Ulnar Neuropathy and Its Treatment

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

Understanding Ulnar Nerve

The ulnar nerve is one of the main nerves of your arm and is a component of the brachial plexus nerve system. The name “ulnar” is derived from its position close to the ulna bone, a bone on the side of your pinkie finger in the forearm.

Your ulnar nerve stretches from the shoulder to your pinkie finger. The ulnar nerve handles the muscles that allow your fingers to make fine moves. It also directs some of your forearm’s muscles which lets you firmly grab objects. In comparison to most of the other nerves, the ulnar nerve is not covered and protected along its path by the muscle or bone. In some areas, it’s close to the skin surface which means that ulnar nerve damage isn’t unusual.

Overview of Ulnar Neuropathy

  • Ulnar neuropathy at the elbow is the second most prevalent upper extremity neuropathy.
  • Ulnar nerve lacks protection at the elbow, as a result making it susceptible to external pressure or compression.
  • It happens almost always in the elbow and occasionally in the wrist.
  • It is also known as cubital tunnel syndrome and is caused when you put pressure on the ulnar nerve each time you bend the elbow which in turn causes the reduced supply of blood to the nerve. This leads to damage to the nerve with the passing time.
  • Hitting your “funny bone” in the elbow pulls the ulnar nerve in the bony groove of the cubital tunnel resulting in the distinctive tingling feeling or shock-like sensation in both of your small and ring fingers (fourth and fifth fingers).

  • These conditions can cause muscle weakness and loss of sensation in your hand. Ulnar neuropathy will impair the ability to make fine movements and perform lots of daily work. It can also lead to muscle wasting, or atrophy in extreme cases, which makes the hand look like a claw. Often, surgery is required in severe cases.

What symptoms you may feel?

Ulnar neuropathy is usually a progressive disease, which means that it becomes worse with passing 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 first examine you thoroughly and will ask you certain questions. After the comprehensive history and physical exam, your doctor may suggest some additional tests to evaluate the muscles and nerves functioning. These tests 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 need surgery. Your doctor may suggest you rest your elbow and hand that are affected and he may also advise to avoid any task that can exacerbate your symptoms. Your doctor may ask you to pad your affected elbow area for a few weeks in order to prevent any additional damage to the ulnar nerve. Nonsurgical treatments options are recommended in not so severe cases and they are as follows.

  1. Pain-relieving medicines

Over-the-counter pain-relieving medicines available, such as aspirin and ibuprofen, may be useful in reducing inflammation at your affected area and also can reduce the ulnar nerve compression symptoms that can get worsen.

  1. Bracing or Splinting

Bracing and splinting are one of the common treatment options that your doctor can recommend. He may ask you to immobilize your affected arm in a brace for a few weeks to prevent any further damage. He also may suggest you to wear a splint while sleeping in order to avoid any bending of the arm.

Hand Therapy

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

Surgical treatment of Ulnar Neuropathy

When non-operative treatment and physical therapies fail to restore functions and pain, then surgical treatment is the best option. The following are the two kinds of ulnar nerve release surgery.

At the elbow

The physician creates an incision on the patient’s forearm and decompresses the nerve then, in certain instances, transfers the nerve on the bottom of the arm such that it is in a more precise location.

At the wrist

If the compression is present at the arm, and wrist, the surgeon allows the incision to the ulnar nerve and does the decompression at that spot.

The following are the surgical treatments for ulnar neuropathy.

Cubital tunnel release

A technique to raise the size of the cubital tunnel to provide more space to the nerve.

Ulnar nerve anterior transposition

A process to transfer 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

A surgery that eliminates part of the protruding medial bone to keep the nerve from rubbing in this region.

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

The performance of the surgical procedure will decide the recovery rate. And it varies from person to person. Surgical results for ulnar nerve neuropathy are always positive, so most patients should predict complete or near-full recovery.

Prevention and Home remedies for ulnar neuropathy

A person having ulnar neuropathy has various options for recovery and healing at home. The following are the approaches that can prevent the recurring 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

http://acsneuro.com/conditions_and_treatments/peripheral_nerves_detail/ulnar_neuropathy.html#:~:text=Medications%20for%20Ulnar%20Neuropathy,an%20extended%20period%20of%20time.

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/

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