Ulnar Tunnel Syndrome: Signs You Have It and Exercises to Treat It

It’s common to attribute any numbness or tingling in your hands to carpal tunnel syndrome, especially if you spend most of your days at a computer typing. But carpal tunnel syndrome isn’t always the culprit. In fact, if you notice numbness and tingling specifically in your little or ring fingers, it may be related to another, less common condition: ulnar tunnel syndrome. 

Unlike carpal tunnel syndrome, which is caused by pressure on the median nerve in the wrist, ulnar tunnel syndrome occurs when the ulnar nerve — another nerve that provides feeling and function to the hand — becomes compressed at the wrist, says Laura Reising, PT, DPT, a physical therapist at Hinge Health. (When the ulnar nerve becomes compressed at the elbow, it causes another, similar condition: cubital tunnel syndrome.)

Ulnar tunnel syndrome doesn’t happen often, but when it does, it can make life more uncomfortable. “When you’re experiencing ulnar tunnel syndrome, it can be harder to open jars, hold objects, or even coordinate your fingers when you’re typing or playing the piano,” says Dr. Reising. But here’s some good news: Ulnar tunnel syndrome responds very well to conservative treatments, like exercise and physical therapy. 

Read on to learn more about what ulnar tunnel syndrome is, what causes it, and what treatments and exercises our Hinge Health physical therapists recommend to start feeling better.

What Is Ulnar Tunnel Syndrome?

The ulnar nerve, one of the three main nerves in the arm, starts at the spinal cord and travels all the way from the neck, down the arm, through the wrist, and into the hand. The ulnar nerve can get compressed, stretched, or irritated at several different spots along that path. With ulnar tunnel syndrome, the compression or irritation of the ulnar nerve occurs at the wrist.  

“The compression usually occurs at the Guyon’s canal, which loops around the bones of the hand,” explains Dr. Reising. “As a result, blood flow to the ulnar nerve is reduced, which, in turn,  impacts hand and finger function.”

Symptoms of Ulnar Tunnel Syndrome

So how do you know if symptoms are due to your ulnar nerve, or carpal tunnel, or something else entirely? Carpal tunnel syndrome usually affects your thumb, index, and middle fingers. With ulnar tunnel syndrome, you’ll mainly notice numbness and tingling of your pinky and ring fingers, notes Dr. Reising. Other signs include:

• Hand weakness.

• Loss of dexterity: It may be hard for you to do activities that involve pinching or gripping, like unscrewing a jar or taking off your shoes and socks. 

• Wrist pain.

• Curving pinky and ring fingers (like a claw). “In more chronic or severe cases, you’ll notice that it’s harder to straighten these fingers out,” says Dr. Reising.

• Loss of sensation along the ring and pinky fingers and side of hand. 

Regardless of what may be contributing to your hand and wrist pain, the toolkit of exercises you'll do to feel better is usually similar. So whether you have an official diagnosis of ulnar tunnel syndrome or not, a solid treatment plan can still help build strength and mobility in your arm, wrist, hands, and fingers.

Common Causes of Ulnar Tunnel Syndrome

Ulnar tunnel syndrome occurs when your ulnar nerve becomes irritated. Some factors that can contribute to ulnar nerve pain include:  

You use your wrists a lot. Doing work or activities that your wrist isn't ready to tolerate can cause irritation in the area. Some bikers, for example, can be affected by ulnar tunnel syndrome because their body weight rests on their hands while pressing into the handlebar. Using power tools is another trigger: The vibrations can put pressure on your hand and wrist.

Your anatomy. If your Guyon’s canal is particularly narrow, you may be more likely to develop ulnar tunnel syndrome.

Ganglion cyst. This is a benign cyst in your wrist that’s filled with a thick gel. It can push against your ulnar nerve and irritate it, says Dr. Reising.

Wrist fractures. If you’ve fractured your wrist, the initial impact of the break can irritate or compress your ulnar tunnel nerve, causing symptoms.

