What is ulnar nerve compression?
The ulnar nerve is one of the major nerves that supplies the muscles of the hand. It also provides feeling for the little and ring fingers. If you’ve ever hit your funny bone and felt a tingling sensation down to your fingers, that’s your ulnar nerve.
The ulnar nerve runs the full length of the arm, passing around the inside of the elbow through the cubital tunnel, which is formed by the ulnar bone, muscles and tendons. If your nerve becomes compressed (otherwise known as entrapped or pinched), you will usually feel numbness and tingling in the little finger and ring finger.
Compression at the cubital tunnel may be due to bursitis (inflammation of the fluid-filled sac in the joint) or putting pressure on the elbow joint by leaning on your elbows for a long time or even sleeping with your elbows bent. It may also be due to injury such as fracture or dislocation.
What are the symptoms of ulnar nerve compression?
Symptoms of ulnar nerve compression are:
- weakness of your hand grip
- numbness or tingling of your hand, especially of the ring finger and little finger
- tenderness of the elbow and of the hand
- increased sensitivity to cold in the affected arm
At first you may only notice symptoms when the elbow is bent. If you sleep with your arms bent, then you may wake up with pins and needles in your fingers.
Without treatment, there may be permanent nerve damage. This can lead to wasting of the muscles supplied by the nerve.
What does your doctor look for?
Your doctor will start with asking you about your medical history and your lifestyle. Your doctor will also do a physical examination of your arm looking for:
- signs of muscle wasting
- numbness of the ring and little fingers
- irritation on tapping on the nerve at the elbow and possibly the wrist
- weakness of grip strength
What investigations are needed?
Your doctor may request anX-ray to look for bone spurs or arthritis.
Your doctor may also do what’s called a nerve conduction study. This is where the speed of conduction through the nerve is measured at the level of the elbow and at the wrist. The test takes about 20 minutes to complete and is slightly uncomfortable to perform.
How is ulnar nerve compression treated?
Treatment options for ulnar nerve compression include:
- non-drug therapy (egphysiotherapy, a splint or brace, an elbow pad worn at night, nerve-gliding exercises)
- medications (eganti-inflammatories, joint injections)
Our specialists at Orthopaedic Clinics Gold Coast will work with you to create the best treatment plan for your particular situation.
Surgery for ulnar nerve compression
If your symptoms don’t improve with non-surgical treatment or your symptoms are severe, surgery may be necessary. This is frequently performed as an open procedure. Although a number of different operations are proposed, the evidence suggests that for most people a simple decompression of the nerve will produce good results.
In some circumstances, if the nerve is unstable or under tension, it may be required to move the nerve. Very occasionally, some of the bone of the cubital tunnel may be removed to reduce the tension of the nerve.
The outcome of surgery is usually very good but it depends on the grade of disease at the time of surgery.Splints may be needed after surgery, but most people will be able to return to driving by approximately two weeks after surgery.
The aim of surgery is to stop the symptoms from getting worse, but total recovery cannot be guaranteed. Some patients will still have some symptoms after surgery, although most patients will claim this is a successful procedure.
Some complications, specifically related to this surgery include infection (which has less than a 1% chance), damage to the very nerve we try and release, which can become painful, and recurrent symptoms which may require future surgery. Repeating surgery on the same site is less likely to provide a good outcome and may not be in your best interests.