The ulnar nerve, which stretches from beneath the clavicle to the little finger, is one of three major nerves controlling the arm. It provides feeling to the little finger and parts of the ring finger, and controls muscles in the forearm and hand. Injury to the nerve has a range of results, from common short-term shocks (banging your "funny bone") to irreversible muscle wasting in extreme cases. Treatments for ulnar nerve damage are well-established and generally quite effective.
Damage and its Causes
Damage to the ulnar nerve involves slowing or preventing proper signalling along the nerve's path. Sources of significant injury include direct sharp impact, long-term direct pressure and pressure or swelling from nearby damaged parts of the body. The nerve may also become compressed at the collar bone, elbow or wrist for reasons that are not fully understood.
Elbow fractures or dislocations frequently lead to problems, as can habitually leaning on your elbow or palm for extended periods. Symptoms to look for include pain, numbness, tingling or burning in your forearm or ring and little fingers. Your symptoms may be especially apparent when you awake from sleeping or after playing sports like golf or tennis. In more advanced cases, you may notice difficulty moving your fingers or weakness when bending your hand or making a fist. If you have any of these symptoms, consult your doctor or orthopedist as soon as possible.
Doctors diagnose ulnar nerve damage through physical examination, X-rays, blood tests and computed tomographic (CT) and magnetic resonance imaging (MRI) scans. If your diagnosis is positive, treatment will depend on the severity of the damage.
For injuries that don't require surgery, treatment may include anti-inflammatories like ibuprofen, naproxen or aspirin, as well as exercises that encourage muscle strength and proper nerve placement. In some cases, your doctor may use a splint to prevent you from bending your elbow. Home splints can be made from towels wrapped securely around the arm. While some doctors may prescribe cortisone injections for swelling, cortisone compounds may actually damage the nerve and should be avoided if possible.
Non-surgical treatment may also involve behaviour modification to avoid harmful sleeping positions, persistent pressure on the elbows or palms, or other bad habits. Consult your doctor about any changes that might be necessary.
Surgery and Recovery
More serious ulnar conditions, including heavy nerve compression around the elbow or wrist, may require surgery. Surgery at the elbow is most common. Simpler elbow surgery may involve shaving back the bone around the nerve to allow better passage. A more common option is nerve transposition, which involves relocating the nerve itself. Doctors can place the nerve in, over or beneath the surrounding muscle, depending on their preferences or your particular anatomy. Surgery for wrist compression typically involves opening up the tract along which the nerve travels, known as Guyon's canal. During surgery, doctors also look for other complicating factors like cysts and remove them if present.
Ulnar nerve surgeries are typically done on an outpatient basis, although overnight stays are sometimes necessary. Healing can take six weeks or longer, and a splint is often used for protection of the surgery site. Physical therapy is also commonly prescribed. Results from ulnar surgeries tend to be quite good, but you should be aware that some damage in advanced cases may be permanent or heal only over an extended period of time.