Home to the “funny bone” part of your arm, your ulnar nerve runs from your neck and through a tunnel of tissue at the inside of your elbow. Our ulnar nerve travels beneath the forearm muscle and down into your hand, enabling sensation in your little finger and half of your ring finger. It also controls most of your hand muscles that produce fine movements. The expert providers at the Rochester Regional Health Orthopedics Upper Extremity Program will help you regain nerve function through surgical and non-surgical treatments carefully crafted around your needs.
A complex joint that allows for straightening and bending (extension and flexion), forearm rotation (pronation and supination), your elbow is formed by the joining of three bones: the humerus, the ulna, and the radius. Your elbow is a combination hinge and pivot joint held together by muscles, ligaments, and tendons that make it possible for us to bend like the hinge of a door and pivot to rotate and twist.
Your ulnar nerve is close to the skin when it moves through your elbow, which is why the shock you experience when bumping it is often called “bumping your funny bone.” Traveling from your neck and down into your hand, the ulnar nerve is responsible for controlling many small muscles, including those that help form a grip and produce fine finger movements.
Cubital tunnel syndrome, or ulnar nerve entrapment, occurs when your ulnar nerve becomes irritated or compressed. It can happen anywhere along where your ulnar nerve runs, but it most commonly occurs behind the inside of your elbow.
Symptoms of Cubital Tunnel Syndrome include:
While the exact cause of cubital tunnel syndrome is not known, several things can put pressure on the nerve at your elbow. These include fluid buildup, a direct blow to the inside of your elbow, repeated or prolonged bending of your elbow, leaning on your elbow for long periods, and an ulnar nerve that slides back and forth. Prior fractures or dislocations, bone spurs or arthritis of the elbow, swelling of the joint, and activities that require repetitive bending or flexing of the elbow are all risk factors for ulnar nerve entrapment.
During your consultation, you and your orthopedic surgeon will discuss your symptoms, medical history, activities, sports, and hobbies, and thoroughly examine your hand and arm. A series of specific tests will be used to determine which, if any, nerve is compressed, as well as the exact location. These tests include: tapping over the nerve at the funny bone, bending your elbow, moving your arm, neck, shoulder, elbow, and wrist in certain ways to determine which positions cause symptoms, and checking for strength and feeling in your hand and fingers.
Additionally, X-rays and nerve conduction studies may be used to determine if and where your nerve is compressed, and its severity.
If your nerve compression has not resulted in much muscle wasting, your surgeon will begin treatment with a non-surgical option. Conservative treatments, changes to daily activities, and bracing typically improve symptoms, but if you do not see improvement, please speak to your orthopedic surgeon about surgical options.
Non-surgical options include:
If your symptoms continue after trying non-surgical options, your provider may suggest surgical treatment.
If your ulnar nerve is severely compressed or has caused damage and weakness, your provider may recommend surgery. After your physical examination and medical history, your orthopedic surgeon will help you find the surgical option that works best for you.
Surgical treatments include:
Cubital Tunnel Release
During this surgery, the ligament “roof” of your cubital tunnel will be cut and divided to increase tunnel size and decrease the pressure on your nerve. New tissue growth will allow for more space for your ulnar nerve as the ligament begins to heal. This procedure works best if you have mild or moderate nerve compression, and if your nerve does not slide out from behind the bony ridge when your elbow is bent.
In this procedure, your ulnar nerve is released by removing part of the medial epicondyle. It prevents your nerve from getting caught on the bony ridge and stretching when your elbow is bent.
Ulnar Nerve Anterior Transposition
During this surgery, your ulnar nerve will be moved from its position behind the medial epicondyle to in front of it, which will prevent it from getting caught on the bony ridge and stretching when you bend your elbow. It can be moved to lie under the skin and fat, but on top of the muscle, or within the muscle, or under your muscle.
Before you undergo surgery, your orthopedic surgeon will speak to you about risks, complications, and any concerns you may have.