What is Ulnar Neuropathy?
Ulnar neuropathy – cubital tunnel syndrome – is a sensory and muscle atrophy condition resulting from compression or entrapment of the ulnar nerve that runs from the neck through the elbow and on into the hand. The pressure on the nerve distorts normal sensation in the small finger and the adjacent half of the ring finger, causing numbness and tingling.
The ulnar nerve is commonly referred to as the “funny bone,” but there’s nothing funny about this condition. Because the ulnar nerve serves the most important muscles of the hand, this condition can lead to increasing weakness and irreversible, permanent muscle atrophy if not treated early. If you are experiencing any of the symptoms, visit our Houston offices to avoid further damage.
Since the ulnar nerve extends all the way from the neck to the fingers, we first examine and test patients with symptoms of ulnar neuropathy to locate where the nerve is being constricted. It may be traced to a herniated cervical (neck) disk that pinches the nerve. At the elbow, the nerve may be constricted by a narrowing of ligament and tendon tissue that form the cubital tunnel. At the wrist, the constriction occurs in the Guyon’s canal (comparable to the carpal tunnel for the medial nerve).
Cyclists, people who use keyboards extensively, and people who use tools like jackhammers that put pressure on the hands, wrist, arm, and neck are particularly susceptible to ulnar neuropathy. A blow to the elbow region, a broken elbow, or even prolonged leaning on your elbows can also trigger the condition, since tissues become inflamed and swollen in response to injury.
Sign & Symptoms
Whether it originates from a pinched nerve in the neck, a compression at the elbow or a constriction in the hand, the symptoms of ulnar neuropathy are similar:
Symptoms may be bilateral if the origin is at the neck and if they remain consistent between daytime and nighttime.
Ulnar neuropathy and the more familiar carpal tunnel syndrome share some common characteristics, but you can discern the difference by noting which fingers are affected—thumb, index, middle, and adjacent half of ring finger for carpal tunnel syndrome, little finger, and adjacent half of ring finger for ulnar neuropathy.
- Pain in the forearm
- Hand weakness, dropping objects, reduced grip strength
- Numbness and tingling in the little finger and ring finger
- Atrophy of interossal muscles (between fingers)
- Gradual contracting or “clawing” of fingers
- Occasional elbow soreness
Diagnosis & Treatment
A physical examination and conversation about medical history is the path to diagnosis. A an electromyography (EMG) test or a nerve conduction study (NCS) can show how much the nerve and muscle are being affected, and if there is a pinched nerve in the neck, which presents with similar symptoms.
Sometimes rest and anti-inflammatory medications, or simply changing the way you position your elbows at the computer or while driving can alleviate pressure and help resolve discomfort. If not, occupational therapy may be helpful in building supporting muscles while splints for the wrist or elbow help the irritated tissues rest and recover.
Steroid injections are sometimes used, but we do this in rare cases since it can be hazardous to inject needles into a tight space where a nerve is entrapped. Diabetic patients should also be cautious about steroid injections, as they can transiently elevate blood sugar levels.
Our surgeons perform a minimally invasive “No Stitch” endoscopic cubital tunnel release for ulnar nerve decompression. This procedure is used when the compression is in the elbow region. A tiny incision is made and an endoscope with a camera is used to guide the surgeon to the compression site. The ulnar nerve may be released by cutting partway through the constraining tissues.
If our surgeons think that more treatment options should be available once into the procedure, they may recommend the open technique. An incision up to six or more inches is made around the elbow. Once the nerve is released, the surgeon may relocate it slightly to a place where there is less tension or compression on it. Sometimes, they create a pocket from the fatty tissue under the skin (subcutaneous transposition) to make a soft bed for the nerve to sit in, or will place the nerve underneath a muscle (submuscular transposition) for protection.
Non-surgical recovery focuses on rest and reducing stressful movements through the use of a splint.
If we opt for the minimally invasive “No Stitch” approach, it results in little or no scarring, no stitches are required, and patients resume normal activity within about three weeks. A physical therapy program including strengthening will be necessary in order to return to prior activities. Total recovery can be expected to take 4–6 months.
Open surgery includes the same physical therapy, but is a more involved post-surgery care period.