Ulnar Nerve Treatment Options for Ring and Pinky Finger Numbness

Most of the time, if I were to be blindfolded and somebody comes in with hand numbness, usually it's going to be a neck disc or a nerve that is exiting the spine or something above the shoulder, if I'm going to gamble on it. You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now, your host, Dr. Sebastian Gonzales. Hey, everyone. I'm Dr. Sebastian Gonzales, your host for the Restoring Human Movement podcast. Thanks for joining the movement movement. If this is your first time, welcome. We are well past 200 episodes, and going on strong, we've decreased the release to do it once every two weeks, mainly to give you guys a chance to go backwards in the archives and really get into the good stuff. There's some great stuff back there for clinicians and patients alike. The whole point of this podcast is to improve the communication of doctor and patient, really get our patients to a better outcome. I think there's a lot of misconceptions about what's expected of each patient to do. And also, sometimes we as clinicians don't understand what our patients want and what their goals are. And so, a lot of that does, it creates magic, let's just say. And so, if you're interested in becoming a better clinician, this is the place to be. Place to be, God. Just strip it on my words today. Anyways, this podcast today is going to be very friendly to patients. And the topic we're going to cover is, quote unquote, ulnar nerve problems. And I'm going to cover this from many different avenues and many different conversation points, just to give our patients a better idea of what is possibly happening to their fingers to make this numbness or pain into the wrist or finger area really come to be. Because the sad thing is that a lot of people who do not find quick care or at least rapid recovery with this end up having some long-term problems. And that's not what we want. And I don't like scare tacticking people into having, into treatment. But if you have consistent numbness into your hand, this is something you need to really deal with because it can become a larger problem. Now, before we actually get into too much of the podcast, just to let you know the format, it's about a 45-minute, hour-long format. I'll be doing this as a solo podcast today. Sometimes we have interviews. Sometimes we don't. But I like to share a little bit about myself via short story so you guys understand who I am as a person and hopefully follow along this journey with me.

And so, if you guys are liking what you hear, please share it. This podcast is not promoted in any other way other than just people sharing it with other people who think that they'll like it is all. And this has been a passion project for many, I mean, two and a half years now. It's been over 200 episodes. So, keep it going on. And it's the greatest compliment you can give to me is just simply sharing this with someone who is in need. Let's get in that short story really quickly and then we'll get back into the ulnar nerve topic. So, one thing that I've done recently is I kind of tricked my dad into doing some exercise. And so, not maliciously, I think it'd be good for him. But so, he's been home for a bit and we've been working on a car. And so, I've been going over there. And so, one of the projects for the car has been a brake line. And so, the option is either to take the body off of the car and do the frame or get under the car and a little bit more cumbersome. But there's multiple reasons why I didn't want to take off the body or why we didn't want to take off the body. It's kind of a pain in the ass to do. But he's like, okay, so we're going to get under, he's going to get in the car and do that. So, he's been every day going underneath the car and crawling in and lunging and so on. And he's like, man, it's been really challenging to get under the car. It's like, it's tiring. And so, I was like, yeah, that's too bad, man. You know, like that.

But basically, you're tricking him into doing crawling exercises and lunges and movement variability, as we call it, which is really good for everybody. And especially, you know, as people age, it's the hardest thing is getting off the ground. So, we're basically, I'm training him to get off the ground. So, that was the way I trick my dad into exercise. All right, now we're getting to the content. Okay, so, the ulnar nerve is an interesting conversation point. And I'm bringing this whole thing up because I've had a lot of people over the years go onto my website and read some of the articles I've written on this. I don't recall why I originally wrote articles on this, but it just happens to be that it's one of the most popular searched articles for that topic.

