ulnar nerve entrapment from large forearms?

hi mountain project,

tl;dr can you have ulnar nerve entrapment from having too large of forearms? does solving that entail reducing your forearm size?

I’m curious to hear from climbers who have struggled with ulnar nerve entrapment issues. Here’s a summary of my history:

Background / Diagnostics

• In May 2020, I started experiencing nerve issues typical of cubital tunnel syndrome bilaterally (numbness and tingling in the distribution of the ulnar nerve). Then, and now, I only feel symptoms worsening when my elbows are bent either statically for a long time (e.g. from typing) or during repeated bending and straightening (e.g. strumming guitar).
• For the rest of 2020 and 2021 I was deep in weeds of diagnosis. The main crux was not be able to determine where exactly the point(s) of impingement were. Some doctors and PTs suggested that the impingement was likely not at the elbow but higher up (a la thoracic outlet syndrome), and some doctors were sure that the issue was at the elbow. when I bent my arm, you could see the ulnar nerve “perched” on the medical epicondyle.

Treatment

• I did PT, mostly chest and neck stretches, for a year without symptom relief. The only thing that helped was avoiding the symptom-provoking activities, but as soon as I returned to them, the symptoms would return.
• I got bilateral subcutaneous ulnar nerve transpositions in May ’21 and September ’21. I experienced just a little relief — essentially, it lengthened the time I could engage in any of these activities before symptoms would kick in (i.e. 5 mins of typing without symptoms became 20 minutes of typing). I am still severely effected post surgery.

My question:

Have you experienced ulnar nerve issues from having too large of forearms? Two of the doctors I’ve seen immediately pointed to my forearms and were like “that’s the problem for sure, your nerves are being crushed by your forearms” — but other docs have assured me that’s not an issue. I do have abnormally large forearms from climbing; they’re much bigger than my biceps. So I’m curious if anyone else has experienced this issue, and if so, what you’ve done that has helped.

For what it’s worth, the act of climbing has never provoked symptoms. However, sometimes when I’m very pumped and locking off, the nerve will be subluxed. I'm more concerned that the adaptations of my physiology because of climbing have predisposed me to the nerve issues.

I’m in the process of getting reevaluated by (yet) more doctors, but in the meantime, I wanted to see if anyone has had similar experiences and what the outcome has been for you.

Where is the pain exactly?

Have you tried an Armaid forearm massage tool for your massive forearms yet?

Thoracic spine mobility.  Wrist flexibility.

If a guitar string was tightly pulled, and it bent around a corner somewhere (and so had a pressure point at that spot), if that guitar string could feel pain, where would you expect the pain to be?  What is the obvious solution?

yeah i have the rolflex and use it a lot but haven’t noticed improvement from it. i have numbness and tingling from my elbow through my 4th and 5th digits.

Hey Blue - any update on your ulnar nerve issues?

I have similar symptoms but never got any sort of ulnar nerve surgery. Been about 5 years for me, although the past 4 years I rarely have serious numbness. I've tried some Thoracic spine mobility after JNE mentioned it (thanks!) but those didn't help me - at least no real improvement in symptoms which are currently pretty mild. I do nerve glides that temporarily help, and forearm curls seem to also temporarily help a ton. My PT thinks it could be a shoulder mobility issue but isn't 100% ruling out Thoracic spine issue. The exercises I tried for about a week are: https://www.movementenhanced.com.au/blog/5-exercises-for-thoracic-mobility

Might need to do it for longer though. My PT said there are tests for thoracic spine mobility but they have a high correlation with other potential problems, so it's tough to really narrow down. I have also had temporary help with a wave tool ( wavetoolstherapy.com/). But everything I've listed never really seemed to nip it in the bud. I'll update as I make some more progress on what does or doesn't seem to help. 

Currently also trying a new keyboard which is also helping a bit ( amazon.com/KINESIS-Gaming-F…;ascsubtag=05EgbMNzfgFYMFDzZXXTn6t). I am on the computer >8 hours a day, and was realizing how badly my posture was with the typical keyboard. 

Good luck!

I have this but I don't know that it has been my forearms. I know that there are a few specific things that irritate my ulnar nerve. The first and biggest is my sleeping position. I've switched to sleeping on my back and wear an arm brace to keep it straight if my nerve is irritated. Camping and sleeping in my car can irritate it and it's usually from sleeping on my side and crushing my arm under my body. Some weight lifting exercises like bench press can seriously irritate it--the flexion of the arm while under load in a pressing position. I've been able to do squats by using a wide grip. 

I think I have irritated my ulnar nerve on multi-pitch climbs when I'm exhausted after leading and pulling up the rope. I have also noticed though that the act of climbing never seems to irritate it and it is primarily either sleeping or weight lifting that does it. When the nerve is irritated, everything makes it worse, climbing, looking at my phone, typing, using my mouse--so if it's irritated, I try to lay off it as much as possible for however long it takes to make it feel normal again. I'll wear an arm brace while working on the computer, sleeping, eat food with the arm that is least affected, keep my phone away from me etc. I know what causes it to get seriously irritated now though so it doesn't really come to this anymore.

