One of the most common nerve problems that happens around the elbow and hand is irritation or compression of the nerve on the inside of the elbow. The ulnar nerve is located on the medial side (middle) of the elbow. This nerve can be injured by striking a hard surface, or it can gradually loosen and start slipping back and forth over the inside part of our elbow. When this happens, you may experience tingling down the arm into the ring and pinky fingers.
Damage to the ulnar nerve can be caused by repetitive motion, pressure on the elbow from prolonged bending, or a poor sitting or sleeping position. It can also be caused by cysts, tumors, or bone spurs in the cubital tunnel where this essential nerve is located.
The ulnar nerve is vulnerable to injury because there is very little natural padding keeping it from rubbing against the bone. The extent of damage to the nerve and any loss of hand function may be determined by the use of X-rays and electromyography or nerve conduction studies.
Is ulnar nerve entrapment the same thing as cubital tunnel syndrome?
Yes. Cubital tunnel syndrome is the common name for the condition involving a pinched nerve that occurs at the inner elbow. It causes a very specific numbness and tingling that gradually appears in the ring fingers and little fingers, and sometimes at the inner hand. Sometimes there is also an aching pain on the inside of the elbow. Left untreated, cubital tunnel can result in loss of hand strength and muscle function.
Can cubital tunnel syndrome be treated with physical therapy?
No. This is one condition where exercise and physical therapy are not the prescribed first steps. If you’ve injured the ulnar nerve to the point of numbness and even loss of motor control in the hand, experienced Chicago orthopaedic surgeon Dr. Anthony Romeo will recommend surgery immediately. Numbness and weakness can become permanent if the condition is not addressed.
Ulnar Nerve Decompression/Transposition
The goal of the surgery is to decompress the nerve by opening the cubital tunnel. If the nerve is unstable or moves out of the tunnel when the elbow is flexed, then it needs to be transposed to the front of the elbow. During ulnar nerve transposition, Dr. Romeo essentially creates a new pathway for the nerve, giving it more space and protection from contact with the bone. Your nerve is physically moved to a new site in front of the medial epicondyle (the bony bump on the inside of your elbow). In this new space, the nerve is better protected from pressure and is well connected to the circulatory system, providing ample blood supply for healing.
In this video, Dr. Romeo explains cubital tunnel surgery (ulnar nerve transposition).
Physical Therapy Protocols
After surgery, a cast or plastic splint is applied to the elbow for two to four weeks so that it stays bent while healing. Once the splint and sutures are removed, you will need to avoid bending the elbow for at least another three weeks. Elevating your arm often and wiggling your fingers can help prevent swelling. Also, ice packs should be applied hourly, 20 minutes at a time. Dr. Romeo will give you specific instructions to manage any post-op pain.
When healing is advanced, your elbow is ready to regain strength with a course of physical therapy to encourage flexibility and motor coordination in your hand and arm. Ulnar nerve transposition has a very high success rate, but you will also need to stay alert for any complications such as infection, elbow pain, continued numbness, indications of nerve damage, elbow instability or unexplained contraction of the elbow. It may take three to six months to make a complete recovery.
For more information about causes and treatment of ulnar nerve entrapment or cubital tunnel syndrome, please request an appointment with experienced Chicago orthopaedic surgeon Dr. Anthony Romeo. Call or email our office today to schedule your visit.
Want to know more? Here’s one of Dr. Romeo’s recent medical journal articles about ulnar nerve entrapment:
Return to sporting activity after ulnar nerve transposition for isolated neuritis in competitive overhead athletes. Journal of Shoulder and Elbow Surgery.
Cubital Tunnel Surgery (Ulnar Nerve Transposition)
Anthony Romeo, MD
Dr. Anthony Romeo is one of the nation’s leading orthopaedic surgeons specializing in the management and surgical treatment of shoulder and elbow conditions. His state-of-the-art practice employs minimally-invasive arthroscopic techniques to accelerate the recovery process for a range of challenging conditions.