Ulnar nerve compression

Ulnar nerve compression is also called ulnar neuropathy. It is often caused by the nerve on the inside of your elbow being squashed (compressed) or stretched. Behind your elbow crease, the nerve is close to your skin and is relatively easily irritated.

When the ulnar nerve is compressed at your elbow it may also be called cubital tunnel syndrome. It can happen if you:

• have a broken bone (fractured humerus) or another injury to your arm
• lean on your elbow, especially if resting on a hard surface
• pull or stretch your arm, such as with overhead activities like throwing
• do activities that involve repetitive bending and straightening of your elbow.

Your ulnar nerve can also be compressed at your wrist, although this is less common. This may happen if you:

• have a broken bone in your wrist or an injury to your wrist on the little-finger side
• repeatedly use your hand in a certain way for a long time, for example using hand tools, pushing someone in a wheelchair or holding onto bicycle handlebars.

Occasionally, your ulnar nerve can be compressed in your armpit area. This may happen when you:

• hang your arm over a chair
• use underarm crutches
• have an infection
• have inflamed blood vessels
• have a lump in your armpit.

Ulnar nerve compression affects men more than women and is more common in older people.

The symptoms you get depend on where the nerve is affected, but you will likely have:

• tingling or numbness in your little and ring fingers, often at night and sometimes bad enough to wake you
• pain or aching on the inside of your elbow or forearm
• a weaker grip
• some loss of hand control (dexterity).

In serious cases, your ring and little fingers may become weak. This causes your fingers to bend, creating a 'clawed hand'.

Symptoms often get worse when you:

• bend your elbow for a long time — for example, when you are sleeping or talking on the phone
• lean on your elbow
• use a tool that you have to grip strongly.

Your healthcare provider is likely to diagnose ulnar nerve compression after talking to you and examining your arm.

Investigations such as blood tests and x-rays are not usually helpful. Your healthcare provider may ask for these if they are trying to rule out something else that may be causing your symptoms.

You may be referred to a specialist for nerve conduction studies. These measure how well and how quickly your ulnar nerve conducts electrical signals. A specialist may also arrange for you to have an MRI.

MRI (magnetic resonance imaging)

Ulnar nerve compression is a treatable condition. Your treatment will depend on how severe your problem is.

Conservative treatment

Conservative treatment can be quite effective in treating ulnar nerve compression and reducing symptoms. Treatment might include:

• avoiding or modifying activities that cause you pain or make other symptoms worse, for example, use a headset when using a phone
• pain relief
• hand therapy
• splinting of the elbow
• wearing protective elbow padding.

An elbow splint should comfortably stop you from fully bending your elbow, instead keeping it slightly bent. Wearing a splint for up to 3 months can often stop your symptoms. You need to wear it at night and during the day while doing activities that make your symptoms worse.

If your ulnar nerve is compressed at your elbow, avoid:

• leaning on your bent elbow
• activities that involve keeping your elbow bent, such as holding a phone to your ear or folding your arms
• anything that makes you repeatedly bend and straighten your arm.

If your ulnar nerve is compressed at your wrist, you could try:

• wearing padded gloves for any activity that involves gripping or putting pressure on your hands
• padding your bicycle handlebars.

Sometimes repetitive heavy tasks at work cause ulnar nerve compression at your wrist, so you might need to change the way you do things. If your symptoms are very disabling or continue for a long time, it may affect your ability to continue your job.

A hand therapist (a physiotherapist or occupational therapist who focuses on the hand and arm) can:

• help you identify what activities make your symptoms worse
• work out ways to change the way you do them
• provide you with a properly fitting elbow splint
• advise you on specific exercises.

You can find a private hand therapist on the Hand Therapy website.

Find a therapist — Hand Therapy New Zealandexternal link

ACC may help with the cost of treatment if your ulnar nerve compression was caused by an injury.

Your healthcare provider will be able to treat and help you manage any underlying conditions that may be making your ulnar nerve compression worse. These include conditions like:

• fluid retention
• rheumatoid arthritis
• osteoarthritis
• connective tissue diseases such as Sjögren's syndrome and lupus.

Surgical treatment

Your healthcare provider or hand therapist may discuss surgery if your hand or arm symptoms do not get better with conservative treatment.

Surgery may be an option if the compression is:

• causing continuous numbness or weakness in your hand
• has lasted for more than 6 months despite treatment.

Surgery aims to stop the nerve from being squashed (compressed) by the surrounding tissue. How the surgeon does that depends on where the problem is.

Before you go ahead with surgery, the surgeon will discuss:

• what they plan to do
• rehabilitation after the operation
• the risks of the surgery.

You can also pay to see a private plastic surgeon, orthopaedic surgeon or neurosurgeon.

Find a plastic surgeon — New Zealand Association of Plastic Surgeonsexternal link

Find a surgeon — New Zealand Orthopaedic Associationexternal link

Neurosurgery — Healthpagesexternal link