So for me the "solution" has been to isolate the specific actions that make it irritated when it's been fine and try to work around them.

I've had a very similar issue, although it more closely resembles compartment syndrome in my forearms, and the ulnar nerve entrapment was mostly on my left side and has subsided. I had no surgeries. The issues are chronic but have improved significantly since starting in 2018. I am not able to write up my full story but can dig up an old blog post and email it to you if you send me an email johnsigmon@gmail.com

The main things that helped are activity modifications and soft tissue modalities.

Activity modifications:

• Do not sit and mindlessly type and scroll for long periods of time. Remove your hands from the keyboard every couple minutes and shake them out. Take several minute breaks every 30 minutes.
• Use the computer and mouse and phone as little as possible. Call instead of text, voice dictate and deal with typos. When it was at its worst I had coworkers help me write things (usually deliverables that would turn out better with two people looking at them anyways, and I'd explain my condition)
• Use wrist braces at night to keep from hyperextending my wrist while sleeping (keep them very loose and dont use them during the day)
• Slouching made it generally worse, as did having my hands lower than my heart. Finding comfortable positions that work is key.
• Lots of PT to correct shoulder posture (years of PT) Find a good PT, they are usually cash only and own their clinics but occasionally can be found in larger hospitals. A bad PT can make things worse, a good one is worth their weight in gold (and worth at least whatever they charge)
• Yoga!

Soft tissue:

• Acupuncture (often available on a sliding scale)
• Cupping (let the acupuncturist do it, the plastic ones on amazon are so so)
• Fascia scraping (be gentle though don't damage anything. probably better to let the acupuncturist do this)
• Massage gun on the forearms (I have a mini/travel sized theragun)
• I was surprised but hemp oil/cbd lotion helps a bit. I have been using one from Rad Soap. Be careful with ones containing capsaicin, it can cause permanent nerve damage. That could be a good last resort for you though if all else fails.

Hope that helps someone!

I recently had hydrodissection on my ulnar nerve in my forearm - really quick procedure, it's an ultrasound guided injection of fluid around the nerve to give it room to move and relieve pressure.  Aside from being pretty cool that you can see it happen in real time up on the monitor, it immediately fixed issues with numbness/tingling in my hand.  It was done by an orthopedist, worth looking into if there's a provider near you that offers that treatment.

Has anyone just experienced small bits of sharp pain down your ring and pinky fingers and a bit of the wrist when doing something as simple as pulling your phone out of your pocket? Im not necessarily feeling numbness or tingling, just fast sharp pains maybe once or twice a day. Tried using anti-inflammatories, ice packs, massage gun and topical the past few days and nothing has significantly reduced the pain. Theres no way to re produce it on command either, it just happens when it wants. So weird. Just started to happen last week

B Y wrote:

Has anyone just experienced small bits of sharp pain down your ring and pinky fingers and a bit of the wrist when doing something as simple as pulling your phone out of your pocket? Im not necessarily feeling numbness or tingling, just fast sharp pains maybe once or twice a day. Tried using anti-inflammatories, ice packs, massage gun and topical the past few days and nothing has significantly reduced the pain. Theres no way to re produce it on command either, it just happens when it wants. So weird. Just started to happen last week

All climbers get “tweaks” and the solution will vary per person. Mostly as climbers we overuse certain muscles and tendons etc and underuse others. It is “balance” you seek.

B Y wrote:

Has anyone just experienced small bits of sharp pain down your ring and pinky fingers and a bit of the wrist when doing something as simple as pulling your phone out of your pocket? Im not necessarily feeling numbness or tingling, just fast sharp pains maybe once or twice a day. Tried using anti-inflammatories, ice packs, massage gun and topical the past few days and nothing has significantly reduced the pain. Theres no way to re produce it on command either, it just happens when it wants. So weird. Just started to happen last week

Yes, I’ve been having a similar issue for the past 8 months or so. The “pain” (it’s a weird sensation) is usually down the ring and pinky finger side of my hand - it feels as if the muscles just stop working suddenly.

It’s hard to consistently recreate on demand, but I typically get the sensation when flexing my wrist back (palm away) and spreading fingers at the same time. It also happens while climbing with certain open hand positions. I believe I’ve isolated it to when the elbow is bent, however.

I have had some relief with wrist pronation/supination exercises- I made this for doing the exercises since a hammer doesn’t really provide enough torque:

Matty T wrote:

"I have had some relief with wrist pronation/supination exercises- I made this for doing the exercises since a hammer doesn’t really provide enough torque:"

That's a great idea. I even have things at home to whip up the same set-up you have. Thanks for the input everyone! 

M M wrote:

Have you tried an Armaid forearm massage tool for your massive forearms yet?

Came to say this