Ulnar Nerve Injury

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Introduction

What is ulnar nerve injury?

An ulnar nerve injury is an injury that damages the ulnar nerve, one of the three main nerves in the forearm. The ulnar nerve runs from the shoulder to the hand and is responsible for carrying signals between the hand and the brain, enabling motion and feeling in the hand and forearm. An injury to the ulnar nerve can damage this communication and thus limit motion and feeling in the hand and forearm. If you have ulnar nerve injury, you will most likely experience symptoms in the area of your ring and little fingers.

Ulnar nerve injuries may be the result of pressure, trauma or illness. The most common cause of injury to the ulnar nerve is entrapment, in which the ulnar nerve is compressed. This may result from bone damage, such as an elbow fracture or dislocation, swelling of soft tissue, or external pressure from certain activities or positions. In some cases, ulnar nerve injuries may arise without a known cause.

Treatment of ulnar nerve injury varies greatly depending on the severity and underlying cause. Your heath care provider may recommend nonsurgical and surgical treatments for ulnar nerve injury. In either case, the goal of treatment is to manage or relieve symptoms and correct the underlying cause when possible.

Seek immediate medical care (call 911) ifasudden tingling or abnormal sensation in the area of the ulnar nerve is accompanied by numbness or weakness of the arm or fingers on one side of your body; a change in level of consciousness or alertness, such as passing out or unresponsiveness; or the worst headache of your life, as these can be signs of stroke.

Seek prompt medical care if you are being treated for ulnar nerve injury but mild symptoms recur or are persistent.

Symptoms

What are the symptoms of ulnar nerve injury?

Symptoms of an ulnar nerve injury include pain, numbness, and loss of muscle strength and coordination in the arm and hand. Symptoms most commonly affect the little finger and the ring finger.

Common symptoms of ulnar nerve injury

You may experience ulnar nerve injury symptoms daily or just once in a while. At times, any of these ulnar nerve injury symptoms can be severe:

  • Burning feeling in hand, arm or finger

  • Increased arm numbness or tingling while typing or writing

  • Increased finger numbness or tingling while typing or writing

  • “Pins and needles” sensation (prickling) in the hand, arm or fingers

  • Tingling or other unusual sensations in the hands

  • Weakness (loss of strength) in the hand, arm or fingers

Symptoms that might indicate a serious condition

In some cases, ulnar nerve symptoms can be a serious condition that should be evaluated immediately in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have any of these serious symptoms including:

  • Change in level of consciousness or alertness, such as passing out or unresponsiveness

  • Change in mental status or sudden behavior change, such as confusion, delirium, lethargy, hallucinations and delusions

  • Chest pain or pressure

  • Difficulty breathing

  • Garbled or slurred speech or inability to speak

  • Paralysis or inability to move a body part

  • Sudden change in vision, loss of vision, or eye pain

Causes

What causes ulnar nerve injury?

There are many causes of ulnar nerve injuries, including pressure, trauma and illness. In some cases, ulnar nerve injuries may arise without a known cause.

The most common cause of ulnar nerve injury is extended pressure on the ulnar nerve, known as ulnar nerve entrapment. As the ulnar nerve travels from the shoulder to the hand, it passes through two tunnels of tissue, the cubital tunnel behind the elbow and Guyon’s canal in the wrist. Both tunnels are common locations at which the ulnar nerve can be compressed and injured. The ulnar nerve may also be compressed at the neck or beneath the collarbone.

Entrapment of the ulnar nerve may result from swelling of soft tissue, cysts, or damage to the bones in the arms. Bone damage causing ulnar nerve injuries include arthritis, elbow dislocations, elbow and wrist fractures, and bone spurs. Repetitive motions of the arm and hand, extensive bending of the elbow, and long-term pressure on the palm of the hand may also cause ulnar nerve injuries.

Ulnar nerve injuries may also be the result of direct trauma to the nerve. Finally, any whole body illness that is known to cause nerve damage, such as diabetes or hypothyroidism, can affect the ulnar nerve.

What are the risk factors for ulnar nerve injury?

A number of factors increase the risk of developing ulnar nerve injury. Not all people with risk factors will get ulnar nerve injury. Risk factors for ulnar nerve injury include:

  • Activities in which your elbow or wrist is bent or twisted for prolonged periods

  • Alcohol abuse

  • Brachial plexus injury (injury to the bundle of nerves that transmit signals from the spine to the shoulder, arm and hand)

  • Diabetes (chronic disease that affects your body’s ability to use sugar for energy)

  • Elbow and wrist abnormalities

  • Hypothyroidism (underactive thyroid)

  • Nerve entrapment or compression, such as of the ulnar nerve in the arm

  • Rheumatoid arthritis (chronic autoimmune disease characterized by joint inflammation)

  • Sleeping positions that put pressure on your ulnar nerve

Reducing your risk of ulnar nerve injury

You may be able to lower your risk of ulnar nerve injury by:

  • Avoiding positions that put pressure on the elbow or inside of the arm

  • Keeping your elbow and wrist straight while sleeping

  • Limiting activities that require the elbow or wrist to be bent for a prolonged period

Treatments

How is ulnar nerve injury treated?

Treatment for ulnar nerve injury begins with seeking medical care from your health care provider. To determine whether you have an ulnar nerve injury, your health care provider will likely perform a physical examination.

The goal of treatment for ulnar nerve injury is to manage or relieve symptoms and correct the underlying cause when possible. Treatment of ulnar nerve injury varies greatly depending on the severity and underlying cause.

Nonsurgical treatments for ulnar nerve injury

Nonsurgical treatments for ulnar nerve injury include:

  • Corticosteroid injections to decrease swelling and reduce pressure on the nerve

  • Occupational therapy

  • Over-the-counter or prescription pain relief medications

  • Physical therapy

  • Splinting the elbow or wrist

Surgical treatment for ulnar nerve injury

Depending on the severity and underlying cause of your ulnar nerve injury, your health care provider may recommend surgical treatment. Surgery may be recommended to:

  • Alleviate pressure from the ulnar nerve

  • Correct bone injuries and damage

  • Open the cubital tunnel behind the elbow or Guyon’s canal in the wrist

  • Relocate the ulnar nerve

  • Remove cysts

Complementary treatments

Some complementary treatments may help some people in their efforts to deal with ulnar nerve injury. These treatments, sometimes referred to as alternative therapies, are used in conjunction with traditional medical treatments. Complementary treatments are not meant to substitute for full medical care.

Complementary treatments may include:

What are the potential complications of ulnar nerve injury?

Complications of untreated ulnar nerve injury can be serious. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of ulnar nerve injury include:

  • Nerve problems that cause pain, numbness or tingling

  • Permanent loss of sensation

  • Permanent nerve damage (due to a pinched nerve), including paralysis

  • Permanent or chronic pain

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Jan 5
  1. Ulnar nerve entrapment at the elbow (cubital tunnel syndrome). American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=a00069.
  2. Ulnar nerve dysfunction. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/000789.htm.
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