Maybe there's not a lot of topics or articles on the ulnar nerve or numbness into the fourth and fifth digit, but my article just by chance is on there. And so, I've improved it over the years. I've addressed things like the spinal component, nerve pressure, entrapment points, and so on, and even drew some pictures on it. And so, I'm going to put a link to that article so you guys can go backwards if you want to, to understand different parts that I might not cover in their entirety. But, it's going to be in the show notes, so you can always hit that when you need to. The first thing to understand with the ulnar nerve, or let's just say numbness of the fingers, fingers, and I do mean the fingers, specifically the fifth and fourth digit, meaning the pinky and the ring finger, usually half of the ring finger. Those are the, that's the distribution of the ulnar nerve. But, it also is of C8, which is a spinal nerve root. And so, I want you to understand first, as we go through this, that numbness or pain into the hand in the distribution of the ulnar nerve is not always the quote-unquote ulnar nerve, because the ulnar nerve is a mixed nerve, which is created of different spinal nerve roots. C8 just happens to be one of them. So, the issue sometimes, when people have numbness into the hand, they'll talk about, well, I have, today it's of the fifth digit, and then tomorrow it's of the index finger, and sometimes the back of the hand. You've just described multiple nerve root, or multiple mixed nerve contributions. The ulnar nerve, again, is specifically the fifth and fourth digit, again, the ring and pinky finger, half the ring finger, actually. The median nerve is the front side of the hand, which includes the thumb, the index, and the middle finger, and half of the ring finger, the inner part of the half of the ring finger. And the radial nerve, which includes most of the the back side, the back side of the hand, and it can go all the way up into the back side of the forearm and the elbow. So, if you're having different areas of the hand affected, this is not your ulnar nerve, although you could have something which is affecting the nerves that create the ulnar nerve. Because, again, some of these mixed nerves, again, the ulnar nerve, median nerve, radial nerve, that go out into the extremity, the hand, the elbow, and the arm, they can be, or they have, some of them have like multiple levels of spinal nerve, which are the same thing. And so, it starts to get the, it starts to make the whole thing very hairy and complicated for people. But the reason I'm trying to make this, get you guys to understand the hand distribution, is mainly because the hand is, if you have different fingers that are not the ulnar nerve, then what is happening is not purely based upon the ulnar nerve. If you had an ulnar nerve correction, let's just say, or say a surgery at parts of the, say the cubital tunnel, or you have one into part of the wrist affecting a tunnel the ulnar nerve goes through, but you have numbness into the, into the index finger, you're missing a large part of the puzzle. I'm not saying there's not maybe compression, compression or irritation there, but probably the root source is somewhere where those nerves, they also innervate into the finger, or the index finger, are also coming from. Usually, that's more up into the neck area, or in the spine area. And a lot of times, addressing these things from a spine driver first, is the most useful thing you can do. Now, what are some common entrapment site areas? Well, we say the coracopectoral tunnel is one that's around the shoulder. You can also have the inner part of the arm, or sorry, the brachium, which is going to be like the, called the inner muscular septum, which is kind of along the side of the bicep. There's also into the elbow, the cubital tunnel. Some people will believe it when it goes through the different heads of the flexor carpial neris, or the muscles of the forearm, it can become interrupt or pressurized. Also, too, in the tunnel of guion, and the inner, actually, the inner part of the hand, kind of around the base of the pinky finger, are the more common spots. But, or sorry, I don't want to say more common spots. The more commonly searched and believed spots, I'd say most, more commonly, it's actually more of the neck, which is going to be from a cervical disc herniation, or a cervical disc, let's just say issue, because we don't really know what type of issue it is, because it could just be, could be a protrusion, could be a prolapse, could be a herniation, could be a bulge, or as we say, you know, and so there's multiple things it could be, but if it's driven by a disc, even though it goes into the hand, and you think it's it, all these different tunnels, you have to reduce it from the neck first.

Can it create, can it, can it, it have entrapment points in the arm? Yes, but wherever it's being driven from, you need to address that first. If you're not addressing that first, you're missing a big part of the puzzle. Now, a lot of times, people can also have primary nerve-based issues up into the spine, which more of your, the nerve is irritated because of where it's being pinched at the spine versus actually by the disc itself. A lot of times, people who are younger, I don't want to say young, young, but let's just say under the age of 70, are going to be probably more disky. Like, I'd say probably at least 30, 40% of people who come in who have hand numbness are going to be disc-based patients. Probably the ones that are above, like your, like your 60, 70-year-old, they could be a lateral foraminal stenosis or central stenosis of the spine. What is stenosis? It is a narrowing of the tunnels of, of the spine. Holes, they're narrowing of the holes, and there's different holes. That's why they have different blah, blah, blah stenosis, foraminal stenosis, central stenosis.

There's different types of stenosis. Stenosis just means narrowing. So the stenosis could be that a normal-sized nerve is going through an abnormal-sized hole. But if the nerve is irritated and there's a tourniquet on it, as Michael Shacklock had referenced in some of his work, the tourniquet effect basically strangulates the nerve from having, not just, it doesn't have, strangulate it from having blood supply. It strangulates it from giving venous return. And as we all know, if you did a tourniquet around your leg, if it's firm enough, it'll get blood to go in, but it won't allow blood out, based upon how, how much pressure you put around the tourniquet. Now the tourniquet, again, it'll allow, or the blood that goes in is because the pressure from the heart has more pressure in the arteries.

