ulnar neuropathy: what you need to know

WHAT IS ULNAR NEUROPATHY?

Ulnar neuropathy, also known as ulnar nerve entrapment, is a dysfunction of one of the nerves in the forearm. This nerve is called the ulnar nerve. The ulnar nerve runs from the inside of the upper arm through the inside of the elbow to the pinky finger.

WHAT ARE THE SYMPTOMS?

Almost all patients complain of numbness and tingling in the pinky finger and ring finger. In addition, patients may experience:

• Loss of strength in the hand;
• Tenderness in the elbow joint;
• Reduced dexterity;
• Pain and cramping in the hand.

WHAT IS THE CAUSE?

Ulnar nerve entrapment at the elbow can occur when:

• Prolonged stretching of the nerve by keeping the elbow fully bent or when there is direct pressure on the nerve from leaning the elbow against a solid surface.

Entrapment at the wrist can occur when:

• Direct pressure on the nerve by leaning on handlebars during long bike rides or prolonged use of hand tools.

In some people, the ulnar nerve does not stay in its proper position and can shift across a bump of bone in the elbow when the arm flexes, referred to as a subluxing nerve. Repeated shifting can cause irritation of the ulnar nerve.

HOW IS A DIAGNOSIS MADE?

A nerve conduction study (EMG) and sometimes a nerve ultrasound can confirm the diagnosis. An EMG examines the nerve function with small electrical impulses. This produces a tingling or throbbing sensation and may cause mild pain. An ultrasound uses ultrasound waves to create images of the nerve. This allows the doctor to determine whether the nerve is thickened.

WHAT TREATMENT OPTIONS ARE AVAILABLE?

Depending on the severity of a person’s ulnar nerve entrapment, the physician may recommend the following:

• Occupational therapy to strengthen the ligaments and tendons in the hands and elbows;
• Drugs such as aspirin, ibuprofen and other nonprescription pain relievers to help reduce pain and inflammation;
• Splints to help immobilize the elbow.

When physical therapy and other forms of nonoperative treatment fail to control pain and restore function, nerve release surgery may be the best option to address symptoms. There are two types of ulnar nerve release surgery:

1. At the elbow: The surgeon makes an incision at the patient’s elbow and performs a nerve decompression, and in some instances, moves the nerve to the inner part of the arm so that it is in a more direct position.
2. At the wrist: If the compression is at the wrist, the surgeon makes the incision there to access the ulnar nerve and performs the decompression at that location.

WHAT TO EXPECT

During Surgery:

The surgeon releases the nerve by cutting through the tissues that are compressing it. The wound is then sutured. Afterward, the patient will receive a pressure bandage for 24 hours. The surgery takes about half an hour.

After Surgery:

After the surgery, it’s advised to not lift heavy items for the first few days. Depending on the severity of the operation, a physician will let the patient know when it is suitable to be at work again. Incidentally, the symptoms often do not disappear immediately after the surgery. This can take a few months or even a year.

COMPREHENSIVE AND COMPASSIONATE CARE

At SMMC, our goal is to improve your quality of life through personalized, compassionate care. From diagnosis to treatment, we are here to support you every step of the way. For more information, please contact the Neurology Department using the information on the back of this brochure.