Ulnar Nerve Entrapment at the Elbow

Ulnar Nerve Entrapment at the Elbow

Article
Brain & Nerve
Bone, Muscle, & Joint
+1
Contributed byKrish Tangella MD, MBAMay 20, 2018

What are the other Names for this Condition? (Also known as/Synonyms)

  • Cubital Tunnel Syndrome
  • Funny Bone Syndrome
  • Ulnar Entrapment Neuritis 

What is Ulnar Nerve Entrapment at the Elbow? (Definition/Background Information)

  • Ulnar Nerve Entrapment at the Elbow is a type of entrapment neuropathy. Entrapment neuropathy occurs when a nerve is physically compressed within an anatomically tight space, resulting in various symptoms of nerve dysfunction
  • The ulnar nerve is the longest unprotected nerve in the human body (meaning it is not protected by any bones or muscles). It is also one of the 3 key nerves that provide sensation and function to the hand
  • The ulnar nerve begins at the neck and travels all the way down the arm, through a region in the elbow, called the cubital tunnel
  • Ulnar Nerve Entrapment at the Elbow is a condition characterized by an entrapment of the ulnar nerve at the elbow. Men are more likely to develop this elbow condition, than women
  • The treatment measures for Ulnar Nerve Entrapment at the Elbow include both nonsurgical and surgical methods. The prognosis of this elbow condition is usually excellent with proper treatment 

Who gets Ulnar Nerve Entrapment at the Elbow? (Age and Sex Distribution)

  • Ulnar Nerve Entrapment at the Elbow may occur in individuals of all ages, races, ethnic groups, and gender
  • Elderly individuals have a higher risk of developing this condition than younger individuals
  • Overall, men are more likely to develop this elbow condition, than women 

What are the Risk Factors for Ulnar Nerve Entrapment at the Elbow? (Predisposing Factors)

Common risk factors associated with Ulnar Nerve Entrapment at the Elbow include:

  • Any repetitive stress on the elbow joint associated with sports
  • Chronic inflammatory disorders, such as rheumatoid arthritis
  • Increased (abnormal) pressure on the joints, due to excessive body weight (obesity)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider. 

What are the Causes of Ulnar Nerve Entrapment at the Elbow? (Etiology)

In many cases of Ulnar Nerve Entrapment at the Elbow, the direct cause is unknown. However, there are several contributing factors for this condition and these include:

  • Heavy lifting; pulling heavy objects
  • Frequently leaning on one’s elbow
  • Direct trauma to the elbow
  • Fluid buildup within the elbow 

What are the Signs and Symptoms of Ulnar Nerve Entrapment at the Elbow?

Most symptoms of Ulnar Nerve Entrapment at the Elbow occur in the hand; they usually take place, when the elbow is bent. This could also happen when an individual is sleeping at night in a specific position. Common signs and symptoms of the condition include:

  • Feeling of weakness or tenderness of the hand
  • A tingling sensation on the palms and fingers
  • Increased sensitivity to cold within the hand or forearm
  • Pain within the elbow joint 

How is Ulnar Nerve Entrapment at the Elbow Diagnosed?

Ulnar Nerve Entrapment at the Elbow is diagnosed using the following tools:

  • Physical examination:
    • A thorough physical examination is important in determining, if an individual has Ulnar Nerve Entrapment at the Elbow
    • During this exam, a physician will examine the arm and hand, to determine which nerve is compressed and identify the location of the compressed nerve
    • A physician may also lightly tap his/her finger over the ulnar nerve to determine if this causes irritation, or check if the nerve slides out of normal position, when the elbow is bent. They may also test the sensation in the hand and fingers
    • Individuals are also expected to provide an explanation of the circumstances that led up to the injury
    • In addition to this, a complete medical history will aid in arriving at a definitive diagnosis
  • X-rays of the elbow: X-rays use radiation to produce images of the elbow. A high percentage of ulnar nerve compressions are difficult to observe on an x-ray. However, a physician will usually order an x-ray, to help rule out other possible causes for elbow discomfort, such as if a fragment of a fractured bone is pressing on a nerve
  • Magnetic resonance imaging (MRI) of the elbow: An MRI is a more detailed scan that use radio waves and strong magnetic fields to produce clearer images of the bones and soft tissue that surrounds the elbow. An MRI scan may show increased fibrous tissue around the nerve
  • Electromyography (EMG) of affected region: An EMG shows the electrical activity of the muscle during rest and contraction of the muscle. Examining the electrical activity may help a physician study any injury to the ulnar nerve within the elbow
  • Nerve conduction velocity (NCV) of ulnar nerve: Nerve conduction velocity shows the speed at which electrical signals move through a nerve. Slowing of nerve conduction speed may indicate damage to the ulnar nerve

