How does ulnar neuropathy develop?
The ulnar nerve is located in a groove behind the bony prominence on the inner aspect of the elbow (the medial epicondyle). The edges of the groove are spanned by a band of tissue forming a tunnel (the “cubital” tunnel). The nerve may be subject to pressure, stretch or irritation from friction in this location from a number of different causes such as bone spurs, soft tissue swelling, synovitis or bleeding and lumps. The nerve may also be subject to external pressure such as persistent leaning on the elbow or may sometimes develop as result of an injury or a fracture. Sometimes the nerve may slip in and out of its groove (known as a “subluxing” ulnar nerve). Over a period of time the pressure on the nerve may affect the ability of the nerve to transmit electrical signals leading to impairment of the function of the nerve resulting in symptoms.
How is ulnar neuropathy at the elbow diagnosed?
The diagnosis of ulnar neuropathy is based upon the history of tingling and numbness affecting the little and ring fingers. Symptoms are often worse at night and may disturb sleep. Some individuals may experience weakness in the hand. Examination may demonstrate diminished feeling to light touch over the little and ring fingers. Shrinkage (or wasting) of the small muscles in the hand may be observed along with weakness when testing strength. Tapping the nerve behind the elbow may reproduce the tingling (“Tinel’s sign”). An x-ray may show bone spurs. Nerve conduction tests will be requested to check the function of the nerve and may give an idea about the severity of the condition. Occasionally an MRI scan of the neck may be requested to rule out a trapped nerve in the neck.
How is ulnar neuropathy treated?
In the early phase, pain may be controlled with the use of pain relieving or anti-inflammatory medication.
Nonsurgical treatment: If the condition is mild it may resolve naturally.
Postural adjustment and splintage: Pressure on the nerve may be minimised by avoiding leaning on the elbow or resting the elbow on a high armrest whilst sitting. Modifications in the work environment may be necessary to ensure that the elbow rests in a comfortable position when using a keyboard. A splint may be prescribed to be worn at night to avoid putting pressure on the nerve when the elbow is flexed.
Medication: Non-steroidal anti-inflammatory medication may be prescribed to help reduce swelling around the nerve and to treat the pain.
Physiotherapy: Manual mobilisation of the nerve at the elbow may sometimes help alleviate the symptoms.
Surgery: Surgery may be considered if the condition is severe such as when there is noticeable muscle weakness. Surgery may also be considered if symptoms have not responded to simple treatments such as medication or splintage or indeed if the symptoms are worsening. Surgery is often effective at relieving symptoms. If the condition is severe, surgery may not relieve all the symptoms but will prevent worsening of the condition. For further information on surgical treatment, please refer to the section on “Surgery for Ulnar neuropathy at the elbow”.