Neuropathy - ulnar nerve

Definition

Ulnar nerve dysfunction is a problem with the nerve that travels from the wrist to the shoulder. The condition causes movement or sensation problems in the wrist and hand.

Alternative Names

Causes

Ulnar nerve dysfunction is a common form of peripheral neuropathy. It occurs when there is damage to the ulnar nerve, which travels down the arm. The ulnar nerve is near the surface of the body where it crosses the elbow, so prolonged pressure on the elbow may cause damage. The damage involves the destruction of the covering of the nerve ( myelin sheath) or part of the nerve (axon). This damage slows or prevents nerve signaling.

A problem with one single nerve group (such as the ulnar nerve) is called mononeuropathy. The usual causes are direct injury, prolonged external pressure on the nerve, or compression of the nerve caused by swelling or injury of nearby body structures. Entrapment involves pressure on the nerve where it passes through a narrow structure.

The ulnar nerve is commonly injured at the elbow because of elbow fracture or dislocation. Prolonged pressure on the base of the palm may also cause damage to part of the ulnar nerve. In some cases, no detectable cause can be identified.

Symptoms

• Abnormal sensations in the 4th or 5th fingers

• Numbness, decreased sensation

• Tingling, burning sensation

• Pain

• Weakness of the hand

Pain or numbness may awaken the patient from sleep. The condition is made worse by activities such as tennis or golf.

Exams and Tests

An exam of the hand and wrist can reveal ulnar nerve dysfunction. There may be weakness of wrist and hand bending and difficulty moving the fingers. Severe cases may display wasting of the hand muscles or a characteristic "claw-like" deformity. A detailed history may be needed to determine the possible cause of the neuropathy.

Tests that reveal ulnar nerve dysfunction may include an EMG (a recording of electrical activity in muscles) and nerve conduction tests. Other tests may include blood tests, x-rays, and imaging scans.

Treatment

The goal of treatment is to allow the person to use the hand and arm as much as possible. The cause should be identified and treated. In some cases, no treatment is required and the person gets better on their own.

If certain cases, a supportive splint or elbow pad may help prevent further injury.

Corticosteroids injected into the area may reduce swelling and pressure on the nerve.

Surgery may be needed if the symptoms get worse, movement is difficult, or there is proof that part of the nerve is wasting away. Surgical decompression may be recommended if the symptoms are from entrapment of the nerve. Surgery to relieve pressure on the nerve may help some people.

Over-the-counter analgesics or prescription pain medications may be needed to control pain (neuralgia).

Other medications may be prescribed to reduce stabbing pains, including gabapentin

Physical therapy exercises may be appropriate to maintain muscle strength.

Vocational counseling, occupational therapy, occupational changes, job retraining, or similar interventions may be recommended as appropriate.

Outlook (Prognosis)

If the cause of the dysfunction can be identified and successfully treated, there is a possibility of full recovery. The extent of disability varies from none to partial or complete loss of movement or sensation. Nerve pain may be uncomfortable and persist for a prolonged period of time. If pain is severe and continuing, see a pain specialist to be sure you have access to all options for pain treatment.

Possible Complications

• Partial or complete loss of wrist or hand movement
• Partial or complete loss of sensation in the hand or fingers
• Recurrent or unnoticed injury to the hand
• Deformity of the hand

When to Contact a Medical Professional

Call your health care provider if symptoms of ulnar nerve dysfunction occur. Early diagnosis and treatment increase the chance of controlling the symptoms.

Prevention

Prevention varies depending on the cause. Avoid prolonged pressure on the elbow or palm. Casts, splints, and other appliances should always be examined for proper fit.