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis. 

What are the possible Complications of Ulnar Nerve Entrapment at the Elbow?

Complications of Ulnar Nerve Entrapment at the Elbow include:

  • Partial or complete loss of feeling or sensation of the hand and fingers
  • Partial or complete loss of hand or wrist movement
  • Chronic pain
  • Emotional depression, due to an inability to participate in athletic, professional, or recreational activities 

How is Ulnar Nerve Entrapment at the Elbow Treated?

The treatment measures for Ulnar Nerve Entrapment at the Elbow include both nonsurgical and surgical methods.

Nonsurgical treatment methods for Ulnar Nerve Entrapment at the Elbow include:

  • Any activity that aggravates the elbow condition should be avoided. The physician may advise the individual to refrain from participating in any physical activities, till the pain stops or symptoms improve
  • Applying ice (or a damp heated towel) to the elbow can help reduce pain and swelling
  • Complete immobilization of the elbow with a cast may be required to restrict movement
  • Non-steroidal anti-inflammatory oral medications, such as indomethacin and naproxen, may be used to treat Ulnar Nerve Entrapment at the Elbow. These medications can help decrease the pain and swelling
  • Corticosteroid injections help in temporary relieving symptoms, such as pain, and in improving the range of motion
  • It is important to begin some light exercises after the symptoms have decreased. Physical therapy may help restore strength, as well as flexibility in the muscles

Surgical treatment methods for Ulnar Nerve Entrapment at the Elbow include:

  • Cubital tunnel release: In this procedure, the cubital tunnel ligament in the elbow is cut and divided, thereby decreasing pressure on the nerve. A part of the wall of the cubital tunnel is a ligament, which is a tough, fibrous band connecting two bones
  • Anterior transposition of the ulnar nerve: This procedure entails surgically moving the nerve to reduce stress 

How can Ulnar Nerve Entrapment at the Elbow be Prevented?

Currently, there are no preventative measures for Ulnar Nerve Entrapment at the Elbow. However, following certain guidelines may help decrease any abnormal pressure on the ulnar nerve. These guidelines include:

  • Avoiding “stress” on the arm, when the elbow is in a bent position
  • Maintaining a good posture; ensuring proper use of the elbow and arms
  • Avoiding leaning on the elbow 

What is the Prognosis of Ulnar Nerve Entrapment at the Elbow? (Outcomes/Resolutions)

  • The long-term prognosis of Ulnar Nerve Entrapment at the Elbow is usually good in a majority of the individuals
  • When properly treated, under the guidance of a physiotherapist and specialist, a high percentage of individuals regain their full strength and range of motion
  • Severe cases of Ulnar Nerve Entrapment at the Elbow may take several months of intense physical therapy to heal and recover completely
  • Early physiotherapy is extremely important to hasten the recovery time 

Additional and Relevant Useful Information for Ulnar Nerve Entrapment at the Elbow:

  • When compression of the ulnar nerve occurs at the elbow, it is called "Ulnar Nerve Entrapment at the Elbow”. When compression of the ulnar nerve occurs at the wrist, it is called “ulnar tunnel syndrome of the wrist”
  • After carpal tunnel syndrome, Ulnar Nerve Entrapment is the second most frequent entrapment neuropathy
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Krish Tangella MD, MBA

Pathology, Medical Editorial Board, DoveMed Team

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