Athena Vale
The ulnar nerve is a single nerve in a network known as the peripheral nervous system, which carries information to and from the brain via the spinal cord. It controls movement and feeling in the hand, ring finger, and little finger. It also helps with gripping and fine motor skills like writing. Ulnar nerve entrapment occurs when something irritates or puts pressure on the ulnar nerve in the wrist or elbow, causing pain, numbness, and tingling in the forearm and the fourth and fifth fingers. Ulnar nerve entrapment can be treated with occupational therapy, medications, splints, and in severe cases, surgery.
| Characteristics | Values |
|---|---|
| Definition | Ulnar nerve entrapment occurs when something irritates or puts pressure on the ulnar nerve in the elbow or wrist. |
| Nerve Function | The ulnar nerve is responsible for stimulating the flexor muscles of the hand, allowing it to bend and move. It also controls movement and feeling in the hand, ring finger, and little finger. |
| Symptoms | Pain, numbness, and tingling in the forearm, hand, and fingers. In severe cases, it can cause weakness in the hand and loss of muscle mass. |
| Treatment | Non-operative treatments include occupational therapy, medications, splints, and braces. Operative treatments include nerve decompression, anterior transposition techniques, and medial epicondylectomy. |
| Prevention | Avoid keeping your elbows bent for an extended period. Do not rest your elbows on a desk or chair while working. |
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What You'll Learn
Ulnar nerve anatomy
The ulnar nerve is a major peripheral nerve of the upper limb. It controls movement and feeling in the hand, ring finger, and little finger. It also helps control fine motor skills, such as writing, and allows you to grip things with your hand.
The ulnar nerve arises from the brachial plexus within the axilla region. It is a continuation of the medial cord and contains fibres from spinal roots C8 and T1. After arising from the brachial plexus, the ulnar nerve descends in a plane between the axillary artery (lateral) and the axillary vein (medial). It proceeds down the medial aspect of the arm with the brachial artery located lateral. At the mid-point of the arm, the ulnar nerve penetrates the medial fascial septum to enter the posterior compartment of the arm. It passes posterior to the elbow through the ulnar tunnel, a small space between the medial epicondyle and olecranon. Here, it gives rise to an articular branch that supplies the elbow joint.
In the forearm, the ulnar nerve pierces the two heads of the flexor carpi ulnaris, travelling deep to the muscle, alongside the ulna. It stays medially above the flexor digitorum profundus and under the flexor carpi ulnaris, giving branches to these muscles. In the lower part of the forearm, the ulnar nerve lies lateral to the flexor carpi ulnaris muscle and medial to the ulnar artery.
The ulnar nerve enters the palm of the hand through the Guyon canal, also known as the ulnar tunnel. The nerve and artery pass superficially to the flexor retinaculum. At the wrist, the ulnar nerve lies just lateral to the pisiform bone. The superficial branch of the ulnar nerve supplies and passes under the palmaris brevis muscles and divides into palmar digital nerves. The deep branch of the ulnar nerve innervates the three hypothenar muscles, the two medial lumbricals, the seven interossei, the adductor pollicis, and the deep head of the flexor pollicis brevis.
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Ulnar nerve entrapment causes
Ulnar nerve entrapment occurs when something irritates or puts pressure on the ulnar nerve, which runs down the arm and into the hand. This pressure can lead to progressive damage, causing a type of nerve compression syndrome. The nerve passes through the shoulder, elbow, and wrist, and entrapment can occur anywhere along its length, but it is most common in areas of the arm that bend, especially at the elbow.
The ulnar nerve is one of the three main branches of the brachial plexus, a network of nerves originating from the spinal cord in the neck. It controls movement and feeling in the hand, ring finger, and little finger, as well as nearly all the small muscles in the hand. It also helps with grip and fine motor skills like writing. When the nerve is compressed, it can cause a tingling sensation, known as hitting your "funny bone".
Ulnar nerve entrapment can be caused by several factors, including injuries, bone and joint diseases, repeated bending of the elbow, or excessive leaning on the elbow, especially on hard surfaces. Elbow injuries such as fractures and dislocations can cause entrapment, as can bone and joint diseases like arthritis and bone spurs. Certain conditions can also increase susceptibility to nerve compression, including diabetes and hereditary neuropathy with pressure palsies (HNPP).
