-Cyprus Orthopaedics

Elbow Ulnar Neuropathy

Ulnar neuropathy at the elbow is a condition where the ulnar nerve becomes irritated, stretched or compressed as it lies behind the elbow. The condition is also known as “Ulnar neuritis” or “Cubital tunnel syndrome”.
Elbow Conditions-Cyprus Orthopaedics

Elbow Ulnar Neuropathy

Elbow ulnar neuropathy, also known as cubital tunnel syndrome, is a condition that affects the ulnar nerve as it passes through the elbow. This nerve is responsible for providing sensation to the little finger and half of the ring finger, as well as controlling some of the muscles in the hand. When the ulnar nerve becomes compressed or irritated at the elbow, it can lead to pain, weakness, and numbness in the hand and arm.

Understanding the Anatomy of the Elbow

To understand elbow ulnar neuropathy, it is important to have a basic understanding of the anatomy of the elbow. The elbow joint is formed by the meeting of three bones: the humerus in the upper arm, and the radius and ulna in the forearm. The ulnar nerve runs along the inside of the elbow, passing through a narrow tunnel called the cubital tunnel. This tunnel is formed by the bony bump on the inner side of the elbow and a ligament that stretches across the top.

When you flex your elbow, the ulnar nerve needs to extend around the bony protrusion known as the medial epicondyle. This stretching can potentially irritate the nerve and reduce its blood flow. Prolonged or repetitive bending of the elbow may result in painful symptoms. For instance, many individuals sleep with their elbows flexed, exacerbating symptoms of ulnar nerve compression, leading to waking up with numbness in their fingers during the night or in the morning.

Causes of Elbow Ulnar Neuropathy

In certain individuals, the nerve may shift out from behind the medial epicondyle when the elbow is bent, which over time, can cause irritation to the nerve due to this repeated movement.

Putting extended pressure on the elbow, such as leaning on it for extended periods, can also compress the nerve. Swelling in the elbow from fluid buildup can contribute to this compression.

Additionally, a direct impact to the inside of the elbow can result in pain, a sensation akin to an electric shock, and numbness in the little and ring fingers, commonly referred to as “hitting your funny bone.”

Engaging in activities like throwing a baseball can impose significant stress on the inside of the elbow, occasionally leading to irritation of the ulnar nerve.

Common Symptoms of Elbow Ulnar Neuropathy

The symptoms of elbow ulnar neuropathy can vary from person to person, but some common signs to watch out for include pain and tenderness along the inner side of the elbow, numbness and tingling in the ring and little fingers, weakness in the hand, and a decreased ability to grip objects. Some individuals may also experience difficulty with coordination and have a tendency to drop things frequently. It is important to note that these symptoms may worsen at night or when the elbow is bent for a prolonged period of time.

Diagnosis of ulnar elbow neuropathy

If you suspect you may have ulnar neuropathy of the elbow, it is important to consult a doctor for an accurate diagnosis. During your appointment, the doctor will review your medical history and perform a physical exam. They may also order additional tests, such as nerve conduction studies or electromyography, to evaluate the function of the ulnar nerve and rule out other possible causes of your symptoms.

Treatment Options for Elbow Ulnar Neuropathy

The treatment for elbow ulnar neuropathy depends on the severity of your symptoms and the underlying cause of the condition. In mild cases, conservative, non-surgical treatments may be recommended. These can include avoiding activities that aggravate your symptoms, using protective padding or splints to minimize pressure on the nerve, and engaging in physical therapy exercises to improve strength and flexibility. In more severe cases, surgical intervention may be necessary to relieve pressure on the ulnar nerve.

Non-Surgical Treatments for Elbow Ulnar Neuropathy

Non-surgical treatments for elbow ulnar neuropathy aim to alleviate symptoms and improve the function of the ulnar nerve. Your healthcare provider may recommend over-the-counter pain medications to manage discomfort, as well as the use of a brace or splint to immobilize the elbow and reduce pressure on the nerve. Physical therapy exercises can also be beneficial in strengthening the muscles around the elbow and improving range of motion. Additionally, modifying activities that exacerbate symptoms, such as avoiding leaning on the affected elbow, can help prevent further irritation.

