Sometime last year, I was diagnosed with Ulner Nerve Entrapment. The ulner nerve runs down the neck, through the arm, past a tunnel created by bones in the elbow, and connects to the last two fingers of the palm – the ring finger and the pinky finger. If this nerve gets ‘pinched’, the arm starts to throb and wrist function as well as mobility is compromised.
Since the condition resulted in tons of money spent on medical bills, loads of working hours lost and inexplicable pain, I decided to research more. Today, I am here to discuss this lesser known condition that is quite a lot like Carpal Tunnel Syndrome, with the difference being that the nerve is pinched at the elbow and not the wrist.
What Is Ulner Nerve Entrapment?
Ulnar nerve entrapment occurs when the ulnar nerve in the arm becomes compressed or irritated. The ulnar nerve is one of the three main nerves in your arm. It travels from your neck down into your hand, and can be constricted in several places along the way. Depending upon where it occurs, this pressure on the nerve can cause numbness or pain in your elbow, hand, wrist, or fingers.
Sometimes the ulnar nerve gets compressed at the wrist, beneath the collarbone, or as it comes out of the spinal cord in the neck. The most common place where the nerve gets compressed is behind the elbow.
When the nerve compression occurs at the elbow, it is called “Cubital Tunnel Syndrome.”
Understanding The Anatomy of The Ulner Nerve
At the elbow, the ulnar nerve travels through a tunnel of tissue (the cubital tunnel) that runs under a bump of bone at the inside of your elbow. This bony bump is called the medial epicondyle. The spot where the nerve runs under the medial epicondyle is commonly referred to as the “funny bone.” At the funny bone the nerve is close to your skin, and bumping it causes a shock-like feeling.
Beyond the elbow, the ulnar nerve travels under muscles on the inside of your forearm and into your hand on the side of the palm with the little finger. As the nerve enters the hand, it travels through another tunnel (Guyon’s canal).
The ulnar nerve gives feeling to the little finger and half of the ring finger. It also controls most of the little muscles in the hand that help with fine movements, and some of the bigger muscles in the forearm that help you make a strong grip.
How The Pain Starts?
In many cases of cubital tunnel syndrome, the exact cause is not known. The nerve is especially vulnerable to compression at the elbow because it must travel through a narrow space with very little soft tissue to protect it.
In my case, the condition started with symptoms very similar to Carpal Tunnel Syndrome. I had numbness and tingling in the fingers, and pain that originated at the elbow, but was felt more acutely at the wrist. It was worse when I tried to curl the last two fingers on my left hand.
When I saw the Neurologist, he explained to me that several things could have caused the pressure on the nerve at the elbow. Here are some things that can result in Cubital Tunnel Syndrome
- When your bend your elbow, the ulnar nerve stretches around the boney ridge of the medial epicondyle. Because this can irritate the nerve, keeping your elbow bent for long periods or repeatedly bending your elbow can cause painful symptoms. For example, many people sleep with their elbows bent. This can aggravate symptoms of ulnar nerve compression and cause you to wake up at night with your fingers asleep.
- In some people, the nerve slides out from behind the medial epicondyle when the elbow is bent. Over time, this sliding back and forth may irritate the nerve.
- Leaning on your elbow for long periods of time can put pressure on the nerve.
- Fluid buildup in the elbow can cause swelling that may compress the nerve.
- A direct blow to the inside of the elbow can cause pain, electric shock sensation, and numbness in the little and ring fingers. This is commonly called “hitting your funny bone.”
In my case, the main cause was leaning on my elbows for long periods of time can put pressure on the nerve. I worked on my laptop for 8 to 9 hours a day, while my elbows rested on the armrests of my chair. To add to my woes, I also slept with an elbow bent and arm crooked under my head. So after 8 to 9 hours of stress through the day, my elbow was again bent throughout the night as I slept.
Treatments Available for Ulner Nerve Entrapment
The treatment was a combination of non-steroidal anti-inflammatory drugs, prescription pain relievers to help reduce pain and inflammation, and steroids to help treat the symptoms faster.
1-Non-steroidal anti-inflammatory medicines. If your symptoms have just started, your doctor may recommend an anti-inflammatory medicine, such as ibuprofen, to help reduce swelling around the nerve.
2-Steroid injections. Steroids, like cortisone, are very effective anti-inflammatory medicines. Injecting steroids around the ulnar nerve is generally not used because there is a risk of damage to the nerve.
3-Bracing or splinting. Your doctor may prescribe a padded brace or split to wear at night to keep your elbow in a straight position.
4-Nerve gliding exercises. Some doctors think that exercises to help the ulnar nerve slide through the cubital tunnel at the elbow and the Guyon’s canal at the wrist can improve symptoms. These exercises may also help keep the arm and wrist from getting stiff.
Let me tell you, none of these medications are easy on the body. The pain killers made me feel disoriented all day long, and the steroids caused a lot of weight gain. The injections were the worst. It took over 6 months to lose the weight after I stopped the medications. I was also asked to wear a splint to help immobilize the elbow.
In severe cases where medication alone cannot solve the problem, surgery becomes impertinent. This surgery moves the ulner nerve from the elbow where it is entrapped to the front of the elbow. The surgical treatment includes surgical transposition of the nerve, medial epicondylectomy and decompression in Cubital Tunnel Syndrome.
Without treatment, the ring finger and little finger can become immobilized and permanently bent, resulting in a ‘hook hand’.
There are many things you can do at home to help relieve symptoms. If your symptoms interfere with normal activities or last more than a few weeks, be sure to schedule an appointment with your doctor.
- Avoid activities that require you to keep your arm bent for long periods of time.
- If you use a computer frequently, make sure that your chair is not too low. Do not rest your elbow on the armrest.
- Avoid leaning on your elbow or putting pressure on the inside of your arm. For example, do not drive with your arm resting on the open window.
- Keep your elbow straight at night when you are sleeping. This can be done by wrapping a towel around your straight elbow or wearing an elbow pad backwards.
In my case, I had to stop working for about 3 months so that my nerve could heal and not get pinched at the elbow again. I was also asked to move from a laptop to a desktop. The desktop is pushed to the further end of the table, so that my arm now rests flat on the surface while I type. I can no longer type without breaks or work for 8-9 hours at a single stretch. Even after complete recovery, my elbow starts to throw and wrist movement feels comprised if I over-stress the left arm.
Could You Be At Risk Too?
Just like me, if you work on a laptop for several hours while your elbows are resting on the armrests, you certainly are at risk.
Some other factors put you more at risk for developing Cubital Tunnel Syndrome. These include:
- Prior fracture or dislocations of the elbow
- Bone spurs/ arthritis of the elbow
- Swelling of the elbow joint
- Cysts near the elbow joint
- Repetitive or prolonged activities that require the elbow to be bent or flexed
Most patients diagnosed with Cubital Tunnel Syndrome have advanced disease (atrophy, static numbness, weakness) that might reflect permanent nerve damage that will not recover after surgery. When diagnosed prior to atrophy, weakness or static numbness, the disease can be arrested with treatment. Mild and intermittent symptoms often resolve spontaneously.
So if you have been feeling numbness and tingling in your fingers and feel a sharp pain that emanates at the elbow or ring finger plus little finger, I recommend you go to a doctor right away.