That's why arteries, when you, like if you got an IV in your artery, it would spurt. That's why they do in the vein, because it's less pressure. Arteries actually can be collapsed with just a nominal amount of pressure. And so sometimes just a little bit of pressure onto a nerve can create the swelling effect. Now, back into the idea of stenosis or the holes. Let's just say, again, if stenosis is an issue, again, with older populations, with people over the age of 60, 70 or so, yeah, this is more common because that's your, um, your quote unquote arthritic aspect to it, which by the way, is not always a big part of it. Um, a lot of times this is, so a normal size nerve is trying to go through an abnormal size hole. However, let's just say if you have a normal size hole, like most of us do, people who don't really have a lot of x-ray and MRI findings of much of anything are going to probably have a normal size hole, but they might have an abnormal size nerve because the nerve is swollen because of the tourniquet. So all we really have to do in simple terms is let the nerve de-swell. And so Michael Shacklock's work of, of, um, of, uh, of de-swelling this nerve is actually pretty darn good. And if the clinicians out there want to learn more about that, I think clinical neurodynamics, his book is pretty darn good. Um, for patients, I think you just really have to find someone who understands what is going on of the, what, what possibilities are happening rather than just looking at the hand. And I don't know if you can tell by what's going on here, but like the conversation, we started talking about the hand, but now we're talking about neck stuff.

And I hope you're being convinced that there's a strong possibility that neck either hole-based stuff or nerve-based stuff or disc-based stuff at the spine is a probable strong relationship to what your hand is doing or even elbow, inner elbow that might look like even golfer's elbow. A lot of this can be related to a spinal-based component. So I hope you're seeing that there's a strong relationship to that. So if you're, if you're seeing somebody who's only working on your hand for the numbness and they haven't looked anywhere above it, maybe you just ask them, just ask them what's going on and say, Hey, uh, you know, I was thinking, I was reading this stuff, you know, about nerve entrapments and, you know, uh, radiculopathies and things coming from the neck that are creating hand numbness.

What do you think? Um, they, they might just take a look, you know, and I've, I've definitely not, um, I haven't investigated everything on everybody. Sometimes I forget. And sometimes, um, sometimes I, I, I forget, you know, or there, there's parts of their history, their examination that don't lead me into thinking that. And so it's always nice when the patient gives me some nice critical information about, um, what they're experiencing. Like, like if you have some neck pain or tightness associated with the hand numbness, that's good information. Do you feel like your neck's tight, um, all the time in this hand numbness, although it might seem unrelated, unrelated, it's, it's, it's funny. It's always on the same side. Have you had shoulder pain on that same side? Um, does it seem like it, um, coincides with shrugging your shoulders up or shrugging them down doing the opposite of shrugging? This is all very useful information for your clinician to make a judgment call on that. Now I'm going to cover next with you guys some things that I really like to use for, uh, treatment. Um, and again, this is the treatment that I prefer to use because it produces very good fruit for me. Your clinician might have different things that they use, but, um, either way, I think discussing with them about what's happening, you know, why we're doing what we're doing, um, is a good starting point. So I'll go over the stuff that works well for me, um, and give you guys some stuff to kind of tinker with just to think about. And, and, uh, although I'm not trying to be your clinician right now, your doctor right now, um, I hope I'm, I'm hoping this is good information for you moving forward. So we're, we're first going to start with some corrections, um, of things of the neck that I tend to use. Now, some of the treatments I really like for, um, the disc of the neck is, um, end range loading, uh, McKenzie's MDT, uh, whatever you want to call it. But, um, for patients that don't quite understand what this is, it's basically exercises you can do at home. Now it is something you can, um, that your doctor can do for you. Um, and a lot of times people with kind of, I would call it like a sticky neck, like a sticky disc. Um, sometimes it doesn't really want to really respond to home care yet, but it doesn't mean you have to ditch it completely.

A lot of movements that you guys do throughout the day, um, are usually driving this problem to continue into the hand. And so I, I'd love to say I can make this thing super complicated, but I really kind of think, you know, over the years, I think I've learned that the body is, um, it basically, it likes movement and it likes a variety of movements. And if we kind of look at what the body's doing a lot of and reverse that, there's a lot of magic in that. Now we sit a lot. Okay. We poke our head forward a lot or a poker chin forward a lot. And we don't look up a lot anymore. And so some of the stuff that people use through some of the end range loading McKinsey MDT work is, um, retractions or doing the opposite of your pigeon, uh, the pigeon, like poking the head forward, just kind of pushing the chin backwards a little bit and giving yourself a little overpressure with the fingers. Uh, we call them double chin or fat faces or ugly kisses.

