Monday Medical: Combatting a compressed ulnar nerve
Numbness and tingling in your small finger and part of your ring finger? A compression of the ulnar nerve at your elbow or wrist may be to blame.
“Oftentimes, it will bother patients when they’re riding a bike, typing, talking on the phone, trying to sleep or driving a car,” said Dr. Patrick Johnston, a hand and elbow orthopedic surgeon in Steamboat Springs and a member of the medical staff at UCHealth Yampa Valley Medical Center. “It can impact anyone and is very common in the general population.”
The ulnar nerve runs down from the neck to the inside of the elbow and the hand. It transmits signals to muscles in the forearm and hand, while allowing for sensation in the ring and little fingers, part of the palm and the underside of the forearm.
In cubital tunnel syndrome, the ulnar nerve gets compressed at the elbow.
“When you flex or rest the elbow down, that creates additional compression or stretch on the nerve, which is why symptoms tend to come out when sleeping with an elbow bent or talking on the phone,” Johnston said.
Less commonly, the ulnar nerve can get compressed in the wrist and hand, a condition known as ulnar tunnel syndrome. This condition is also called cyclist’s palsy since it can be irritated when gripping the handlebars of a bike.
In either case, it’s important to address the symptoms as soon as possible.
Johnston likens the body’s nerves to television cables: the outer protective covering is like the tunnel of tissue that encases the nerves, while the wires inside are like the nerves themselves.
If you stack a bunch of bricks on the cable, you’ll not only lose the picture, but can damage the wires. Similarly, if nerves are compressed for a long time, you will experience numbing, tingling and muscle weakness. Eventually, the associated muscles can die.
“While I can take the stack of bricks off and release the compression, I can’t fix the wires on the inside,” Johnston said. “That’s why we want to get the compression off before it causes permanent damage.”
When dealing with an ulnar nerve compression, Johnston recommends trying conservative treatments first. For compression at the elbow, patients can try using a splint to keep the elbow in a straighter position when sleeping so the elbow doesn’t rest on the nerve. For compression at the wrist, Johnston recommends getting a proper bike fit and working on core strength to help avoid extra pressure at the wrists when riding.
Sometimes, a surgical treatment is needed. In a cubital tunnel release, the ligament portion of the tissue tunnel around the ulnar nerve is cut at the elbow; in an ulnar tunnel release, the ligament portion is cut at the wrist. In both cases, the ligament heals in a more open position, taking pressure off the nerve.
After a surgery, a patient can expect to have limited restrictions for two weeks, but should be back to their everyday lives after that.
“There are very minimal risks associated with this surgery,” Johnston said. “Cubital tunnel release is probably my second or third most common procedure.”
Rarely, a nerve transfer is helpful to address severe cases. “When someone’s already lost some muscle quickly, I’ll take a branch off the medial nerve and plug it into the ulnar nerve to supercharge that ulnar nerve so it can give more power to muscles,” Johnston said.
In most cases, the condition cannot be prevented, but it can – and should – be addressed.
“If people suspect they have this condition, they should come in for an evaluation,” Johnston said. “Any kind of problem with nerve compression is something we don’t want to leave untreated and undiagnosed because it can lead to permanent problems.”
Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at firstname.lastname@example.org.
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