This blog post is an excerpt from the newly released textbook by Matt Callison—“Sports Medicine Acupuncture: An Integrated Approach Combining Sports Medicine and Traditional Chinese Medicine.” Go to smatextbook.com for more details.
Figure 1. The cubital tunnel, just distal to SI 8, is a common site for ulnar nerve entrapment.
Cubital tunnel syndrome is a common sports injury in throwing and racket sports that require repetitive elbow flexion and extension combined with ulnar and radial deviation of the wrist. These repetitive activities create valgus tension on the medial elbow, which contributes to a soft tissue entrapment of the ulnar nerve. The ulnar nerve passes posterior to the medial epicondyle and is secured by ligamentous tissue that is located deep to SI 8 (xiaohai). Continuing along the Small Intestine channel approximately 1 cun distal from SI 8 and the medial epicondyle, the ulnar nerve passes through a tunnel of aponeurotic tissue that connects the humeral and ulnar heads of the flexor carpi ulnaris (FCU). This soft tissue passageway for the ulnar nerve is called the cubital tunnel and it is a common site for ulnar nerve entrapment (Fig. 1).
Numbness and tingling in the ring finger and little finger are common symptoms of ulnar nerve entrapment as a result of cubital tunnel syndrome. Often, these symptoms are intermittent and can happen more often when the elbow is bent, such as when driving or holding a phone to the ear. This condition can be exacerbated by particular sleeping positions. Many people sleep on their sides with their arm tucked under themselves in a position of elbow flexion, forearm supination and wrist flexion, which can aggravate the symptoms of ulnar nerve compression. The patient will often wake with the last two fingers numb and tingling. The numbness and tingling of ulnar nerve entrapment presents similarly to that of thoracic outlet syndrome, so these two conditions must be differentiated.
String musicians, such as guitar, bass and violin players, also get cubital tunnel syndrome, usually on the fret hand, as the fingers and wrist flexor muscles are used to hold the strings. In a position of full forearm supination and elbow and wrist flexion, the contracted wrist flexors subject the medical epicondyle to excessive and prolonged strain.
Target Tissue Needling for Cubital Tunnel Syndrome
Figure 2. Cubital Tunnel: Shallow Needling Technique. A) Palpating finger is directed toward the medial epicondyle. The blue dot indicates the medial epicondyle. B) Palpating finger is directed away from the medial epicondyle. C) Shallow needling technique in the direction that elicited the most painful response during palpation. Once qi is obtained, the practitioner gently pulls on the needle for 30-60 seconds.
Presented here is a localized treatment for opening the cubital tunnel and decompressing the ulnar nerve. This needle technique should be combined with other points along the myofascial channel, as well as addressing the postural imbalances and organ-related constitution of the patient is strongly advised.
Cubital Tunnel Syndrome: Shallow Needling Technique
Palpate for a tender ropy band of tendinous tissue approximately 1 cun distal from the medial epicondyle, located near the Small Intestine channel. This is the region of nerve entrapment in the cubital tunnel. Once the point has been located, the practitioner should determine the direction that the needle will be inserted by palpating in two different directions:
1. On a line following the FCU muscle fibers, push toward the medial epicondyle (Fig. 2A).
2. On a line following the FCU muscle fibers, push away from the medial epicondyle toward HT 7 (shenmen) (Fig. 2B).
Whichever direction is the most uncomfortable is the direction toward which the needle will be angled. After inserting the needle perpendicularly just past the skin, the practitioner uses a Shallow Needling technique, or Qian Ci, with an oblique/transverse needle angle in the appropriate direction. The needle should travel beneath the skin and along the superficial tendinous tissue. Once qi is obtained, rotate the needle clockwise and counterclockwise 180˚ to determine which direction provides the most resistance. Once the direction of most resistance is determined, rotate the needle in the same direction until the needle cannot be turned any further due to tissue tightness. The needle sensation should be strong but tolerable for the patient. The practitioner will then gently pull on the needle for 30-60 seconds (Fig. 2C). Leave the needle in place as part of the treatment protocol. After 15-20 minutes, the needle should withdraw easily, if it does not, rotate the needle in the opposite direction until the needle withdraws easily. The goal of this technique is to wrap the fascial and connective tissue affecting the cubital tunnel around the needle and apply a “pulling” technique to open up the dense tissue and re-establish qi and blood flow and proprioception, which help to counteract the pressure on the entrapped nerve. Due to the amount of torsion placed on the acupuncture needle, it is important to use a high quality, uncoated, stainless steel acupuncture needle.
Caution: Too steep of a needle angle or too aggressive of a needle technique can penetrate the ulnar nerve and cause patient discomfort.
Matt Callison is the president of the Sports Medicine Acupuncture Certification program. He has been combining sports medicine and traditional Chinese medicine (TCM) for over 26 years. He is the author of the Motor Point and Acupuncture Meridians Chart, the Motor Point Index, The Sports Medicine Acupuncture textbook and many articles on the combination of sports medicine and TCM.