Ulnar Nerve Entrapment
Ulnar nerve entrapment occurs when the ulnar nerve in your arm becomes compressed or irritated.
The ulnar nerve is one of the three main nerves in your arm. It travels from your neck down into your hand and can be squeezed in several places along its path. The most common place for compression of the nerve is the inside of the elbow; this is called “cubital tunnel syndrome.”
Symptoms
Many people will be familiar with the sensation of “hitting your funny bone” – a blow to the inside of your elbow puts direct pressure on the ulnar nerve and can give rise to pain and numbness in your little and ring fingers, like an electric shock.
In a similar way, ulnar nerve entrapment can cause:
- an aching pain on the inside of your elbow
- numbness and tingling in your ring and little fingers, especially if your elbow has been bent for long periods or after you’ve been resting on your elbows
- weakness of grip and difficulty with finger co-ordination (in more severe cases)
- muscle wasting in the hand – if the nerve is very compressed or has been compressed for a long time. Unfortunately, once this has happened it cannot be reversed, so it is very important to see your doctor if your symptoms are severe or have been present for more than 6 weeks.
Selfcare and more information
Try and avoid keeping your elbows bent for long periods as this stretches the ulnar nerve around a bony ridge on the inside of your elbow.
Many people sleep with their elbows bent and this may cause you to wake up at night with your fingers asleep. Try to find a way to keep your elbows straight at night, such as wrapping a towel around your elbow.
Avoid leaning on your elbows as this will put more pressure on the nerve, for example avoid driving with your arm resting on the open window and avoid resting your elbow on the chair armrest whilst working at a computer.
Over-the-counter medicines from your pharmacy such as Non-steroidal Anti-Inflammatory tablets or gel (e.g., Ibuprofen) can help particularly if the condition is painful.
When to contact your GP
See your GP if your symptoms are severe or if they have lasted more than 6 weeks.
Your GP will examine your elbow and hand and consider if further tests may be helpful, such as nerve conduction studies to identify where the nerve is compressed and if it is causing muscle damage.
They may also consider referring you to an orthopaedic specialist to decide if surgery may be appropriate.
Treatment
Conservative treatment
Non-steroidal anti-inflammatory medication. If your symptoms have just started, your doctor may recommend an anti-inflammatory medicine, such as ibuprofen or naproxen, to help reduce swelling around the nerve.
Steroid injections are generally not recommended as there is a risk of damaging the nerve.
Bracing or splinting. Your doctor may prescribe a padded brace or splint to wear at night to keep your elbow in a straight position.
Nerve gliding exercises. Some doctors think that exercises to help the ulnar nerve slide through tight areas at the elbow or wrist can improve symptoms. Your GP may refer you to a physiotherapist for advice, or you can self-refer in some areas. Please see below links for further information:
- Physiotherapy in Torbay & South Devon
- Physiotherapy in Plymouth
- Physiotherapy in North Devon
- Physiotherapy in East Devon
This video by Hounslow and Richmond Community Healthcare Trust demonstrates 3 sliding exercises:
Ulnar nerve slider level 1 | Hounslow and Richmond Community Healthcare NHS Trust | Published: 20 July 2020
Surgical treatment
Your doctor may recommend surgery to take the pressure off the nerve if:
- conservative treatments have not helped
- there is severe compression
- there is muscle weakness or damage
These procedures are most often done on an outpatient basis, but some patients do best with an overnight stay at the hospital.
Cubital tunnel release
In this operation, the ligament roof of the cubital tunnel on the inside of the elbow is cut and divided. This increases the size of the tunnel and decreases pressure on the nerve.
Ulnar nerve anterior transposition
In some people, the ulnar nerve slides out from behind the bony ridge on the inside of the elbow (medial epicondyle) when the elbow is bent. Over time, this sliding back and forth may irritate the nerve.
Moving the nerve to the front prevents it from getting caught on the bony ridge.
Medial epicondylectomy
Another option to release the nerve is to remove part of the medial epicondyle.
Depending on the type of surgery you have, you may need to wear a splint for a few weeks after the operation. You may be referred to physiotherapy to help you regain strength and movement in your arm. Nerves recover slowly, so it may take a long time to know how successful the surgery has been.
Waiting for a specialist opinion
If you have been referred for a specialist opinion your details will be reviewed, and it may be recommended that you are seen by a hospital clinician. Information to support you in choosing your preferred hospital, including waiting times can be found using the links below.
How long will I wait?
If a hospital assessment and/or treatment is clinically recommended your information will be sent to a specialist. Click below to find out more about waiting times for routine hospital assessment and/or treatment.