The ulnar nerve provides sensory and motor innervation to your little (5th) finger and half of your ring (4th) finger. The ulnar nerve is part of a bunch of nerves called brachial plexus, which allows you to bend and move the fingers as well as the hand and forearm. When the ulnar nerve is compressed or damaged, symptoms of ulnar nerve neuropathy may ensue. This condition is called ulnar nerve entrapment or ulnar nerve compression, which is often a painful disorder. It can also cause weakness of the fingers, or ulnar nerve palsy.
Symptoms of Ulnar Nerve Entrapment
Ulnar nerve entrapment can cause mild transient symptoms, such as numbness to weakness and clawing of the ring and small fingers. It can result in progressive loss of sensation and motor function of these fingers, with symptoms such as:
- Tingling or burning sensation in your fingers
- Numbness of the fingers
- Loss of hand coordination
- Weakness of the hand
- Weakness worsened by physical activity
- Loss of strength when gripping
These symptoms can affect your ability to do ordinary things in daily life, such as holding a glass of water. Over time, without adequate treatment, your hand may look like a claw.
Causes of Ulnar Nerve Entrapment
Various factors may contribute to ulnar nerve compression. These may occur alone or in combination and lead to ulnar nerve entrapment.
- Ulnar nerve entrapment most commonly occurs when a direct impact affects the long nerve as it passes along the arm below the elbow. The most common cause is a fall that leads to a direct impact, which may injure or compress the nerve. Direct damage to adjacent tissues may cause inflammation and swelling, which may compress the nerve.
- Damage to adjacent tissue may also result from overuse that usually involves excessive gripping. Over time, this causes tissue inflammation, chronic swelling and scar tissue formation, thus placing pressure on the ulnar nerve.
- Ulnar nerve entrapment may also result from excessive traction on the nerve. This is common in athletes who perform repeated throwing actions. Their elbow is subjected to excessive forces during the cocking act while throwing.
- The ulnar nerve may also be compressed due to over development of an arm muscle due to weight training.
- Bony irregularities or spurs that develop within the groove in the elbow may contribute to compression of the ulnar nerve. This is common among athletes who sustain overuse injuries in the elbow.
- A previous history injury involving the shoulder, neck, upper back, wrist, or elbow may increase your likelihood of developing ulnar nerve entrapment.
Other factors that can increase the risk of ulnar nerve entrapment include:
- Excessive physical training
- Excessive muscle enlargement in the arm
- Muscle tightness
- Muscle weakness
- Joint tightness
- Poor sporting techniques
- Inadequate warm-up
How to Manage Ulnar Nerve Entrapment
1. Conservative Treatment
Your doctor will recommend nonsurgical treatment if your symptoms are transient and mild, and probably caused by blunt traumaormal position. These include:
- Non-steroidal anti-inflammatory drugs. These include medications such as ibuprofen to reduce swelling and pain around the nerve.
- Steroid injections. These include cortisone, which is very effective in reducing inflammation. Injecting steroids adjacent to the ulnar nerve is not used often because of the risk of damaging the nerve.
- Nerve gliding exercises. Your doctors may prescribe exercises to help your ulnar nerve slide into the elbow tunnel and the Guyon's canal in the wrist to improve symptoms. These special exercises may help keep your arm and wrist from becoming stiff.
- Bracing/splinting. You may be advised to use a padded brace or splint at night to keep the elbow in a steady straight position.
2. Other Home Caring Tips
Here are more tips to help relieve symptoms of ulnar nerve entrapment or ulnar nerve palsy:
- Avoid doing activities that require bending your elbows for long periods.
- If you are using a computer frequently, maintain a proper posture and good ergonomics, making sure that your chair level is not too low and your elbow is not resting on the armrest.
- Refrain from leaning on your elbow or applying pressure on the inside of the arm. This includes avoiding resting the arm on a car window while driving or using the elbow to lift your body while rising from bed.
- When sleeping, try to keep your elbow straight by wrapping the elbow with a towel or by wearing elbow pads backwards.
3. Surgical Treatments
Your doctor may recommend surgical treatment to relieve pressure off your ulnar nerve if:
- Conservative treatments do not improve your condition.
- Your ulnar nerve is severely compressed.
- You have developed muscle wasting.
Talk to your orthopedic surgeon about the options involved in treating ulnar nerve entrapment. Most procedures are done on an outpatient basis, although some patients may need to have an overnight stay at the hospital. These include:
- Cubital tunnel release. This involves cutting the ligament above the cubital tunnel to increase its size and decrease pressure on the ulnar nerve. This procedure works best when nerve compression is mild and the ulnar nerve does not slide out of the bony ridge in the elbow when it is bent.
- Anterior transposition of the ulnar nerve. This procedure involves moving the ulnar nerve from its place behind a bone called medial epicondyle to a position in front of it. This prevents the nerve from getting caught on the ridge of the bone and stretching as you bend your elbow. The nerve is moved to lie either under the skin and fat (subcutaneous transposition), under a muscle (submuscular transposition), or within a muscle (intermuscular transposition).
- Medial epicondylectomy. This involves removing a portion of the medial epicondyle to prevent the ulnar nerve from getting caught on the ridge and stretching it when you bend your elbow.