Chiropractic management of a patient with ulnar nerve compression symptoms: a case report

Abstract

Objective: The purpose of this case report is to describe chiropractic management of a patient with arm and hand numbness and who was suspected to have ulnar nerve compression.

Clinical features: A 41-year-old woman presented with hand weakness and numbness along the medial aspect of her right forearm and the 3 most medial fingers. The onset of symptoms presented suddenly, 3 weeks prior, when she woke up in the morning and assumed she had "slept wrong." The patient's posture showed protracted shoulders and moderate forward head carriage. Orthopedic assessment revealed symptomatic right elevated arm stress test, grip strength asymmetry, and a Tinel sign at the right cubital tunnel.

Intervention and outcome: The patient was treated using chiropractic care, which consisted of manipulative therapy, myofascial therapy, and elastic therapeutic taping. Active home care included performing postural exercises and education about workstation ergonomics. She demonstrated immediate subjective improvement of her numbness and weakness after the first treatment. Over a series of 11 treatments, her symptoms resolved completely; and she was able to perform work tasks without dysfunction.

Conclusion: Chiropractic treatment consisting of manipulation, soft tissue mobilizations, exercise, and education of workstation ergonomics appeared to reduce the symptoms of ulnar nerve compression symptoms for this patient.

Keywords: Chiropractic; Cubital tunnel syndrome; Nerve compression syndrome; Thoracic outlet.

Fig 1

Elastic therapeutic taping technique. A, A “lifting” technique placed over the cubital tunnel (white dot is where the center of the patient’s cubital tunnel is located) with 25% to 50% of tension applied to the tape. B, Reducing the hypertonicity of the common wrist flexor group by applying elastic tape from the ulnar styloid up to the medial epicondyle with approximately 25% to 50% of tension in the tape. C, Completed tapings shown together.

Fig 3

Postural exercises. A, Normal posture (before exercise). B, Patient is instructed to lift chest superiorly and anteriorly while also creating an anterior pelvic tilt. C, Patient is asked to breath normally and tuck the chin into retraction toward his neck without inducing neck flexion. D, Patient will then attempt to bring his shoulder blades together by externally rotating arms and placing them into extension (special focus on not activating the upper trapezius muscles).

Fig 4

Thoracic outlet: compression of the brachial neurovascular bundle (A) due to the pectoralis minor muscle (B).

Fig 5

Cubital tunnel syndrome: the 5 common areas of entrapment of the ulnar nerve. (1) arcade of Struthers, (2) medial intermuscular septum, (3) medial epicondyle, (4) cubital tunnel, and (5) flexor-pronator group.