Ulnar nerve entrapment occurs when you have too much pressure in the nerve that crosses your elbow from muscles, bones, tendons or cartilage and the ulnar nerve becomes inflamed and irritated. This is also called cubital tunnel syndrome or ulnar nerve compression. It is a pinched nerve in your elbow that can cause numbness, weakness or pins and needles sensations in your arm and hand. This ulnar nerve supplies feeling and movement to the pinky side of your hand. The ulnar nerve travels into the wrist which is another site the nerve can become inflamed. A physical exam will indicate ulnar nerve entrapment and imaging tests can further show the damaged areas. Ulnar nerve entrapment may heal on its own or require conservative treatment like rest, wearing an arm brace, or taking anti-inflammatory medications. More severe nerve injury or failure to improve after 6 months may require an ulnar nerve decompression procedure to decrease pressure on the nerve and restore function. Getting an accurate evaluation and appropriate care will help you get better as quickly as possible.
The first thing you might notice with ulnar nerve entrapment is that your hands may feel weak and you may have trouble grasping or picking things up. You may lose strength and flexibility in your pinky and ring fingers. Holding your hands by your sides and not over your head or shaking out your hands may temporarily make this feel better. You may have burning or tingling in your hands and fingers which can extend up your arm. When you hit your elbow “funny bone” and feel tingling that is your ulnar nerve. The elbow may be tender. The arm may be hypersensitive to cold. Your pinky and ring finger may look deformed. Repetitive motions may cause pain and cramping in the wrists and hands. Symptoms tend to worsen with more bending the elbow and better with arm straightening. You can have permanent muscle and nerve damage with severe or untreated ulnar nerve entrapment. Before this point you should seek medical attention. If you have persistent symptoms of ulnar nerve entrapment for over one month you should contact your physician.
The ulnar nerve is very close to the skin by the elbow which makes it vulnerable to injury. Prolonged pressure on the elbow like resting on your elbows may irritate the nerve. You may not know exactly how you came to have the symptoms from ulnar nerve entrapment. Repetitive motions like playing tennis can cause ulnar nerve entrapment. Anything that creates inflammation in the ulnar nerve can irritate the median nerve which slows nerve impulses to and from your hands to both weaken and decrease sensation. Bursitis is a fluid collection from inflammation in the bursa sac on the point of the elbow that can irritate the nerve. Bone spurs, a broken elbow, arthritis and just having the ulnar nerve slip out of its groove can cause symptoms. Conditions like obesity, hypothyroidism, hypertension, diabetes and rheumatoid arthritis have a higher risk of ulnar nerve entrapment.
Your doctor will perform a complete history and physical exam that will evaluate you for your source of your pain and discomfort. A history of heavy lifting or the time of onset is important. Your arm, hand and finger nerve function will be evaluated along with and muscle strength and skin sensation. The doctor should check if the ulnar nerve stays in its groove around the elbow with bending.
Imaging tests can help your doctor identify injured areas of spinal bones and muscles. X-rays of the elbow may be used to look for fractures or bone spurs around the ulnar nerve. An ultrasound uses sound waves to create a picture inside to look for swelling or inflammation. An magnetic resonance imaging (MRI) exam uses powerful magnets and radio waves to create a detailed picture of soft tissue of the muscles, soft tissue and nerves. Contrast dye may be used during the MRI to better evaluate the area of inflammation. Nerve conduction studies look for nerve damage by using electrodes to measure how quickly a nerve impulse is transmitted. An electromyogram uses needle electrodes to look for muscle damage. Evaluation of your strength and sensation may be monitored on a regular basis to look for improvement and imaging tests may be repeated as well.
Treatment of ulnar nerve entrapment depends on how far the syndrome has progressed. Mild cases will frequently improve within a few weeks or months. Resting or limiting the repetitive motions that caused the syndrome are important. Stretching, strengthening or “nerve gliding exercises” through the wrist and elbow given to you by a physical therapist can help the nerve move more easily. An elbow pad can prevent pressure on the nerve when resting your elbow. Wearing a splint to immobilize the wrist and elbow while working or sleeping can take pressure off of the nerve. Over-the-counter medications like ibuprofen (Advil, Motrin) or naproxen (Aleve) are NSAIDs (nonsteroidal anti-inflammatory drugs) that can decrease pain and swelling. Muscle relaxants and nerve pain medications can also be used. Steroid injections can decrease pain and inflammation. An occupational therapist can help you with skills to improve daily functioning when there is prolonged pain or weakness.
Surgery may be needed if your ulnar nerve entrapment is severe with obvious injury or if conservative treatments do not provide pain relief or improve symptoms. The goal of a surgical procedure is to take pressure off of the ulnar nerve. An ulnar nerve anterior transposition will move the ulnar nerve so it no longer is stretched over the bony elbow joint. A medial epicondylectomy takes the bump inside of the elbow joint to decrease pressure on ulnar nerve. A cubital tunnel release is the removal of a portion of the compressed tube that the ulnar nerve is travelling through. If the ulnar nerve is compressed at the wrist then a wrist incision is performed to relieve pressure on the nerve. These are short procedures and you will be able to go home about an hour after surgery. Our neurologists can let you know if you are a good candidate for nerve surgery. Physical or occupational therapy may be required to improve strength and coordination after surgery with return to full activity in about a month.
Ulnar nerve entrapment can have symptoms that are mild to debilitating. The Norelle Health neurosurgeons are highly trained and skilled in the diagnosis, management, and treatment of ulnar nerve entrapment. Our neurosurgeons can provide the optimal treatment. Neurosurgery is considered essential by insurances and should be covered with your plan. As out-of-network providers, we will check your benefits for you and let you know what they are so there are no surprises. We use an individualized treatment plan for your concerns to provide a personalized holistic plan of care. If you would like assistance, please feel free to contact us (link to contact page) or call our office (link to phone number).