Just kind of pulling back a little bit. Um, I have some video references on our YouTube page, by the way, you can look up performance place. Um, just look up, look up performance place sports care and you'll, you can go to our, our, you can go to our, our, our channel, which, which gives some examples of some of the things I'm going to be referencing today. So kind of pulling the chin back a little bit is very helpful for a lot of people. Also too, sometimes just taking something like, like, say you're wearing a jacket and if you kind of hold onto the cuff of the jacket, like, uh, right around the, uh, I guess where you'd have a, uh, course course set is what they call it. I think it's, uh, what are they, what do you wear to prom? Um, kind of hold that thing and just simply look up over your head. Now, a lot of times what happens here is that the first couple of reps with people is it's kind of startling. The body doesn't always like reversing what it, what it's been doing. And it's like jumping into cold water. And so sometimes just doing about 10, 10 reps or so, 20 reps is enough to kind of figure out, Hey, do I feel better or not? Are my fingers less numb? A lot of times this bears very good fruit. And I've met a lot of people who all they have to simply do is the opposite of what they've been doing a lot of in the opposite of what they makes them feel worse. Um, or especially in the hand or peripheralize into the hand, um, they do the opposite. It feels better. And it's super, it seems super like, I want to say it seems dumb to like suggest that to people. I always feel like I'm like, they're coming in, they're paying me good money. And they're like, so you want me to do that? That's it? Like you have back pain, I have back pain and you're just telling me to go for a walk.

Yeah, I am because you've been sitting a lot, do the opposite. The body really likes variety. Okay. And a lot of times using this movement, these movements as medication, all we have to do is just dose them. Now, when we usually dose these things, it's just throughout the day. Um, I like to consider these first aid movements because it's not like we want to keep doing these neurotic things all the time. Like let's say if you have back pain, you have to get up every hour and go walk around for 10 minutes. Like a nice, nice habit to have, but it's not sustainable for most people. And a lot of people go throughout life sitting and not having a ton of back pain all the time. They go throughout life sitting and not having numbness in the hands or neck pain. It's, it's, it's, it happens for a lot of people. So I don't want to say this, the devil, but in certain situations for certain people, they, their bodies just had enough. Their body's like, please do something opposite. Please do something different.

And I will reward you with getting unnumb and feeling much better. And so a lot of times through our exam process, we'll, we'll figure out if people are going to respond well to that by orthopedic testing, um, history taking in physical exam. Now, does this require you to have an MRI or an x-ray? No, it doesn't. Is that useful information? Yeah, it's useful. It's also expensive and it's not always needed right away. And it sometimes muddies the situation up. Does everyone need a nerve conduction test? No, they don't. It's good information to have, but a lot of times I'd say a strong majority, I'm going to say a strong majority, I'd say well over, I'd say well over nine out of 10 people I see with hand numbness. I do not require them to get an x-ray or MRI or nerve conduction test because it's not needed yet. When do we need it? Maybe I think we need it when you're not getting better. And a lot of times with these people, I'll get, I'll make them a deal, especially if they have consistent numbness.

Okay. I don't mean intermittent in and out like it's, like it's, it's only like at nighttime or it's only when I sit, but better when I walk around, which is common by the way, if you're noticing that it's, it's, uh, notice those are opposite movements and the body likes movement. So when it's intermittent, a lot of times there's wiggle room, there's the nerve is still getting some of its supply of nutrients. It's still able to, you know, flush itself out periodically. You're not, you're not strangulating it, but just like oxygen, like no one likes to be deprived of oxygen, but, um, you can kind of hold your breath every once in a while and it's okay. So when things are consistently tingly and numb and always painful, I tell these people that we got to make a deal. We got to make a deal because I think the clock is ticking for you guys and I want you to get better. You need to get better. You need to get this symptom to become an intermittent and get out of your hand and into your wrist or out of your wrist and into your elbow and track all the way up like a thermometer, all the way up your arm until it gets to your neck and then it goes away. It needs to happen soon. And so I usually tell them, I want to see you twice a week for two weeks and we need to figure, we need to make sure we get to this quicker than later. I don't want to see that you come in like once, once today and then wait a month and like, no, I think that's, I think it's a bad management on my part to, uh, let you do that.

