Understanding the Treatment of Ulnar Neuropathy

Ulnar Tunnel Syndrome and Cubital Tunnel Syndrome

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Most people are probably familiar with carpal tunnel syndrome, where impingement of the median nerve in the wrist (carpal tunnel) causes pain, tingling and numbness in the thumb, index finger, middle finger and part of the ring finger as well as part of the palm. 

However, a similar disease process can take place on the other (medial) side of the wrist or arm where impingement of the ulnar nerve causes pain, tingling and numbness in the pinky finger, half the ring finger and part of the palm.

  This constellation of disease is called ulnar neuropathy and can be secondary to either cubital tunnel syndrome or ulnar tunnel syndrome.

What Is Cubital Tunnel Syndrome?

After branching off the brachial plexus, a network of nerves which originate from the spinal cord, the ulnar nerve ("funny bone" nerve) runs the length of your arm. Cubital tunnel syndrome occurs when the ulnar nerve is compressed at the level of the elbow. 

Because cubital tunnel syndrome involves the elbow, discomfort, tingling and numbness in the pinky finger, ring finger and palm can be aggravated by sustained flexion of the elbow (think talking on the phone). These symptoms can cause night-time awakening, and people with cubital tunnel syndrome often sleep with their elbows flexed. Cubital tunnel syndrome can also result in pain in the forearm and weakness in muscles of the hand.

Conservative (nonsurgical) treatment for cubital tunnel syndrome involves use of an elbow pad and splint as well as medications for pain relief like ibuprofen (NSAIDs).

The splint should maintain the elbow at a flexion of 45 degrees and can be worn either continuously or only at night depending on the severity of illness.

If conservative therapy fails to provide relief from the symptoms of cubital tunnel syndrome, surgery is performed. Surgery involves decompression of the ulnar nerve at the level of the elbow.

Before surgery, however, the patient must undergo nerve studies (electromyogram or nerve conduction studies).

Physical therapy after surgery for cubital tunnel syndrome focuses on strength training and regaining movement in the elbow. Recovery can take up to 12 weeks.

What Is Ulnar Tunnel Syndrome?

Just like cubital tunnel syndrome, ulnar tunnel syndrome involves compression of the ulnar nerve and causes ulnar neuropathy with pain, tingling and numbness in the palm, pinky finger and part of the ring finger. In later stages, cubital tunnel syndrome can also cause hand weakness secondary to atrophy or shrinking of the hypothenar and interosseous muscles (deep muscles in your hand).  In the most severe cases, this atrophy can even cause “clawing” of the hand (which can also be seen in cubital tunnel syndrome).

However, ulnar tunnel syndrome is caused by compression of the ulnar nerve at an anatomic location different from carpal tunnel syndrome. Specifically, ulnar tunnel syndrome affects the ulnar nerve as it passes through the Guyon canal on its way to innervating the pinky finger and part of the ring finger.

 

Ulnar tunnel syndrome can be caused by repetitive use injuries such as hammering. Thus, sheet metal workers are encouraged to use a rubber mallet to mitigate further damage to the ulnar nerve.

Ulnar tunnel syndrome can be treated conservatively with splinting and pain medications like ibuprofen.  Like other forms of nerve impingement, surgery to decompress the nerve can result in relief. Of note, if a person has both carpal tunnel syndrome and ulnar tunnel syndrome, release of the transverse carpal tunnel ligament, which forms the roof of the carpal tunnel and part of the ulnar tunnel, can relieve pressure on the ulnar nerve.

If you or someone you love is suffering from an apparent ulnar neuropathy, it's important to get this problem checked out by your physician. Please keep in mind that although conservative treatment may provide some relief of pain and discomfort, if you have a severe case of cubital or ulnar tunnel syndrome, surgery will likely provide long-term relief.

Sources

Bednar MS, Light TR, Bindra R. Chapter 9. Hand Surgery. In: Skinner HB, McMahon PJ. eds. Current Diagnosis & Treatment in Orthopedics, 5e. New York, NY: McGraw-Hill; 2014. Accessed September 18, 2015.

Rempel DM, Amirtharajah M, Descatha A. Shoulder, Elbow, & Hand Injuries. In: LaDou J, Harrison RJ. eds. CURRENT Diagnosis & Treatment: Occupational & Environmental Medicine, 5e. New York, NY: McGraw-Hill; 2013. Accessed September 18, 2015.

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