Ulnar Nerve Inflammation

• Prolonged Elbow Flexion: Bending the elbow stretches the ulnar nerve. This can irritate the nerve and decrease blood supply. When the elbow is bent for extended periods, such as while sleeping, holding a phone, or holding a mouse while working on the computer, it can irritate the ulnar nerve. If it is compressed for a long period, it can cause the fingers to become numb.
• Repetitive Motions: Repeatedly bending or leaning on the elbow, common in certain occupations and activities, can pressure the ulnar nerve.
• Direct Trauma: A direct blow to the inner part of the elbow, commonly known as hitting the “funny bone,” can damage the ulnar nerve.
• Systemic Conditions: Diseases like diabetes or rheumatoid arthritis can lead to inflammation and nerve damage, increasing the risk of Cubital Tunnel Syndrome.
• Risk factors include a prior elbow dislocation or fracture, bone spurs, elbow arthritis, cysts near the elbow joint, and baseball pitching.

• Numbness and Tingling: Frequently felt in the ring and little fingers, especially when the elbow is bent. These symptoms typically come and go. A sensation of the ring finger and little finger falling asleep can make it difficult to perform certain movements. Numbness can also affect the hand.
• Pain on the inside of the elbow, particularly during athletic activity such as throwing or golf.
• Weakness: Difficulty with grip strength and finger coordination for fine motor skills, such as typing or playing an instrument. This is more common in severe cases.
• Muscle Wasting: Atrophy of the hand muscles that results from longstanding nerve compression cannot be reversed. This is why it is important to contact Dr. Waterman when symptoms have lasted over a few weeks.

Symptoms usually start slowly. As the disease progresses, symptoms may progress to constant numbness, weakness, clumsiness, and loss of hand dexterity.

Dr. Waterman will review and discuss your medical history, inquire about your symptoms, activities, and medications, and perform a physical examination. He will use certain tests to evaluate the function of the ulnar nerve. Blood tests for diabetes and thyroid disease may be ordered.

X-rays will be ordered to evaluate the bones and check for bone spurs, arthritis, and other structures that may be compressing the nerve. Other imaging studies, such as an MRI or ultrasound, may be used to assess elbow anatomy and identify structural abnormalities that may be contributing to nerve compression. He may order nerve conduction studies to determine how well the nerve is functioning and pinpoint the compression site.

Initial treatment is generally a trial of conservative nonsurgical management. The goal is to relieve pressure on the nerve.

Conservative management includes:

• Activity Modification: Avoiding activities that worsen symptoms and taking frequent breaks during repetitive tasks.
• Splinting or Padding: A splint or elbow pad can keep the elbow in a more extended position, particularly at night if you sleep on your arm.
• Medications: NSAIDs can help reduce pain and inflammation. In some cases, corticosteroid injections may be used to decrease inflammation.
• Physical Therapy: Hand therapy includes exercises and stretches to improve flexibility and strength and ergonomic adjustments to reduce nerve compression.

Conservative treatment is beneficial for 90% of patients with mild symptoms. Surgery is considered for patients with persistent symptoms.

Dr. Waterman may recommend surgery to relieve pressure on the nerve when nonsurgical methods fail to improve the symptoms, the nerve is seriously compressed, and it has caused muscle weakness or damage. Surgery is designed to decompress the nerve. It will take months for the nerve to heal.

Outpatient Surgical Treatment Options:

• Cubital Tunnel Release: Surgery to increase the size of the cubital tunnel and reduce pressure on the ulnar nerve.
• Ulnar Nerve Transposition: Moving the ulnar nerve to a new position in front of the elbow joint to prevent it from getting caught in the cubital tunnel.
• Medial Epicondylectomy: Removing part of the medial epicondyle to relieve pressure on the ulnar nerve.