Ulnar nerve entrapment

[spartan87]

Hi,
I have a patient who is 38yrs old. He is about 5,7" and very muscular. I have seen him twice now. First time he had lots of trigger points in his upper back for which i treated and he reported an improvement a few days later. His problem has been ongoing for around 3 months now. I suspected possible Thoracic outlet syndrome, possibly Csp disc prolapse.
Recently I treated him with maitland mobs due to his hypomobile spine.

HPC: Considerable weakness and sensation changes in right little finger. Had pain in right upper back and changes in sensation at back of arm.

PMH: L3 and L5 prolapsed discs within last year.

No red flags.
Upper limb tension tests - Positive, into fingers and forearm, very uncomfortable for patient
Posture - good
Neck - NAD
Thoracic Sp - NAD
Palpation - C and T spine hypomobile

Anyone have any ideas, I'm not sure what to do next with this patient what can I look at? Do you have any ideas what treatments I should do? I'd really appreciate some help as I'm at a bit of a loss.

Thanks alot
Kane

Similar Threads:

• Median nerve and Ulnar nerve lesions
• ? Posterior Tibial nerve compression/entrapment
• C6 nerve root entrapment.
• femoral nerve entrapment?
• Possibly LE Nerve Entrapment

[HighRevinDPT]

I will see if I can help you r/i or r/o a few of the possibilities
1. TOS
*Hand Muscle Atrophy?
*Pec Minor and/or Scalene Tightness (Adson Maneuver) or Pain w/ Palpation
*Palpable Cervical Rib?
Consider 1st Rib Mobilizations, Pec Minor Stretching, Scalene Trigger Release

2. C/S HNP
*Changes in Pain with specific Neck Movements (i.e. Repeated Flexion or Extension etc) that produces a comparable sign to chief complaint
Consider continuing PA Mobs for C/S and T/S Hypomobile Segments and Manual Traction. Dependent on herniated disc possibility, consider flexion, extension, rotation principles to reduce derangement.

3. Any evidence of peripheral entrapment?
*Isolate segments of the Ulnar Nerve Tension Test or examine it Prox-Distal and Distal-Prox
Ulnar Nerve Glides or Soft Tissue Mobilization

I would certainly continue the C/S and T/S Mobilizations as they are hypomobile; consider adding traction to the C/S and monitor changes in sensation. The addition of Ulnar Nerve Gliding Techniques may also prove advantageous in either breaking nerve adhesions or r/i or r/o the possibility of entrapment. If TOS is suspected, possibly recommend seeking a 2nd opinion for imaging. Hope this is of some assistance and best of luck.