Most people have heard of carpal tunnel syndrome, a wrist and hand condition that causes tingling, numbness, and pain from nerve compression in the wrist and fingers. Still, there is also has a lesser-known condition, ulnar tunnel syndrome, which can have similar symptoms. Ulnar tunnel syndrome is when the ulnar nerve is compressed as it enters the wrist between two bones of the wrist. Compression of the ulnar nerve can also occur at the elbow and cause the same symptoms. Most people have probably experienced the not-so-funny occurrence of when the “funny bone” is bumped. In reality, this is when the ulnar nerve is quickly compressed on the humerus bone, and if you’ve had this happen, you may experience shooting pain, tingling, and numbness.
The ulnar nerve starts at the neck and runs in front of the shoulder, through the inside of the upper arm. It then goes behind the elbow, enters the forearm on the inside, and goes down to the wrist into the hand on the small finger side. The ulnar nerve is responsible for bending the wrist towards the forearm and closing the gap between the small finger and the forearm. It also controls the muscles that spread and open the fingers, assisting with thumb stability and mobility, using the small finger, extending the smaller knuckles of the hands, and bending the big knuckles of the hands. When pressure is placed anywhere on the nerve, it can cause numbness, tingling, and pain in the little and ring finger and along that side of the hand to the wrist. Hand weakness may also be experienced. An injury to the ulnar nerve can make it difficult to open jars and packages, use scissors, type, write or spread the finger apart and together.
Weight-bearing on the elbow and pressure on the palm (such as on bicycle handlebars) can irritate the nerve. Keeping the elbow bent for prolonged periods, like when using your cell phone to text or holding it up to the ear, or when sleeping with bent elbows, can put tension on the nerve, which also causes nerve irritation. Repetitive trauma can also occur from tool use with pressure on the little finger side of the wrist, such as using a hand sander or jackhammer. Another source of irritation could be a benign (non-cancerous) cyst called a ganglion from the wrist. Overuse of the hands, elbow, and forearms or tightness in the areas that the nerve travels may cause some of the same symptoms.
Conservative treatment may involve occupational or hand therapy with specific exercises to help guide the nerves through these narrow pathways at the wrist and elbow. Think of the nerve as being flossed through these areas like floss passes between teeth.
Padding the palms with anti-vibration gloves or using a splint or brace to keep the elbow straight at night can help avoid excess pressure and tension on the nerve. This can help alleviate pain, tingling, and paresthesia, or the pins-and-needles sensation. Avoiding awkward postures with the wrists bent forward or any postures that increase pain, tingling, and numbness, can calm the aggravated nerves.
Should these tactics above not alleviate the symptoms, your doctor may order special tests to look for a cyst, bone fragment, or a study on the nerve to see if it is working correctly. Suppose the condition is severe and muscle wasting/atrophy appears on the small finger side of the palm. In that case, surgery may take pressure off the nerve, which will allow the nerves’ signals to go through uninterrupted. Nerves repair at about the same rate that hair grows, roughly an inch per month, so if the nerve is entrapped at the elbow, it can take more than a year for the nerve to repair fully.
Should you have questions about pain or weakness in your hands, you can make an appointment with one of our hand therapists to address your concerns. Our experts can provide you with a specialized program to facilitate an optimal outcome to prevent surgery or address wound care, scar management, and other physical changes after surgery.
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1. Nicole, Bickhart. “Ulnar Nerve Compression.” Hand and Upper Extremity Rehabilitation: A Practical Guide, Elsevier, St. Louis, 2016, pp. 97–107.
2. Slaby, Frank, et al. Gross Anatomy in the Practice of Medicine, Lea & Febiger, Philadelphia, PA, 1994, p. 119.
3. Taylor, Michele. “Ulnar Tunnel Syndrome: Symptoms, Causes, Diagnosis, Treatment.” WebMD, WebMD, 15 July 2020, https://www.webmd.com/pain-management/carpal-tunnel/ulnar-tunnel-syndrome.
4. “Ulnar Tunnel Syndrome of the Wrist – Orthoinfo – Aaos.” OrthoInfo, Dec. 2013, https://orthoinfo.aaos.org/en/diseases–conditions/ulnar-tunnel-syndrome-of-the-wrist/.