And is it a money issue? I don't know. I don't need the money for it, but I want to see you get better. And I think this is your best chance. And so mainly because people, again, there's a timeline ticking. If you let the nerve waste away, you will have a very hard time recovering some, some of your hand function. Um, it's called atrophy. Um, if you look up some very disturbing pictures on, you look up, um, uh, ulnar nerve hand atrophy and you'll find these are usually extreme cases, but they're people that just generally have neglected to either find good care or they couldn't find good care or, um, whatever. They just basically their nerve wasn't able to breathe for a little bit of time. So we need to make that correction happen very quickly. Now the other thing surprisingly that works for a lot of people too, especially if they have nerve stuff, um, up into the neck, not necessarily for disc, um, or, or like vertebra disc segment issues up into the neck, which I mentioned before the other two things, the lookups and the, in the fat base usually work pretty well for people is that the, if it's the hole we're talking about and kind of like the nerve is just generally irritated, not because of the disc, it's just generally irritated, but it's intermittent and it's dependent upon neck position and movement. Then we just find a position that makes the neck neck, neck not hurt and makes the hand not numb. Remember the guiding factor in this stuff is what makes the hand better? I've met a lot of people who have misinterpreted what their body's trying to say and they say, well, the hand's just numb. It's not a big deal. It's not painful.

I can't take my neck being, being tight and painful. I can't sleep. Well, the more important thing is you got to get it out of your hand. Okay. You have to get it out of your hand. You have to get it above the elbow. Now, will it increase in pain when it comes up? Maybe. It's still a better of the two evils and there's, we can address neck pain, not a big deal, but if the hand becomes atrophied, then we got a bigger problem at hand. So I usually mention to people again, find a position. It might be looking down. It might be looking up. It might be looking into the armpit perhaps that just makes it so the hand numbness goes away. You might be surprised that a common one is looking away and generally just kind of stretching, lightly stretching the levator scapula muscle. And so a lot of people will kind of put their head down and away and they'll just put their hand above their head a little bit and pull down gently on the head. And when they hold this position for about 10, 20 seconds, a lot of times their tingling will get better. And this is a really good sign. Again, you should be examined. I'm not going to say that you shouldn't be looked at for hand numbness. You definitely should because again, it's a timeline. This is a good sign. You want it to become intermittent.

The other thing which actually helps out with a lot of people is there's a common sign in examination that we do. It's called Bacotti sign. And so when people come in with hand numbness of various parts of the hand, not just the ulnar nerve aspect of it, but you have them put their hand on top of their head and let them leave it there for about 10, 20 seconds and ask them how they feel. And a lot of times when they rub their fingers together up there, they say, hey, it got better. So this is called Bacotti sign. It basically means that yes, your issue is above the shoulder joint. Your issue is above the shoulder joint. If you have this sign, I'm fairly certain. Again, I'm not your doctor, but I'm fairly certain. I'd gamble every penny I have that it is not below the elbow. Okay. So, um, could it be below the elbow? Could you have a double crush? Yeah, it could be, but the central driver of the issue is probably going to be well above the elbow. It's probably into the neck and shoulder area. Uh, and I would double down on that every single time. So, um, those are just some basic things to consider. The last thing, which is, it's kind of nice. It's just different. And, and everybody's sitting probably here. They're probably sitting around. Maybe you're walking and listening to this podcast. But one thing is that if you are sitting, just breathe, just relax, breathe into your belly. So belly breathing kind of on the sides, like you're breathing into your deep into your hip pockets, like you're trying to fill your pockets full of air from your lungs. And you have to breathe that deep down there. Sometimes after about three to five breath cycles of in the nose, three seconds, out the mouth, six out pursed lips, like you're blowing out a little straw. Sometimes just three to five breath cycles really decreases people's hands pain or numbness. Why does this happen? The theory is that the muscles of the neck area, specifically the scalenes work as accessory respiratory breathing muscles. And so what we want to do is deflect some of the effort of breathing away from them so that they can chill out. The whole thing is about wherever the pressure on the nerve is, we need to chill it down and get it to stop before we build some support around the area. Is it at the disc? Maybe. Is it at the neck? A hole? Maybe. Is it at the scalenes? Maybe. Is it at the wrist? Maybe. Either way, wherever it is, you have to decrease it to get this problem to go away in most cases. So I guess before I move on down the arm a little bit, I should address first is, are there things that tissue work that will help up there? Because I didn't mention any.

Yeah, things like tissue work will be helpful, but again, will it stick? The reason I kind of go towards the route of having homework that is movement-based is because they can provide a high dosage. Kind of like if I gave someone an antibiotic, which I can't recommend medication, but I feel like the general understanding is if I had an infection, I go to the doctor, they give me the first pill that they had out of their cabinet, the sample pills of the antibiotic, and they say, hey, here you go. Take this one. By the way, go to the pharmacy and take the other ones. There's going to be five days, five in the first day, and then four, then three, then two, then one. Finish them all okay.

