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Ulnar Nerve Entrapment


The so-called "funny bone” in the elbow isn't a bone at all, and really isn’t that funny either. It is a spot at the tip of the elbow where the ulnar nerve is exposed. When the ulnar nerve is bumped, it is compressed against the humerus, causing the familiar tingling sensation.

Because of the anatomic positioning of the ulnar nerve, it is subject to entrapment and injury by a wide variety of causes. It is the second most common entrapment neuropathy in the upper extremity (the first being the median nerve and its branches). Because of its superficial position at the elbow, the ulnar nerve is often injured by excessive pressure in this area (leaning on the elbow during work or while driving a car).

Problem

Pressure or injury to the ulnar nerve along its anatomic course may cause denervation and paralysis of the muscles supplied by that nerve. One of the most severe consequences is loss of intrinsic muscle function in the hand.

Diagnosis

Although the problem is in the elbow area, most symptoms occur in the hand and fingers because the ulnar nerve controls movement and sensation there. Both sensory and motor skills are affected. A physician can use several methods to diagnose ulnar nerve entrapment. If you've experienced a fall, blow, or other injury to the elbow, a physician may request an X-ray, may apply pressure around the nerve to see if pain or tingling occurs, check to see if the hand muscles are weakening, or do an electrical stimulation test to see how well the nerve conducts sensory information.

Symptoms

Symptoms of an ulnar entrapment include:

  • Tenderness along the inside of the elbow
  • Tingling and numbness in little and ring fingers (especially at night)
  • Numbness in your hand when the elbow is bent, such as when you drive
  • Difficulty with hand coordination (such as typing)
  • Decreased grip and pinch strength, muscle weakness
  • Pain along the inside border of the shoulder blade

Medical Therapy

Patient education and insight are important. Resting on elbows at work, using elbows to lift the body from bed, and resting elbows on car windows while driving all are causes that can be corrected without surgical treatment.

Nonsteroidal anti-inflammatory medications can relieve nerve irritation. Oral vitamin B-6 supplements may be helpful for mild symptoms. It is suggested that this treatment be carried out for 6-12 weeks, depending on patient response.

Surgical treatment of ulnar nerve entrapment depends on the site of compression. The two most common sites are the elbow and the wrist.

Home Treatment

Some elbow conditions, such as mild strains, sprains, and tendonitis call for simple home treatments such as: 

Others demand more advanced physical therapy techniques:

  • Carefully and scientifically tailored exercises to strengthen the elbow and improve range of motion
  • Mobilization
  • Ultrasound and electrical stimulation

Still other problems require surgery or other major interventions.


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