting range of motion. For CuTS, taping might be applied to:
  • Decompress the cubital tunnel: By gently lifting the skin and fascia around the elbow.
  • Encourage elbow extension: By applying tape that resists full elbow flexion, especially at night.
  • Support forearm muscles: To reduce strain on the ulnar nerve’s muscular pathway.
  • Rigid Taping/Splinting: In more acute phases or for nighttime use, a rigid tape or brace might be used to prevent excessive elbow flexion and protect the nerve.
• Muscle Energy Techniques (MET)
  • METs are gentle, active techniques that use a patient’s own muscle contractions to improve joint mobility and reduce muscle hypertonicity.
  • For CuTS, METs can be used to:
    • Improve elbow extension: By using a gentle contraction of the elbow flexors followed by relaxation to gain range of motion.
    • Release tight forearm muscles: Using a post-isometric relaxation principle.
    • Mobilize the first rib or thoracic spine: If these areas are contributing to overall nerve tension.
• Strengthening and Motor Control Exercises
  • Once acute symptoms subside, strengthening exercises are introduced to improve stability and function.
  • Scapular Stabilizers: Strengthening muscles like the rhomboids, lower trapezius, and serratus anterior is crucial for maintaining good upper back and shoulder posture, reducing tension on the entire arm.
  • Forearm and Hand Muscles: Strengthening exercises for the ulnar nerve-innervated muscles (e.g., grip exercises, finger adduction/abduction) are introduced cautiously, ensuring they do not exacerbate nerve irritation.
  • Core Stability: A strong core contributes to overall postural control, reducing compensatory movements that might strain the upper limb.