Ulnar neuritis - Ulnar nerve compression

Ulnar nerve neuritis - Ulnar nerve compression is also known as cubital tunnel syndrome if it is compressed at the elbow.

The ulnar nerve is one of the three main nerves that cross the elbow. It runs in a groove (the cubital tunnel) behind the medial aspect (inner side)

of the elbow. The ulna nerve may become compressed in this groove.

The ulna nerve provides sensation to the little and ring fingers and supplies motor power to the small muscles of the hand.

Initially symptoms of tingling and numbness in the little and ring fingers may be intermittent, depending on the position of the elbow.

Poorly defined pain may also be felt, occasionally localized to the inner side of the elbow radiating down the forearm to the hand.

 In advanced cases if the nerve has been under pressure for a prolonged time the intermittent tingling may be replaced with permanent

numbness and weakness of the small muscles of the hand.

The weakness of the small muscles may lead to difficulty opening jars and reduced pinch strength.

At rest the hand may adopt a slight claw like posture as the muscles get out of balance.

The nerve may not only be compressed behind the elbow, in some people it is forced out of its groove as you bend the elbow. This is called a

subluxing ulna nerve.

Repeated subluxation may also lead to pain and nerve injury.

 The nerve travels from your neck to your hand and can be compressed anywhere along its course.

 The elbow is the commonest site of compression, the neck then the wrist being other common sites.

 It is not always a mechanical cause that leads to numbness pain and tingling. Some medical conditions, particularly diabetes may injure the

nerves leading to impaired nerve function. Occasionally a viral infection may affect the nerves.

Diagnosis

The diagnosis is often made on the story and examination. However there are other places the nerves that supply sensation to your hand can be

compressed eg. in the neck or at the wrist.

 X rays of the elbow and or the neck may be requested to see if there is any bony reason for compression of the nerve at the neck or elbow.

 If still in doubt an MRI scan of the neck may be requested to see if the nerves are being compressed by a disc in the neck.

 Nerve conduction tests are often requested to confirm or exclude conduction delay (a blockage) of the nerve at the elbow.

The Double crush - this is a concept where the nerve may be compressed at several places both mechanically and or medically.

 For example in patients with diabetes, the diabetes may lead to nerve injury and vague neurological symptoms in the hand, this may be

associated with some compression at the elbow.

 Both in isolation may not be severe enough to lead to symptoms but together they impair nerve function enough to lead to symptoms.

Treatment

Treatment in the first instance is non operative if symptoms are mild and nerve conduction studies show no significant nerve injury.

 If symptoms are severe and nerve conduction studies show evidence of permanent nerve injury, then early surgery is recommended.

 Non operative treatment

 Pay attention to the position of the elbow, when sleeping try keep elbow straight, wrap it in a towel or pillow.

An occupational therapist may make splints to keep the elbow nearly straight. When sitting and when at work avoid keeping elbow bent for long

periods of time and avoid pressure on the nerve.

 If these are unsuccessful and nerve conduction studies confirm some compression at the elbow then surgery may be considered.

 Operative treatment

 Surgery is indicated if non operative treatment fails, symptoms are severe and or the nerve conduction studies show severe nerve compression

and the risk of permanent nerve injury if not decompressed.

 There are several kinds of operation for ulnar nerve compression at the elbow:

•

Ulnar nerve decompression - here the roof is removed from the cubital tunnel and the nerve simply decompressed. It can be done as a day

case. The arm is placed in a bulky bandage and activities of daily living are started from the start.  Wounds heal within 10-14 days and early

elbow movement is encouraged.

•

Ulnar nerve anterior transposition - here if the nerve does not sit nicely in its groove and continually tries to sublux the nerve is transposed

(moved) to the front of the elbow. This can also be performed as a day case, recovery is only slightly slower than simple decompression.

•

Ulnar nerve surgery and surgery on common flexor origin (golfers elbow) - Occasionally patients will have symptoms of ulnar neuritis and

golfers elbow. It is possible to address both problems at the same time, decompressing, transposing the ulna nerve and releasing and

debriding the common flexor origin (see golfers elbow).