A Quick Comparison of Carpal, Cubital and Radial Tunnel Nerve Compressions

Three peripheral nerves provide power and sensation to the hand and arm.  The following is a quick comparison of the most common sources of pain caused by compression syndromes of these nerves.

nerve paths

Carpal Tunnel Syndrome

  • Nerve Affected:  Median
  • Location of Compression:   Wrist
  • Numbness and/or Tingling:  Usually in the Thumb, Index, Middle & Half of Ring Fingers
  • Pain:
    • Usually in the Thumb, Index & Middle Fingers
    • A band of pain around the wrist
    • Pain in the muscles at the base of the thumb
    • Pain radiates up the forearm
  • Likely Cause (activity related):
    • Frequent gripping/squeezing/holding of tools
    • Gripping or pinching tools or objects for a period of time
    • Finger movement with the wrist held at an awkward angle
  • Prevention:
    • Avoid sustained or repetitive grip and pinch
    • Maintain the wrist in a neutral (straight) position with activity
    • Avoid leaning on or putting pressure against the front of the wrist of the base of the hand
  • Splinting:   A wrist brace that  holds the wrist in the neutral (straight) position at night

Cubital Tunnel Syndrome

  • Nerve Affected:  Ulnar
  • Location of Compression:   Elbow
  • Numbness and/or Tingling:  Usually in the Ring & Small Fingers
  • Pain:
    • Usually in the Ring & Small Fingers
    • Pain in the hand muscles on the small finger side of the hand
    • Pain radiates up the forearm and into the elbow along the small finger side
  • Likely Cause:
    • Leaning on the elbow or pressure against the forearm along the small finger border
    • Frequently bending and straightening the elbow, such as when pulling a lever
    • Holding the elbow bent for long periods of time, such as when sleeping or holding a phone to the ear
    • Forceful elbow extension (straightening) activities, such as rowing, gym activity, push-ups
  • Prevention:
    • Avoid leaning on the elbow or putting pressure on the forearm muscles
    • Avoid holding the elbow bent more than 90 degrees for any length of time
    • Avoid repetitively bending and straightening the elbow
    • Avoid repetitive or forceful elbow extension activities
  • Splinting:   A soft pad or elbow support that holds the elbow in a mostly straight position at night

Radial Tunnel Syndrome

  • Nerve Affected:  Radial
  • Location of Compression:   Muscles on the back of the forearm near the elbow
  • Numbness and/or Tingling:  Uncommon
  • Pain:
    • Usually in the elbow and forearm muscles
    • Pain may radiate down the arm into the wrist and the back of the hand
    • Pain may radiate up the arm towards the shoulder
  • Likely Cause:
    • Computer mouse activity, swiveling the wrist and forceful mouse “clicking”
    • Holding the fingers tensely extended over the computer keyboard
    • Forcefully bending the wrist forward and back
    • Repetitive twisting movements, such as when using a screwdriver
    • Carrying or lifting heavy objects, particularly with the forearm pronated (palm rotated down)
  • Prevention:
    • Maintain the wrist in a neutral position while using the computer mouse
    • Don’t hit the keys or click the mouse forcefully and keep the fingers relaxed over the keys and mouse
    • Avoid repetitive and forceful wrist movements or twisting movements
    • Avoid heavy lifting, especially with the palm facing down, such as carrying a suitcase or heavy briefcase
  • Splinting:   A wrist splint that holds the wrist neutral may be helpful when performing stressful activities
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What is Cubital Tunnel Syndrome?

Everyone has now heard of carpal tunnel syndrome. The term is seen in everyday magazines, is used commonly in texts and tweets, and is even the name of a musical group. Carpal tunnel syndrome is the most commonly occurring nerve compression of the upper extremity. It is caused by the median nerve becoming pinched at the wrist causing numbness in the thumb, index finger, middle finger, and partially in the ring finger. It can cause weakness in the muscles at the base of the thumb and cause pain that radiates up the arm into the shoulder and neck. Like the older sibling who gets blamed for all wrong-doing, carpal tunnel syndrome has become synonymous with all hand pain.

Lurking in the shadow of carpal tunnel syndrome’s fame is its counterpart, cubital tunnel syndrome. Cubital tunnel syndrome is the second most commonly occurring nerve compression of the upper extremity. It is caused when the ulnar nerve, running parallel to the median nerve in the forearm, becomes pinched at the elbow. When you hit your “funny bone”, you are actually hitting this nerve. The ulnar nerve is responsible for sensation in the small finger and partially in the ring finger. Trauma to the ulnar nerve can cause pain in the small finger side of the hand that radiates into the forearm towards the inside of the elbow. It can cause weakness to the small muscles in the hand and, if severe, loss of coordination.

It is time to bring cubital tunnel syndrome out from behind carpal tunnel syndrome’s shadow. If diagnosed correctly, there are simple modifications that can be made to help relieve the symptoms of this frequently overlooked nerve compression.

  • Avoid bending the elbow for any length of time. This stretches the nerve tautly through the cubital tunnel. Activities that can irritate the nerve and simple solutions include:
    • sleeping with the elbow bent – use pillows for support; wrap an ace wrap or towel loosely around the elbow to keep it from bending; avoid sleeping on the arm or sleeping with the hands positioned up behind the head.
    • holding a phone to the ear – use a head-set.
    • blow-drying hair.
    • driving – adjust the seat position so that the elbows are open and relaxed; avoid resting the arms on the elbow supports or window sill.
    • computer work – position the height of the keyboard and mouse so that the elbows are open a bit more than 90 degrees.
    • playing the guitar (because of the positioning of the fretting hand) – warm-up prior to playing, take frequent breaks, stretch often. 
  • Don’t lean on the elbow.
  • Don’t lean on the forearm, especially if it is placed over the hard edge of a desk or table. Place a soft support or cushioning under the forearm.
  • Position the mouse and the keyboard in front of you so that you do not need to reach forward or out to activate them.
  • The mouse and keyboard should be low enough that the shoulders are relaxed.
  • Activate the mouse by keeping the wrist solid and using shoulder movement for positioning.
  • Keep the wrists neutral. The wrists should be flat over the keyboard, not bent forward or back. The wrists should not be angled towards the small finger while typing. Using a split keyboard or a vertical mouse may help position the wrists correctly and relieve tension in the forearms.
  • Avoid repetitive elbow bending and straightening.
  • Avoid over-developing the triceps during gym and sports activities.

As with other injuries, it is important to:

  • take frequent breaks when performing repetitive work.
  • gently stretch the forearm muscles.
  • warm-up prior to performing strenuous activity.
  • avoid or modify activities that cause pain.
  • use cold packs to control post-activity pain when necessary.

Need more information?  Or want to share your experiences or ask questions of our community?  Visit us online at HandHealthResources.com or via our Facebook or Twitter accounts.

Let’s put some caring back into healthcare!  Marji