Then you're going to feel better. The same thing applies with some of the dosage stuff that I give people. I like to make it so we can have a bigger impact in the area by having more dosage throughout the day. Granted, can I just have them and do the stuff that I'm doing, have them only do the stuff that I'm doing in my office? I could, but they're only with me for like 30 minutes of the day. They could easily hit a home run multiple times with this thing if they just do a little bit on their own. Now, can they do their own tissue work? Yeah, they certainly can if you teach them how to do it. I usually don't do it too much for teaching people tissue work because they'll make themselves too tender. I'll do some tissue work on day one with people if I see there's a need for it, specifically in some of the muscles around the shoulder girdle and on the sides of the neck like the cervical paraspinal muscles, the scalenes, the pec minor, the levator scapula, the upper trap.

These are all good ones to target with some tissue work to cool everything down because sometimes those things will be contributing factors. Now, another twist on the story is there's a possibility that these spasms that you might be having up there are actually a protective spasm. Think about that. Your muscles are trying to help you. I know they hurt, but the muscles up there might be trying to help you out. And in this case, we got to poke the bear with this type of thought-provoking thing, I guess, is if by removing the muscle spasm or the trigger point, are you now taking away the protection? I would generally say that if the spasm comes back within a couple hours, it's protective. If you do tissue work and it goes away for like five days at a time, you know, three days at a time and it feels good, I think we're probably on the right track with things. But if it comes back very quickly or at least in the next day it comes back, that's probably a protective spasm. And I think we can probably reduce the need for the protective spasm if you reduce the central cause or the central threat. Okay? This is probably going to sound like a tangent, but I promise there's a reason for the story. A lot of times people will wonder why these protective spasms happen and why the muscles guard up. Well, what if I taught you for like six months to be the best walker? Like we're going to teach you how to walk. Walk with pride. You're a speed walker.

You're like, you're just good. You're like, you're a badass walker. Next is now the competition day comes up. You're going to be on the showcase. You're walking the runway. Like you're like Zoolander. You just strutting your stuff. It's a walk off. So I'm going to turn the lights off on runway and I'm going to have you walk. You will not be able to do the same thing, the same technique, the same form, the same proudness that you had before because there's a threat of falling. Is the threat real? Yeah, probably. You might be wearing some slippery shoes and you're on a slippery runway, I think. That's how you can do all those spinning things and stuff. But what happens is as long as there's a threat involved, a bigger threat, the muscles will spasm up. They'll tighten. And so I don't know if you can feel yourself walking that runway, but when there's a threat of slipping and falling, your muscles generally tighten up. It's kind of like walking on ice. It's just slippery and you kind of tighten everything up. There's nothing wrong with it again, but reducing the threat of slipping and falling and turning the lights on, you'll probably walk perfectly fine again and all the tightness will go away. And so if we can get the body in the neck, in the holes or whatever's the problem higher up or higher importance, usually within the nervous system where the nerve has pressure on it, the muscle spasms will naturally go away. You don't have to do anything to them. Now, if you've had this for a very long time, yes, we have a bigger need to address those tissue adaptations that have occurred because a lot of times the muscles will build and you build a lot of tension and habits. I guess people say muscle memory. I don't think that's a thing, but it's an easy thing for people to remember that their muscles kind of have this default setting or their nervous system tells their muscles to protect. And so it becomes more of a dominant pattern or a dominant habit and it's harder to break. So a little bit more manual therapies require. So those are the central talking points again for the most common. I mean, I gamble, I gamble almost all my money on this is that most of the time if I were to be blindfolded and somebody comes in with hand numbness, usually it's going to be a neck disc or a nerve that is exiting the spine or something above the shoulder if I'm going to gamble on it. Now, trauma is a wild card, okay? Trauma is a wild card in this if you slip and fell or if you had a surgical intervention. These things are different. So if you had wrist reconstructive surgery and then your hand got numb, there's other aspects to this that is outside of the norm. And I honestly don't work with a lot of people in those situations because they just, I guess, don't come in. And I don't see them much. Like we don't work on post-surgical cases. We don't work on trauma cases. Anyone with a broken bone, I refer them out until they're cleared by their orthopedic to do rehab with us. But there's other considerations below. And it's probably important at this point to note that the nervous system slides. Nerves slide, nerves move. And healthy nerves will be able to move quite a bit when you move your arm. The arm, a lot of times, again, the tension will increase as you reach up and above your head. And a lot of times people are familiar with nerve stretches. And these nerve stretches are putting the nerve at tension, okay? But there's also nerve sliding exercises too. So most people are familiar that nerves do slide and they do stretch in their dynamic structures. They're not just sitting there like fishing line. I guess fishing line does stretch. So at some point, it might be a good idea to restore that movement. Now, would we do that before taking the pressure off the nerve? Well, I think it'd be really hard to slide a vacuum cleaner cord if there was a knot in it and it was stuck in like a little mouse hole between like under the wall. So it'd be really hard to slide it in that fashion. I would rather not yank it to get it free because nerves don't like a lot of tension. I think it's 8% is the normal. So it doesn't like a lot. And they like even less when they're under threat. So I think a better idea is, again, just first state it. Chill it down. Chill everything down. Get it so the nerve gets happy again. And then you can start sliding in again a little bit later. I tend to not do a lot of sliding and nerve stretches with people, especially early on. I've done some, but I've not done a lot of them because most people get better without having to actually do them. And the surprising thing that if you guys have been looking for a bunch of things on YouTube and, you know, the internet to see what works for nerve stuff, surprisingly, I've had a lot of people come to my office stretching a nerve that is already irritated. Again, they don't generally like a lot of tension anyways. They can tolerate tension. But certainly when they're irritated and they're numb and tingly, don't stretch it. Like people with sciatica, like with leg pain, with foot numbness or with like searing leg pain, a lot of times they'll try to stretch out their hamstring, which is a big no-no in most cases. And it actually makes it so their condition progresses and makes it worse. So I don't think anybody at home should be doing nerve flossing stuff unless they've seen anybody for it. And it's been deemed okay and it's been shown.

