Disclosures: James B. Meiling, DO: No financial relationships or conflicts of interest

Case Diagnosis: Ulnar neuropathy secondary to prolonged handcuff use

Case Description: A 40-year-old left-hand dominant tattoo artist presented with right-hand numbness and weakness after prolonged handcuff use. Three months prior, he was arrested and spent multiple hours with both hands handcuffed behind his back. Later that same evening, he had his right hand handcuffed to a hospital gurney for several more hours. He suffered significant skin injuries to the ulnar side of the right wrist, immediate claw-like posturing of his fourth and fifth digits, and numbness of the same digits. Since the original injury, he showed improvement and no longer exhibited claw posturing, but still endorsed some right-handed weakness, numbness, and clumsiness. He had decreased right-handed grip and pinching strength, decreased light touch sensation on the palmar aspect of the right fourth and fifth digits, and a positive Tinel’s over Guyon’s canal on the right. He was diagnosed with right ulnar neuropathy, just proximal to Guyon’s canal, sustained from prolonged compression and damage secondary to handcuff use.

Setting: Outpatient hand clinicAssessment/

Results: His symptoms improved with time and would likely continue to improve with natural healing. Opted for simple observation.

Discussion: Handcuff neuropathy is most commonly due to prolonged compression or trauma of the superficial branch of the radial nerve (SBRN) near the wrist. Much rarer is involvement of the ulnar nerve, which occurs by similar mechanisms. However, unlike a sensory-only SBRN injury, damage to the ulnar nerve also affects motor innervation to many intrinsic hand muscles. Injury to the ulnar nerve at the wrist can provoke serious motor impairments and functional challenges which require time, rehabilitation, and potentially surgery to fully recuperate.

Conclusion: Although rarer than the commonplace counterpart, ulnar neuropathy can be a serious and potentially devastating side effect of prolonged handcuff use due to the subsequent impairments of the ulnar-nerve-innervated intrinsic musculature of the hand.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/ulnar-neuropathy-secondary-to-prolonged-handcuff-use-a-case-report/