Caring for Your Ulnar Nerve

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.

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What is Ulnar Nerve Entrapment at the Elbow?

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:

• Muscle wasting - which may occur if your nerve has been compressed for a long time or is extremely compressed
• Numbness, tingling, paresthesia - these symptoms tend to come and go, but typically occur in the ring finger and little finger, especially when your elbow is bent
• Weakening of your grip and difficulty with finger coordination - these symptoms typically occur in severe cases, and may interfere with activities that require dexterity, like typing

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.

Treating 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.

Non-surgical Treatments

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:

• Bracing or splinting - a padded splint or brace worn at night can help you keep your arm straight during sleep
• Home remedies - avoiding activities that aggravate your elbow, and those that cause your elbow to remain bent for a long period can go a long way towards easing symptoms. Similarly, not leaning on your elbow, keeping it straight while you sleep, and avoiding putting pressure on the inside of your arm may help. If your symptoms, despite home remedies, persist for more than a week or two, schedule a consultation with a Rochester Regional orthopedic surgeon.
• Nerve gliding exercise - these exercises, carefully created to prevent stiffness in your arm and wrist, focus on helping your ulnar nerve slide through the cubital tunnel at your elbow and the Guyon’s canal at your wrist.
• NSAIDs - Nonsteroidal anti-inflammatory medications work to help reduce swelling around your nerve. If you are given a stronger, over-the-counter NSAID, please speak to your provider about the appropriate dose and the length of time you’ll use the drug.

If your symptoms continue after trying non-surgical options, your provider may suggest surgical treatment.

Surgical Treatments

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.

Medical Epicondylectomy

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.