The ulnar nerve controls muscles in the forearm and hand, and gives sensation to parts of the hand. As the ulnar nerve travels to the hand from the arm, it passes through the elbow. The ulnar nerve rests in the condylar groove of the cubital tunnel (the elbow joint) and can be compressed by bands of connective tissue. Flexion of the elbow stretches the nerve, which also increases pressure. If the nerve becomes entrapped in this area, it can cause numbness and tingling in the palm, ring finger, and small finger. This is called cubital tunnel syndrome syndrome, or ulnar neuropathy.
Symptoms include tingling and pins and needles sensation along the ring and little finger and discomfort along the medial aspect of the forearm. As the disease process progresses patients may complain of pain around the elbow that is exacerbated by any kind of contact. Later symptoms include numbness and weakness of the hand muscles. There often is significant wasting of the intrinsic hand muscles. The last two fingers can assume a classic claw hand posture from ulnar neuropathy.
Physical exam findings include electric shocks or tingling sensation in the ring and little fingers by tapping the nerve at the cubital tunnel (elbow). Sensory exam may show diminished sensation to pinprick and light touch along the little and ring fingers. Weakness of spreading the fingers apart may also appear later in the disease process. Patients may have trouble holding on to a sheet of paper with their thumb and index finger (Froment’s sign).
Electromyography (EMG) and nerve conduction studies (NCS) are done to confirm electrical changes in the ulnar nerve indicative of significant compression.
Conservative management involves using an elbow splint at night, using elbow pads for “elbow resters” and modification of work-related repetitive elbow flexion. Over-the-counter pain relievers can also provide temporary relief. Many people will have significant relief of their symptoms with conservative treatment.
Patients who fail conservative therapy or having severe symptoms with neurological deficit may undergo surgery to relieve the pressure on the nerve.
Ulnar decompression involves making a 3-4 inch incision over the elbow joint and incising one of the ligaments of the tunnel. This opens the tunnel and reduces the pressure on the nerve. This is performed under local anesthesia and is usually an outpatient procedure. No immobilization is necessary after the surgery and patients recover quickly.
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