Ulnar Neuropathy of the Elbow
Ulnar neuropathy of the elbow is a condition that causes irritation of the ulnar nerve at the elbow.
The ulnar nerve is one of the three main nerves going to the muscles of the forearm and the hand, and supplying feeling to part of the hand. In its course from the spinal cord to the hand, the ulnar nerve travels behind the elbow in the region of the “funny bone.” There it is often compressed or injured.
There are a number of causes of compression of the ulnar nerve at the elbow. These include:
- Direct injury. A blow to the inside of the elbow can injure the nerve. It lies close to the surface. Leaning on the inside of the elbow, or resting it on a table top or car door handle for long periods may produce irritation of the nerve in some people.
- Tumors can cause pressure on the nerve and irritate it. Occasionally, unusual muscle formation causes pressure on the nerve.
- Bone spurs caused by arthritis or old injury can compress the nerve.
- Abnormal angulation about the elbow joint may cause stretching of the nerve.
Signs and Symptoms
The ulnar nerve supplies feeling to the small and ring fingers of the hand. It supplies many of the small muscles in the hand responsible for gripping and fine dexterous manipulation, as well as muscles in the forearm. Irritation of the ulnar nerve can cause pain or numbness and weakness of the muscles supplied by it. If the condition persists over long periods of time, weakness and atrophy of the muscles of the hand may result, and the numbness may become permanent.
Resting the arm in a position which causes pressure over the nerve usually exacerbates the symptoms. Straightening the elbow may partly alleviate the symptoms, while bending the elbow may aggravate them.
Other conditions may mimic the symptoms of ulnar neuropathy of the elbow. Compression of the ulnar nerve anywhere along its course from spinal cord to hand, including in the axilla (arm-pit), neck or wrist, can cause similar symptoms. Thorough testing in the office, sometimes supplemented by nerve conduction tests and EMGs or other studies may be warranted if the diagnosis is in doubt.
In early cases of ulnar neuropathy of the elbow, identification and elimination of predisposing factors such as repetitive injury to the elbow, frequent resting on the elbow or prolonged elbow flexion may alleviate the symptoms. Reducing external pressure of the nerve by wearing a padded elbow stocking may help. If symptoms occur at night, wearing an elbow splint to prevent bending of the elbow, and resting the elbow on a pillow may be helpful.
If symptoms are severe or if the conservative measures fail to bring relief, surgery can often help. The goal is to reduce pressure on the ulnar nerve.
New minimally invasive techniques may be appropriate for ulnar nerve release in many circumstances. As with all minimally invasive techniques, we strive for less soft tissue trauma, less invasive procedures and quicker recovery times.
After surgery the patient’s arm will be placed in a compressive dressing for one to two weeks. During this time it is essential to elevate the hand and arm and exercise the fingers often to prevent swelling. The arm may be immobilized in a cast or splint. Elbow motion will usually be started no later than three weeks after surgery.
It will usually be six to twelve weeks before vigorous activity can be resumed. Full recovery will take longer. If numbness or weakness were profound before surgery, they may not fully recover. As in all surgery to relieve pressure on nerves, longstanding nerve damage may be irreversible. However, relieving pressure on the nerve is the best hope to prevent further progression of the disease.