Ulnar Neuropathy and Its Treatment

Ulnar neuropathy, or ulnar nerve entrapment, is a common injury to a nerve that passes through the arm into the fingers on the outside of the hand and is the second most common entrapment neuropathy at the elbow. While ulnar neuropathy is not usually dangerous, it can have permanent effects if not treated properly, including loss of feeling in the affected hand or arm and paralysis. However, most patients with ulnar neuropathy can make a full and successful recovery with early diagnosis and treatment.

Understanding Ulnar Nerve

The ulnar nerve is one of the major nerves in your arm and is part of the brachial plexus nerve system. The name “ulnar” comes from its location near the ulna, a bone on the side of your little finger in your forearm.

Your ulnar nerve runs from your shoulder to your little finger. The ulnar nerve controls the muscles that allow your fingers to make fine movements. It also controls some of the muscles in your forearm that allow you to grasp objects firmly. Unlike most other nerves, the ulnar nerve is not covered and protected by muscle or bone as it travels. In some areas, it's close to the surface of the skin, which means that ulnar nerve damage is not uncommon.

Overview of Ulnar Neuropathy

• Ulnar neuropathy at the elbow is the second most common upper extremity neuropathy.
• The ulnar nerve lacks protection at the elbow, making it vulnerable to external pressure or compression.
• It almost always occurs in the elbow and occasionally in the wrist.
• Also known as cubital tunnel syndrome, it is caused when you put pressure on the ulnar nerve every time you bend your elbow, which in turn causes reduced blood flow to the nerve. This leads to damage to the nerve over time.
• Striking the “funny bone” in your elbow pulls on the ulnar nerve in the bony groove of the cubital tunnel, causing a distinctive tingling or shock-like sensation in both your little and ring fingers (fourth and fifth fingers).

• These conditions can cause muscle weakness and loss of sensation in your hand. Ulnar neuropathy affects the ability to make fine movements and perform many daily tasks. It can also cause muscle wasting or, in extreme cases, atrophy, which makes the hand look like a claw. Surgery is often required in severe cases.

What symptoms you may feel?

Ulnar neuropathy is usually a progressive disease, meaning it gets worse over time.

Symptoms that you may feel in ulnar neuropathy

• You may feel pain, weakness, numbness in your hand.
• Loss of function of the hand is also a common symptom.
• In the early stages of neuropathy, you may feel tingling in your palms and pinky and ring fingers (fourth and fifth fingers).
• You may also feel the fourth and fingers “falling asleep”
• You may experience sensitivity to cold.
• Daily routine tasks will be difficult to perform and as it gets severe your wrist could begin to hurt.
• You also may suffer tenderness at the elbow joint.

What causes Ulnar Neuropathy?

The most common cause of ulnar neuropathy is compression or pressure on the ulnar nerve which may be due to:

• Any previous or current injury to your elbow.
• Leaning on your elbow for a prolonged period.
• Any illness that can damage your nerve like from trauma, fractures, arthritis, swelling, or and vascular and bony abnormalities.
• Elbow dislocation.

When your ulnar nerve is damaged, it is like cutting a phone cord. The messages that your brain sends cannot be properly received by their targets that are located in your hands and arms.

How is Ulnar Neuropathy diagnosed?

Your doctor will start by giving you a thorough examination and asking you certain questions. After a thorough history and physical exam, your doctor may suggest some additional tests to evaluate muscle and nerve function. These tests may include:

1. Electromyography (EMG) which records the activity of your muscle and its response to the nerve stimulation.
2. Nerve conduction study (NCS) that records the speed and amount of electrical impulse conduction through your nerve.

Your doctor may also perform any of the following imaging techniques:

• MRI
• Ultrasound
• MR neurography – a procedure that produces enhanced images of the nerve.

What possible treatments are there for Ulnar Neuropathy?

Nonsurgical Treatment for Ulnar Nerve Compression

Ulnar neuropathy usually doesn't require surgery. Your doctor may suggest that you rest your affected elbow and hand, and may also advise you to avoid any tasks that could make your symptoms worse. Your doctor may ask you to pad the affected elbow for a few weeks to prevent further damage to the ulnar nerve. Non-surgical treatment options are recommended for less severe cases and include the following

1. Pain-relieving medicines

Over-the-counter pain relievers, such as aspirin and ibuprofen, may be helpful in reducing inflammation in the affected area and may also reduce ulnar nerve compression symptoms, which can worsen.

2. Bracing or Splinting

Braces and splints are one of the most common treatment options your doctor may recommend. He or she may ask you to immobilize the affected arm in a brace for a few weeks to prevent further damage. He or she may also suggest that you wear a splint at night to avoid bending your arm.

Hand Therapy

Hand therapy is a useful technique for ulnar neuropathy. It is recommended by many physicians. Only occupational therapists perform hand therapy. Hand therapy includes stretching and strengthening exercises for the elbow, arm, and hand.

Surgical treatment of Ulnar Neuropathy

When non-operative treatment and physical therapy fail to restore function and pain, surgical treatment is the best option. The following are the two types of ulnar nerve release surgery.

At the elbow

The physician makes an incision in the patient's forearm and decompresses the nerve, then in certain cases repositions the nerve on the underside of the arm to a more precise location.

At the wrist

If the compression is in the arm and wrist, the surgeon will allow the incision to reach the ulnar nerve and perform the decompression at that point.

The following are surgical treatments for ulnar neuropathy.

Cubital tunnel release

A technique to enlarge the cubital tunnel to provide more space for the nerve.

Ulnar nerve anterior transposition

A procedure to move the nerve from the back of the muscle to the front of the nerve so there is less tension on the nerve when the elbow is bent.

Medial epicondylectomy

Surgery to remove part of the protruding medial bone to prevent the nerve from rubbing in this area.

When ulnar neuropathy is severe and causes muscle wasting and weakness. Then doctors use these approaches as a first-line treatment.

How well the surgery is done determines the recovery rate. And it varies from person to person. Surgical results for ulnar nerve neuropathy are always positive, so most patients should expect a complete or near-complete recovery.

Prevention and Home remedies for ulnar neuropathy

A person with ulnar neuropathy has several options for recovery and healing at home. The following are approaches that can prevent the recurrence of ulnar neuropathy.

• Refrain from any action and movement that leads to stretching and bending of the elbow.
• Maintain proper posture position while using a computer.
• At night, keep your elbow straight

Home remedies and active prevention can help to manage the ulnar neuropathy.

References

https://www.physio-pedia.com/Ulnar_Nerve_Entrapment

https://www.webmd.com/pain-management/carpal-tunnel/ulnar-tunnel-syndrome

https://emedicine.medscape.com/article/1141515-overview

https://www.medicalnewstoday.com/articles/318043

https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=zp4521

https://www.hopkinsmedicine.org/health/conditions-and-diseases/ulnar-nerve-entrapment

https://nyulangone.org/conditions/ulnar-nerve-compression-in-adults/treatments/nonsurgical-treatment-for-ulnar-nerve-compression

https://www.healthline.com/health/ulnar-nerve-dysfunction

https://www.precisionhealth.com.au/healthcare-services/neurology/conditions-treated/ulnar-neuropathy/