In some cases, ulnar nerve entrapment can occur with no clear cause. However, certain activities and behaviours can contribute to the condition. For example, cycling, doing excessive push-ups, and other activities that cause repeated external pressure on the hand or wrist can lead to entrapment at the wrist. Similarly, sleeping with bent elbows for long periods can cause or worsen symptoms.
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Symptoms of ulnar nerve entrapment
Ulnar nerve entrapment occurs when the ulnar nerve in the arm becomes compressed or irritated. The ulnar nerve is responsible for controlling movement and sensation in the hand, ring finger, and little finger. It also controls nearly all the small muscles in the hand.
- Numbness and tingling in the ring finger and little finger, which may come and go.
- Weakened grip and difficulty with finger coordination, such as typing or playing an instrument.
- Muscle weakness and clumsiness.
- Pain in the affected area.
- Inflammation.
In severe cases, ulnar nerve entrapment can cause:
- Muscle wasting in the hand.
- Weakness in the hand.
- Loss of muscle mass.
- Clawing of the ring and little fingers.
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Treatment options for ulnar nerve entrapment
Treatment for ulnar nerve entrapment depends on the severity of the condition. It is important to seek treatment for ulnar nerve entrapment to avoid permanent consequences such as paralysis and loss of feeling in the affected hand or arm.
For less severe cases, doctors will usually recommend non-surgical treatment options first. These may include:
- Anti-inflammatory medications such as ibuprofen or naproxen to reduce swelling.
- Elbow braces or splints to keep the joint straight at night.
- Avoiding activities that can worsen symptoms, such as repeated flexion of the elbow.
- Exercises and physical therapy to help the nerve slide through the arm correctly.
If non-surgical treatments are ineffective, or if the nerve compression is causing muscle weakness or damage in the hand, surgery may be recommended to relieve pressure and fix ulnar nerve entrapment. Surgical treatment options include:
- Cubital tunnel release: A procedure to increase the size of the cubital tunnel to give the nerve more room.
- Ulnar nerve anterior transposition: A procedure to move the nerve from behind the muscle to in front of it, reducing tension when the elbow is bent.
- Medial epicondylectomy: A procedure that removes part of the protruding medial bone to prevent the nerve from rubbing on this area.
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Surgical procedures for ulnar nerve entrapment
Surgical procedures are usually recommended for severe or long-standing cases of ulnar nerve entrapment that have not responded to non-surgical treatments. The type of surgery performed depends on the severity of the nerve compression and the patient's symptoms, occupation, and surgeon's expertise.
Ulnar nerve decompression surgery is a procedure that explores the region around the elbow through which the ulnar nerve passes and removes anything that is compressing the nerve. This can be performed under local, regional, or general anaesthetic. In open ulnar nerve decompression surgery, a 3-4 inch incision is made along the elbow to reveal the nerve. Alternatively, endoscopic or keyhole surgery is a minimally invasive form of surgery that uses smaller incisions and an endoscope with a camera, resulting in a quicker recovery.
Cubital tunnel release surgery is a procedure used to treat cubital tunnel syndrome, or ulnar nerve entrapment at the elbow, by relieving pressure on the nerve. During this surgery, an incision is made over the back of the inner side of the elbow, and any tight tissue compressing the nerve is cut. In some cases, a piece of bone may need to be removed, or the nerve may be moved to the front of the elbow in a procedure called ulnar nerve anterior transposition surgery. This surgery is typically performed as an outpatient procedure under regional anaesthesia and does not require an overnight hospital stay.
Following ulnar nerve surgery, patients may need to wear a brace or splint for several weeks, and complete recovery may take several weeks or longer. Pain, numbness, and tingling in the fingers usually subside quickly after the procedure. An individualized rehabilitation plan may be recommended, which may include physical therapy and/or occupational therapy.
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Frequently asked questions
The ulnar nerve is a single nerve in a network known as the peripheral nervous system. It controls movement and feeling in the hand, ring finger, and little finger. It also helps with fine motor skills like writing and gripping.
Ulnar nerve entrapment occurs when something irritates or puts pressure on the ulnar nerve in the elbow or wrist. It can cause pain, numbness, and tingling in the forearm and the fourth and fifth fingers.
Symptoms of ulnar nerve entrapment include pain, numbness, and tingling in the forearm and fingers. In severe cases, it can cause weakness in the hand and loss of muscle mass.
Ulnar nerve entrapment can be treated with non-operative methods such as occupational therapy, medications, and splints. In severe cases, surgery may be required to release the nerve at the point of entrapment.
