Ulnar Neuropathy: How to Treat a Crazy Bone

Ulnar Neuropathy: How to Treat a Crazy Bone

Do you remember how it felt when you hit your elbow on something hard and it sent shocks through your forearm and onto your little finger? Not very nice, that's for sure. But the bad feelings were just momentary, and for now, you remembered not to do that again.

The ulnar nerve is a peripheral nerve-bundle that runs from the spinal cord through the neck and is responsible for this bothersome ailment. The nerve fibers go via the "ulnar groove," which you might know as the "funny bone" or "crazy bone," and they travel much of the length of the arm.

Some people have a longer-lasting problem with the ulnar nerve called ulnar neuropathy. The medical suffix "-pathy" implies "illness" or "impairment." So, "ulnar neuropathy" means an illness or impairment of the ulnar nerve. There are more than one reason why the ulnar nerve can be hurt or pinched in the ulnar groove. First, it is not surrounded by soft muscles and tendons. Instead, it is sandwiched between a layer of skin on the outside and only hard bone on the inside. The ulnar nerve needs to go the long way around the elbow as it bends, which makes it stretch.

The ulnar nerve-bundle is like a telephone cable with lots of wires. Some of these wires direct the muscles what to do, while others send data back to the brain and spinal cord about what the skin and other tissues are feeling. This means that when the ulnar nerve is damaged, it can cause both motor and sensory problems. The ulnar nerve tells most of the muscles in the hand what to do, so when it isn't working right, the muscles in the hand can become weak. The muscles that spread the fingers and those that straighten the middle joints of the ring and little fingers are typically damaged. Changes in sensation also happen when the ulnar nerve is damaged. The heel of the hand and the ring and little fingers can both lose feeling.

There are more than one method that the ulnar nerve can get hurt. Some people could have the problem because they lean on their elbows too much. This can put pressure on the ulnar nerve in the ulnar groove. It's true that a lot of individuals lean on their elbows without hurting their ulnar nerves, but like most things in medicine, an ulnar neuropathy is usually caused by a combination of variables, and some people may be more susceptible to have it than others because of how their bodies are built. Of course, changing the way your body is shaped, such after an elbow fracture, can also make you more likely to get ulnar neuropathy.

You can also hurt the ulnar nerve by straining it too much. The author worked with a skinny, young woman who was an emergency medical technician and had loose elbow joints. She hurt her ulnar nerves over and over again while lifting heavy patients. It was a problem that wouldn't go away for her, so she changed jobs.

As we talked about, the ulnar nerve at the elbow is quite easy to hurt. It can also get hurt if it is squeezed or constricted by nearby tissues that aren't normal. Tendons, ligaments, blood vessels, cysts, and scars are the most common causes.

An ulnar neuropathy is sometimes the first sign of a "polyneuropathy," which means that all of the body's peripheral nerves are slightly damaged, but the ulnar nerve is the first one to exhibit symptoms that the person can detect. Polyneuropathy is not caused by an accident, but it can happen in a number of diseases, such as diabetes, alcoholism, and even in families.

A doctor will start by asking about the symptoms and doing an exam to figure out what is wrong with the ulnar nerve. After that, the doctor may prescribe nerve conduction testing, which measures the electricity in the nerves and muscles to see how bad the damage is. Also, nerve conduction investigations can look at other nerves to see if the ulnar nerve is the only one that isn't working right or if there are many others that aren't working right.

What if the doctor finds that the ulnar nerve at the elbow is hurt? What can be expected? The good news is that the peripheral nerves may mend themselves to some extent. So, if the nerve damage isn't too bad, conservative treatment is the way to go. Good, randomized, controlled trials, which compare the outcomes of a treated group of patients to those of an untreated group, have not looked into any conservative treatments, which is a shame. Randomized, controlled trials are the best way to find out if a treatment works or not. In this case, though, we can only rely on "clinical judgment" and what we see.

Putting a sport-pad (not a medical brace) on the elbow with foam covering the ulnar groove is a common conservative treatment. This does two things. First, the nerve is still safe if the elbow is leaned on. Second, a pad that fits nicely also stops the elbow from bending too much, even while you sleep, which can hurt the nerve again. Eating balanced, healthy meals and taking vitamins also gives the ulnar nerve the building blocks it needs to heal as quickly as possible.

If the nerve injury is very bad or doesn't go better with conservative treatment, surgery might help. A simple release procedure can be enough to free up the nerve if it is stuck in scar tissue or forced down by adjacent aberrant tissues. In a surgery called "anterior transposition," the nerve is moved out of the ulnar groove so that it won't get hurt when you lean on your elbow. It also gets to take the short way around when you bend your elbow.

Researchers at Radboud University Nijmegen in the Netherlands did a randomized, controlled trial on individuals with ulnar neuropathy at the elbow. Half of the patients had simple release surgery, while the other half had anterior transposition. In this study, the results of the two procedures were the same. About two-thirds of the people in each group had a result that was thought to be either excellent or good. But the individuals who had the anterior transposition technique had more problems, hence the study's results preferred the basic release method.

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