Ulnar Nerve Entrapment
Ulnar nerve entrapment, often called cubital tunnel syndrome, is a common nerve problem in the arm, usually occurring in the elbow groove on the inner part of your arm. This condition happens when something presses on, irritates or restricts the ulnar nerve. The ulnar nerve travels from your neck, down your arm and into your hand. It provides sensation, or feeling, to your ring and small finger.
If you have ulnar nerve entrapment, you may have pain, numbness, tingling or weakness, which can limit your arm and hand movement. The tingling and numbness typically occur in the ring and small fingers. However, if you also feel these sensations in the thumb, index or middle finger, you may have symptoms of carpal tunnel syndrome as well. Over time, these symptoms may worsen without proper care. Experts at Summit Orthopedics are highly experienced in diagnosing and treating elbow conditions, including ulnar nerve entrapment, to help you regain strength and function.
Types of Ulnar Nerve Entrapment
Experts classify ulnar nerve entrapment based on how badly the nerve is affected. Knowing the type helps your provider decide the most effective treatment.
- Type 1. This affects both the deep and shallow parts of the nerve, leading to problems with movement and feeling. The hand muscles may become weak.
- Type 2A. With this type, you may have sensory symptoms along with muscle weakness when you pinch or grip. There’s no muscle atrophy, which is a decrease in the size of the muscle.
- Type 2B. In this type, you may have sensory problems, visible muscle atrophy and very limited muscle strength.
- Type 3. Type 3 is a severe form that involves muscle weakness and severe sensory issues.
What Causes Ulnar Nerve Entrapment?
Ulnar nerve entrapment occurs when the ulnar nerve becomes compressed or irritated, most often behind the inner side of the elbow. At this site, the nerve travels through a narrow passageway of tissue called the cubital tunnel, where pressure or stretching can cause pain, tingling or numbness in the arm and hand.
This tunnel runs under a bony bump on the inside of the elbow called the medial epicondyle. When you accidentally bump this spot, you hit the nerve, causing a shock-like sensation, which is why people often refer to this area as the funny bone.
Other possible causes include:
- Arthritis
- Bone spurs
- Fractures
- Repetitive movements that involve bending the elbow
Diagnosing Ulnar Nerve Entrapment
Your doctor will perform a physical examination and other tests to determine if you have ulnar nerve entrapment.
During the physical examination, your doctor checks the feeling and strength in your hands and fingers. They often perform the Tinel sign test by lightly tapping the ulnar nerve over the funny bone, checking for a tingling or shock-like sensation.
You’ll also have to bend your elbow while the doctor watches for symptoms.
To confirm the diagnosis, your doctor may perform an electromyography (EMG), a nerve study that measures how quickly signals travel along the nerve. If the signal slows down significantly as it passes the elbow, your doctor identifies that area as the site of compression. If the EMG doesn’t find ulnar nerve entrapment, your doctor may recommend an ultrasound to evaluate the nerve.
Treating Ulnar Nerve Entrapment Without Surgery
If your symptoms are mild, your doctor may recommend nonsurgical treatments, like taking anti-inflammatory medications such as ibuprofen or naproxen, wearing a brace to keep your elbow straight at night and doing physical therapy. During these exercises, a physical therapist can teach you nerve-gliding techniques and how to move your wrist and arm to help relieve your symptoms.
Surgical Treatment
Your doctor may recommend surgery when nonsurgical treatments do not work or if the nerve compression is severe and has caused muscle weakness or muscle damage.
Surgeries to treat ulnar nerve entrapment include:
- Cubital tunnel release. Your surgeon cuts the ligament that forms the roof of the tunnel, which enlarges the tunnel and decreases pressure on the nerve. This works best for mild to moderate cases.
- Ulnar nerve transposition. Your surgeon moves the nerve from its spot behind the medial epicondyle to a new location in front of the bone. Moving the nerve stops it from catching or stretching when the elbow is bent.
- Medial epicondylectomy. In this procedure, the surgeon removes the medial epicondyle’s bony bump to decompress the nerve.
Preventing Ulnar Nerve Entrapment
You can help prevent ulnar nerve entrapment. Strategies focus on avoiding compression and prolonged bending of your elbow:
- Avoid activities that require repetitive elbow bending or flexing.
- Avoid holding your elbow bent for long periods, such as when driving or frequently talking on a cellphone.
- Avoid leaning directly on the inside of your elbow or putting pressure on it for prolonged periods.
- If you use a computer, adjust your chair height so you don’t rest your elbow on the armrests, as this can put pressure on the nerve.
- Keep your elbow straight when you sleep by wearing a padded brace or elbow pad, or by loosely wrapping a towel around your arm.
Care for Ulnar Nerve Entrapment at Summit Orthopedics
If you’re experiencing ulnar nerve entrapment, we’re here to help. Our goal is to provide an accurate diagnosis and develop a personalized treatment plan focused on your full recovery.
Summit Orthopedics surgeons are available at nearly 30 convenient locations across the Minneapolis/St. Paul area, serving Minnesota and western Wisconsin. Our state-of-the-art, comprehensive orthopedic centers offer same-day appointments from a team of experts who offer the full scope of orthopedic care.
Find your Summit Orthopedics elbow expert, request an appointment or call us at (651) 968-5201 to schedule a consultation.