Surgical Treatments for Elbow Ulnar Neuropathy

In cases where non-surgical treatments do not provide sufficient relief, surgical intervention may be necessary. The specific surgical procedure will depend on the cause and severity of the ulnar neuropathy. The goals of surgery are to relieve pressure on the ulnar nerve and create more space within the cubital tunnel. This can be achieved through various techniques, such as releasing the ligament that forms the roof of the cubital tunnel or repositioning the nerve to a different location. Your surgeon will discuss the most appropriate surgical approach based on your individual circumstances.

Prevention and Management of Elbow Ulnar Neuropathy

While it may not be possible to prevent all cases of elbow ulnar neuropathy, there are steps you can take to reduce your risk and manage the condition. Avoiding prolonged pressure on the elbow, such as by using ergonomic cushions or adjusting your workstation, can help prevent irritation of the ulnar nerve. Engaging in regular strength and flexibility exercises can also promote overall joint health and reduce the risk of developing nerve compression. If you have a job or hobby that involves repetitive elbow movements, taking regular breaks and using proper technique can help minimize the strain on your elbow.

The ulnar nerve is located in a groove behind the bony prominence on the inner aspect of the elbow (the medial epicondyle). The edges of the groove are spanned by a band of tissue forming a tunnel (the “cubital” tunnel). The nerve may be subject to pressure, stretch or irritation from friction in this location from a number of different causes such as bone spurs, soft tissue swelling, synovitis or bleeding and lumps. The nerve may also be subject to external pressure such as persistent leaning on the elbow or may sometimes develop as result of an injury or a fracture. Sometimes the nerve may slip in and out of its groove (known as a “subluxing” ulnar nerve). Over a period of time the pressure on the nerve may affect the ability of the nerve to transmit electrical signals leading to impairment of the function of the nerve resulting in symptoms. 

The diagnosis of ulnar neuropathy is based upon the history of tingling and numbness affecting the little and ring fingers.  Symptoms are often worse at night and may disturb sleep. Some individuals may experience weakness in the hand. Examination may demonstrate diminished feeling to light touch over the little and ring fingers. Shrinkage (or wasting) of the small muscles in the hand may be observed along with weakness when testing strength. Tapping the nerve behind the elbow may reproduce the tingling (“Tinel’s sign”). An x-ray may show bone spurs. Nerve conduction tests will be requested to check the function of the nerve and may give an idea about the severity of the condition. Occasionally an MRI scan of the neck may be requested to rule out a trapped nerve in the neck.

In the early phase, pain may be controlled with the use of pain relieving or anti-inflammatory medication. 

Nonsurgical treatment: If the condition is mild it may resolve naturally.

Postural adjustment and splintage: Pressure on the nerve may be minimised by avoiding leaning on the elbow or resting the elbow on a high armrest whilst sitting. Modifications in the work environment may be necessary to ensure that the elbow rests in a comfortable position when using a keyboard. A splint may be prescribed to be worn at night to avoid putting pressure on the nerve when the elbow is flexed.

Medication: Non-steroidal anti-inflammatory medication may be prescribed to help reduce swelling around the nerve and to treat the pain.

Physiotherapy: Manual mobilisation of the nerve at the elbow may sometimes help alleviate the symptoms.

Surgery: Surgery may be considered if the condition is severe such as when there is noticeable muscle weakness. Surgery may also be considered if symptoms have not responded to simple treatments such as medication or splintage or indeed if the symptoms are worsening. Surgery is often effective at relieving symptoms. If the condition is severe, surgery may not relieve all the symptoms but will prevent worsening of the condition. For further information on surgical treatment, please refer to the section on “Surgery for Ulnar neuropathy at the elbow”.  

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