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Ulnar Nerve Compression

Cubital tunnel syndrome happens when the ulnar nerve (also known as the “funny bone” nerve), which passes through the cubital tunnel (a tunnel of muscle, ligament, and bone) on the inside of the elbow, is injured and becomes inflamed, irritated, and swollen.

Causes

Pressure: The nerve has little padding over it. Direct pressure (like leaning the arm on an arm rest) can press the nerve, causing the arm and hand — especially the ring and small fingers — to “fall asleep.”

Stretching: Keeping the elbow bent for a long time can stretch the nerve behind the elbow. This can happen during sleep.

Anatomy: Sometimes, the ulnar nerve does not stay in its place and snaps back and forth over a bony bump as the elbow is moved. Repeated snapping can irritate the nerve. Sometimes, the soft tissues over the nerve become thicker or there is an “extra” muscle over the nerve that can keep it from working correctly.

Arthritis, bone spurs, and previous fractures or dislocations of the elbow can also cause cubital tunnel syndrome. In many cases, the cause is not known.

Signs and Symptoms

Cubital tunnel syndrome can cause pain, loss of sensation, tingling and/or weakness. “Pins and needles” usually are felt in the ring and small fingers. These symptoms are often felt when the elbow is bent for a long period of time, such as while holding a phone or while sleeping. Some people feel weak or clumsy.

Treatment

Activity modification: Resting and stopping any activity that aggravates the condition, such as bending the elbow should be the first course of action.

Brace: Wrapping a pillow or towel loosely around the elbow or wearing a splint at night to keep the elbow from bending can help. Avoiding leaning on the “funny bone” can also help. A hand therapist can help find ways to avoid pressure on the nerve.

Medications: Anti-inflammatories such as ibuprofen (Motrin or Advil) and naproxen (Aleve) are used to reduce pain and inflammation. The max dose for ibuprofen is 800 mg three times per day. The max dose for naproxen is 500 mg twice daily. Prolonged usage should be avoided and these should be taken with food since they can affect the stomach lining. If one experiences an upset stomach these should be stopped.

Injections: Injection of a steroid (cortisone) may be used to provide pain relief and facilitate physical therapy. We perform these injections with an ultrasound machine. This allows direct visualization of the joint and improved accuracy of the injection. Up to three injections over a two-year period are allowed. Beyond this there are typically diminishing returns and excessive injections may be detrimental.

Surgery: Sometimes, surgery may be needed to relieve the pressure on the nerve. This can involve releasing the nerve, moving the nerve to the front of the elbow, and/or removing a part of the bone.

Therapy is sometimes needed after surgery, and the time it takes to recover can vary. Numbness and tingling may improve quickly or slowly. It may take many months for recovery after surgery. Cubital tunnel symptoms may not totally go away after surgery, especially if symptoms are severe.

Sources: https://www.assh.org/