Treatment Options for Ulnar Tunnel Syndrome

Most of the time, ulnar tunnel syndrome can be treated conservatively with lifestyle modifications and exercises to improve mobility of the hand, wrist, and fingers, says Dr. Reising. The following tips from our Hinge Health physical therapists and medical doctors can provide relief for ulnar tunnel syndrome:

Modify activity. If your ulnar nerve syndrome is irritated by biking or driving, Dr. Reising recommends that you take more frequent breaks to do some of the stretching and strengthening exercises listed below.

Adjust your bike. “One of the first things I do with my physical therapy patients who are bikers is have them show me their bike to make sure it’s set up right,” says Dr. Reising. “Is the seat too high? Are the handlebars too low? Are their tires overinflated? All of these factors can contribute to ulnar tunnel syndrome.” You can also go to your local bike store and ask one of the bike technicians to take a look, too.

Wear padded gloves. These can help provide more hand protection and take pressure off the wrist, so you can continue to do the activities you enjoy, like biking or gardening.

Avoid leaning on your wrists. Most of us do this without realizing that it puts stress on the ulnar nerve, says Dr. Reising. As you start your recovery, you want to try to keep your wrist in a neutral position more often. If you’re at a desk all day, this may mean that you use a computer pad to help cushion your wrist as you type. As the pain calms down, you can build up tolerance to more flexed or extended wrist positions.

Take over-the-counter medications. Pain relievers such as ibuprofen (Advil, Motrin) or naproxen (Aleve) can be helpful to relieve nerve inflammation and pain. It’s important to make sure that you’re safely able to take them, based on your medical history.

Try physical therapy. A physical therapist can show you exercises to help strengthen surrounding muscles to take pressure off the ulnar nerve, says Dr. Reising. These include range-of-motion exercises (to keep arm and hand muscles limber) and nerve gliding exercises (to stretch out your ulnar nerve). You can see a physical therapist in person or use a program like Hinge Health to access a PT via a telehealth or video visit. 

These exercises are recommended by Hinge Health physical therapists to support healing if you’re experiencing ulnar tunnel syndrome, and generally help keep your arms and wrists strong and flexible. Nerve compression can cause weakness in hand muscles, so you want to make sure you’re strengthening your hands and wrists — and all the muscles that support them — to prevent future reinjury. 

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Don’t Delay Getting Help

If you notice symptoms of ulnar tunnel syndrome, consider seeing a physical therapist sooner rather than later or be proactive about managing your own treatment plan at home. “Patients who seek conservative care early by taking frequent stretch breaks, performing some nerve glides, modifying their activities, and adapting their environment, will not only help to reduce symptoms, but also significantly reduce the need for more invasive treatment, like surgery,” stresses Dr. Reising. The earlier you start, the faster you’ll be able to get back to doing the activities you enjoy.

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program. The best part:

You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you. See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Doherty, T.J.  January 12, 2023. Ulnar neuropathy at the elbow and wrist. UpToDate. https://www.uptodate.com/contents/ulnar-neuropathy-at-the-elbow-and-wrist 

2. Lleva, J. M. C., Munakomi, S., & Chang, K.-V. August 13, 2023. Ulnar Neuropathy. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK534226/ 

3. Chen, L.-C., Ho, T.-H., Shen, Y.-P., Su, Y.-C., Li, T.-Y., Tsai, C.-K., & Wu, Y.-T. (2020). Perineural Dextrose and Corticosteroid Injections for Ulnar Neuropathy at the Elbow: A Randomized Double-blind Trial. Archives of Physical Medicine and Rehabilitation, 101(8), 1296–1303. doi:10.1016/j.apmr.2020.03.016

4. Nagarajan, E. August 31, 2022. Ulnar Neuropathy: Background, Anatomy, Pathophysiology. Medscape. https://emedicine.medscape.com/article/1141515