Though ulnar nerve entrapment is commonly linked with the acute, stinging feeling of hitting your “funny bone,” the condition is much more complicated and can result in a disorder that impacts the hand’s function over time. It may even affect one’s quality of life. This guide aims to identify the signs and advanced diagnostic options, implement comprehensive treatment approaches, and help develop proactive prevention measures and optimally promote hand health.
While both tingling and numbness occurring in the pinky and ring fingers might be considered symptoms of ulnar nerve entrapment, it also has additional symptoms such as a weaker grip and diminished the ability to perform daily tasks. Opening jars and holding things becomes quite challenging. Some fine motor movements, like typing or buttoning a shirt, may also be tough. Some people have elbow pain or tenderness that flares after intense elbow bending, especially when resting the elbow on a hard surface. Symptoms tend to get worse during the night or during activities that stretch or compress the nerve. In the more advanced stages, hand muscle atrophy may develop pointing to the need for early intervention. Symptoms may also be exacerbated by cold temperatures.
A complete diagnosis is critical in differentiating ulnar nerve entrapment from other similar conditions with overlapping symptoms. A physician’s examination along with some sophisticated diagnostic tests is what the specialists rely on:
Clinical Assessment: The physician checks the strength and sensation of the hand and fingers, along with the nerve function. Froment’s sign, Tinel’s test by tapping the elbow, and Wartenberg’s sign are some tests that check for weakness at the muscles
and nerves³.
Electromyography (EMG) and Nerve Conduction Studies (NCS): These tests evaluate muscle and nerve electrical activity, which helps in determining the site and degree of nerve compression in addition to other peripheral nerve disorders¹.
Imaging: MRI and neuromuscular ultrasound provide high resolution images of the nerve and adjacent tissues to detect compressive lesions from cysts, bone spurs, and other pathological changes. Also, x-rays can be useful in viewing some bone conditions like arthritis or existing bone fractures.
Goals for treatment of ulnar nerve entrapment focus on relieving nerve compression,minimizing symptoms, and improving function. These can be non-operative or surgical depending on the severity of the condition:
Nonsurgical Interventions:
● Anti-inflammatory Medications: The pain and inflammation can be managed using both over the counter and prescription level medications such as NSAIDs.
● Physical and Occupational Therapy: An important aspect of conservative treatment is nerve-gliding exercises which helps the ulnar nerve to move more freely and without restriction through the cubital tunnel. Modification of activities along with ergonomic improvement counseling can also be provided by physical therapists¹.
● Splinting or Bracing: Use of splinting or bracing especially during the night can protect against elbow flexion contracting for long periods while sleeping².
● Activity Modification: Recovery is significantly aided by refraining from focusing on harmful activities that involve elbow flexion up and down, leaning on the elbow monotonously, or any repetitive elbow flexing movements.
In cases where conservative therapies are ineffective or if the nerve compression is particularly intense, surgery may be an option. Surgical options include:
Cubital Tunnel Release: This surgical procedure is performed to relieve pressure on the ulnar nerve as it passes through the cubital tunnel at the elbow. It involves releasing or removing the tight tissues or anatomical structures, such as the fascia or the Osborne’s ligament, that are compressing the nerve. By decompressing the ulnar nerve, the surgery aims to reduce symptoms such as numbness, tingling, and weakness in the hand and fingers, particularly the ring and little fingers. Cubital tunnel release can be done through a traditional open incision or via a minimally invasive technique, depending on the severity of compression and the surgeon’s recommendation¹.
Ulnar Nerve Anterior Transposition: In some instances, the nerve is repositioned to the front of the elbow so it will not be stretched or pinched during bending. Advantages of this approach may include simple decompression, which could translate to a shorter procedure and avoidance of nerve kinking².
Recovery varies, but patients tend to do well with improvement. Individual needs dictate whether physical therapy will be needed postoperatively. While the pain and sensory changes tend to respond well to treatment, muscle weakness and atrophy is much more difficult to treat, illustrating the need for timely action. Early intervention is crucial to recovery².
In order to help prevent (or at least slow the progression of) ulnar nerve entrapment:
Ergonomic Adjustments: Ensure that your workspace is ergonomically set up to avoid resting your elbows on surfaces for long periods of time. Exercise armrests may be used to support your forearms while encouraging the “funny bone” position.
Regular Stretching: If your work routine is repetitive in nature, incorporate arm and elbow stretches into your regular routine.
Posture: Throughout the day, actively monitor your arms and elbows posture. Guard against sleeping with the elbows flexed tight; a towel or brace which maintains a straighter position can be helpful during the night.
During stationary repetitive movements, straighten and stretch the arms regularly to counter flexed elbow positions.
Considerable discomfort can be relieved and hand function preserved by understanding the factors involving ulnar nerve entrapment, taking corrective measures, and employing preventive actions.
Ulnar Nerve Entrapment is can get in the way of life when it is not taken care of by an expert. Our highly trained specialist Dr. Galpern can evaluate your pain and give you a proper plan of action.
Call or contact us today and schedule a consultation to learn more about treating ulnar nerve entrapment!
1. Cleveland Clinic. (n.d.). Ulnar nerve entrapment: Causes, symptoms & treatment. https://my.clevelandclinic.org/health/diseases/22272-ulnar-nerve-entrapment
2. UCLA Health. (n.d.). Ulnar nerve entrapment. https://www.uclahealth.org/medical-services/neurosurgery/conditions-treated/ulnar-nerve-entrapment
3. Hospital for Special Surgery. (n.d.). Ulnar nerve entrapment. https://www.hss.edu/health-library/conditions-and-treatments/list/ulnar-nerve-entrapment
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