And plus, sliding stuff of the legs of the lower extremity of sciatica, they can certainly slide certain things. And it's generally safer because the movements are less complex. I'm sure you've watched a video where it's like someone's doing this, you know, like twisty movement with their wrists and they try to put the little circle around their eye and they're like, I mean, it's just, it's complicated movement and it's very specific. So I don't think I would have a lot of people do that at least in the beginning. So if you're encountering that and it's not working for you, I would ditch that thing right away and maybe encounter it later, use it later when things have calmed down a bit. Now, as we start moving our way down in from the shoulder and from the, or in the elbow and wrist, the, those common entrapment points there, again, uh, I would say that these ones, there's tests that you can do locally to see if there's any possibility of it happening there. Um, and they're usually called 10 L's sign. And so you basically just kind of hold pressure on where the nerve passes. But remember the whole nerve from the spine is the same nerve.

Okay. So if it's pissed off, it'll piss off the entire path. So just because you create pressure on it doesn't mean that that's the spot. I cannot stress that enough. If you put pressure on the cubital tunnel or the tunnel a guy on and it creates the, it increases the tingly, it does not mean it's the spot. It's just information. So, um, there are tests that people can do. Um, this is nothing you can do on your own, Sally, but there's a upper limb tension test or neurodynamic test, which will show beyond reasonable doubt what it's creating the numbness if it's intermittent. Um, so, uh, basically you can see beyond reasonable doubt that hand numbness will be increased or decreased with head movement or shoulder movement. And all that means is it's, it's happening above. Okay. There's no reason to chase it down past the elbow too much now into the area of the, of the actual elbow and the wrist. If the, if the area of entrapment is, is right there, I like to do local tissue work to decompress the area. Also to another thing I like to do is, um, also tape people in positions, which open tunnels there. Again, if the theory is that there's compression there, what is creating the compression? And so if it's a tunnel, again, most of these tunnels, again, they're created usually by bone on some sides and then soft tissue on another ligaments on another side, say, um, then what we can do is we can close, we can, we can close the hand down, let's just say a little bit. And then they'll do this with cyclists with tape jobs is they'll close it down a little bit. So there's not as much, uh, so there's a little more room within that dynamic bony tunnel. It's not, it's not a fixed tunnel either because there's, it's, it's the borders are multiple bones. And so you can move things and let it de-swall there as well. At the wrist, a lot of times, or sorry, at the elbow, a lot of times it will bother the people with numbness in the fourth and fifth digit. Again, if you have numbness or, or issues into the other digits, like the ring, or sorry, into the thumb, the index, the ring, or the middle finger, then we're looking at a different, um, nerve. So this would not apply because again, remember those, the dynamics are a little bit different. They change.

Wrist and elbow movements in positions are specific to the nerve or addressing hand here. And so sometimes what works with people that actually have, um, pain when they bend their elbow, like, and they put their elbow maybe on a, uh, on something hard and just irritates it. Again, that's mechanical pressure. Uh, it can be still from the top. It doesn't mean it's at the elbow, but if bending the elbow bothers the fingers, what we could do is just tape them slightly out of the bend that creates the finger numbness. Again, just taking away the movement, which creates the problem. Again, this is people who are intermittent. They're not consistent. And so if you're listening to this, you're like, I don't, I can't figure out. It's all, all the time. Then, then it's all the time, you know, but if there's things that make it worse and better than there's things that make it worse and better. And that's something I would start writing down in a little diary and just documenting it for when you go and talk to your doc. And if the elbow bend bothers it, a lot of times people will figure this out when they're sleeping. Elbow bend bothers it and they'll start to straighten their arm elbow and it'll go away. So one simple thing is you can take something like, um, most people have some type of rock tape or, um, kinesio tape that they can use, which is not the best by the way, for this type of application. Tapes are all used for different things.

