Neuropathy

What is it?

This is a condition affecting the ulnar nerve as it passes behind the medial epicondyle (at the tip of the elbow and otherwise known as the funny bone) on the inside of the elbow joint. The nerve is most commonly susceptible to irritation or compression here, but can be affected at any point along its track in the arm.

Why does it occur?

Also known as cubital tunnel syndrome, the ulnar nerve is affected most commonly as a result of constant pressure over time. This may be resting on the elbows while working at a desk, or keeping the elbow flexed for long periods when driving. The nerve stretches abnormally when in this position for too long, and can flick out of the cubital tunnel. Previous trauma or injury to the elbow which has generated scar tissue can cause compression of the nerve, and become painful.

What are the symptoms?

Pain and an altered sensation can be felt in areas supplied by the ulnar nerve, from the elbow to the hand. Numbness and tingling of the ring and little finger are common symptoms, and pain can sometimes also be experienced on the inner aspect of the elbow radiating towards the hand.

How is it diagnosed?

Your consultant will take a thorough medical history and a physical examination, specifically testing the ulnar nerve. You may be referred for nerve conduction studies to assess its function.

How is it treated?

Non-surgical treatment
Conservative treatment options include rest and anti-inflammatory medication. Your symptoms should also settle with some lifestyle changes that involve lots of elbow flexion with frequent breaks. Some patients benefit from bracing, a and splint is particularly useful if  symptoms are experienced during the night. A splint or brace also helps to protect the nerve from external pressure, and reduce flexion of the elbow.

Surgical treatment
An operation may be considered when other treatment options are ineffective, or if there are signs of increasing damage, such as wasting or weakness in the muscles supplied by the ulnar nerve. This day-case procedure is known as an ulnar nerve decompression, and involves releasing any surrounding soft tissues that are causing restriction.

Treatment options

The One Orthopaedics team specialists

Anthony Hearnden

Consultant Orthopaedic Specialist FRCS (Tr & Orth)