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Electrodiagnostic / Neuromuscular Medicine

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301 - A Report on Restraints: An Investigation of Ulnar Neuropathy Post-Handcuff Placement

Thursday, February 22, 2024
5:00 PM – 6:30 PM EDT
Case Diagnosis: Right-sided ulnar neuropathy with concurrent bilateral median neuropathies.

Case Description: A 54-year-old male presented to a physiatry clinic reporting numbness and tingling in both hands. He had pre-existing paresthesia in all left-handed digits but began experiencing paresthesia in his right hand after being handcuffed following an arrest. The patient described that he was handcuffed with his hands behind his back and his wrists forced into flexion. He was then seated in the back of a police vehicle, where his body weight placed significant pressure on the medial border of his right wrist.


Nerve conduction studies (NCS) demonstrated prolonged latencies and decreased amplitudes of the median sensory nerves bilaterally. The right ulnar sensory nerve did not respond to stimulation across the wrist, but the right dorsal ulnar cutaneous nerve retained normal latency and amplitude with stimulation. All other NCS findings were within normal limits and electromyography studies were normal.

Discussions: The patient’s electrodiagnostic evidence of a right-sided ulnar neuropathy of the wrist, coinciding with the patient’s prompt onset of symptoms, indicate ulnar nerve injury secondary to compression. The patient’s description of immediate paresthesia in the right fourth and fifth digits following handcuffing, along with no response on NCS findings of the right ulnar nerve across the wrist, suggests entrapment within Guyon’s canal. In addition, the findings of bilateral median neuropathies across both wrists, suggestive of pre-existing carpal tunnel syndrome, may have been further exacerbated by the compressive injury.

Conclusions: Handcuffs present a high risk for ulnar nerve compression considering the force placed at the wrist. Physiatrists should retain a high index of suspicion of ulnar entrapment at the wrist in the setting of ulnar neuropathy symptoms following recent arrest.