Ulnar neuropathy at the elbow

Neuropathy affecting the ulnar nerve at the elbow

Ulnar neuropathy at the elbow (UNE), also known as cubital tunnel syndrome, is a condition that involves compression or irritation of the ulnar nerve as it passes through the cubital tunnel at the elbow. This condition can lead to pain, numbness, and muscle weakness in the hand and forearm.

Anatomy

Anatomy of the ulnar nerve

The ulnar nerve is one of the major nerves of the upper limb. It originates from the brachial plexus and travels down the arm, passing behind the medial epicondyle of the humerus at the elbow. This area is commonly referred to as the "funny bone." The nerve then continues down the forearm into the hand, where it innervates the flexor carpi ulnaris and the medial half of the flexor digitorum profundus, as well as the intrinsic muscles of the hand.

Pathophysiology

Ulnar neuropathy at the elbow occurs when the ulnar nerve is compressed or irritated as it passes through the cubital tunnel. This can be due to various factors, including prolonged elbow flexion, direct trauma, or anatomical abnormalities. Compression of the nerve can lead to demyelination and, in severe cases, axonal loss, resulting in sensory and motor deficits.

Symptoms

The symptoms of ulnar neuropathy at the elbow typically include:

• Numbness and tingling in the ring finger and little finger
• Weakness in the hand, particularly in the grip and pinch strength
• Muscle wasting in the hand, especially in the hypothenar eminence and the interossei muscles
• Pain or discomfort along the inner aspect of the elbow and forearm

Diagnosis

Diagnosis of ulnar neuropathy at the elbow is primarily clinical, based on the patient's history and physical examination. Key diagnostic tests include:

• Tinel's sign: Tapping over the ulnar nerve at the elbow may reproduce symptoms.
• Elbow flexion test: Prolonged flexion of the elbow can exacerbate symptoms.
• Nerve conduction studies and electromyography (EMG): These tests can confirm the diagnosis and assess the severity of the neuropathy.

Treatment

Treatment options for ulnar neuropathy at the elbow depend on the severity of the condition:

• Conservative management: This includes activity modification, splinting to prevent excessive elbow flexion, and nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation.
• Physical therapy: Exercises to strengthen the muscles and improve nerve gliding can be beneficial.
• Surgical intervention: In cases where conservative treatment fails, surgical options such as ulnar nerve decompression or transposition may be considered.

Prognosis

The prognosis for ulnar neuropathy at the elbow varies. Mild cases often improve with conservative treatment, while severe cases may require surgery. Early diagnosis and treatment are crucial to prevent permanent nerve damage and muscle atrophy.

Related pages

• Ulnar nerve
• Cubital tunnel
• Peripheral neuropathy
• Brachial plexus