Um, I prefer like a leukotape and a cover roll, not just leukotape on the skin because that would really piss off the skin. Um, but you can tape them so they don't go into full elbow flexion, which will decrease tension on the nerve, which feels good. So we want to do things that feels good. It sounds really stupid, but do what makes your hand feel good and probably do it a lot. Um, now if you guys are looking for more suggestions on this stuff, again, actually, you know, I should, I should retract on this before, uh, before I, before I, uh, go into too much. Um, I, I want to, I want to say that, that people who have the numbness again, uh, I've mentioned this over and over again, and I believe in saying things multiple times just because, uh, sometimes you hear it, sometimes you don't. If it's getting worse, you need to, you need to go see somebody.

Okay. If you feel like you can't pick up little objects, you need, you definitely need to go see somebody. If you can't button your shirt, you're dropping keys. You need to go see somebody. Um, these are things we call as, as red flags. And in the articles that I've written on my website, again, in the show notes, if you need them, uh, I've, I've referenced all these things for you guys. Um, it's always a good idea to go see somebody, but these are the things where it's like, holy shit, you need to start, you need to start addressing these things. Now, um, if you're wondering about more information that, that I have about what to do next and, um, what's a whole game plan for something like this, I, because I've gotten so many people who have looked at the articles on ulnar nerve on my website, I've created just a massive ebook. Um, it was, it was funny. It used to be a small book. It used to be like, it was just five exercises that were references of what we did at the office. Some of the things I mentioned in this video. And, um, it was just like five links and we, we sold it for a little bit of money. It was not much, but also too, it was a blank PD.

It was a PDF that just had like five links on it. It was just kind of like, here's what we do. Um, someone didn't like it one day and, uh, they said, why would I pay 15 bucks for something like this? And I thought, well, these exercises are great ones, but you're right. I could do better. I did better. And there's a hundred page ebook I put, I put on this thing. So it's E it's not physical book. Um, and then we changed it over to a web, a webpage version so I can make changes as needed. And we didn't have to keep asking people to look at the new copies and so on. So we update it on the website all the time. Um, and I'll keep updating it over time. And if you guys are looking for that, I will put it in the show notes, but I would venture to say that I know that it's very challenging for everybody to go through and research all of these things. And as you see with listening to this podcast, it's, it's, you're probably thinking, wow, there's a lot of parts to this that I did not consider my head spinning. I just want to go watch lost, you know, and, and I totally get it. I want you guys to read through on your own timeline. I think this is something you should look at something you should get. And the reason is, is because rather than digging through all these random sites, um, they have old information, not updated. Again, we, I update this rather than getting old information, uh, about numbness of the hand. I put it all in one place. It's like a hundred pages. Okay. It's pretty. It's funny though, when people have read it now, they're like, wow, why is this so long? Why can't it just be like a page or two? I'm like, Oh dear God. Like I, I just, we just came from there, but it has video references. It has links and so on, but it's, it's, I mean, you have, I even drew pictures in there so you guys can get a good idea of entrapment site locations and like things like that. So, um, it really actually brought me back to, I used to do a lot more art. I was drawn a lot when I was a kid, so it was kind of fun to do. And so, um, all the, you'll see how the drawings are actually mine. So if you guys are looking for that, um, reference, then I will put it in the show notes and, um, feel free to look through and hopefully you like it and hopefully it saves you a lot of time and effort looking through all these random webpages. I don't know how many hours of my life I've probably spent looking through YouTube videos, which I really wish someone would organize it for me there. So, um, if you're in a Huntington Beach, California, feel free to reach out to me or if you're looking for someone to help you out, um, just email me. It's info at P2 sportscare.com. Again, info at P the P the letter to the number sports is plural care.com. Uh, I'd love to help you guys out, uh, any way that I can. And, um, thank you everybody for listening to the podcast. This is, um, it's always fun to do. Uh, it's always a little bit of a challenge to do, um, solo podcasts because I have to say everything and you can't just spitball off somebody else. So, um, hopefully you guys like these solo podcasts and it provides enough good information that you can share with somebody else. So again, this podcast only gets promoted when you promote it. So thank you for being part of the movement and I'll see you guys next time.