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Diagnosis and Treatment of Ulnar Neuropathy at the Elbow

By Last updated on April 5th, 2020 Last updated on April 5th, 2020 No Comments

Ulnar Neuropathy at the Elbow

Nerves located throughout the body allow us to move and to feel. These nerves are often surrounded by protection but they can become pinched or damaged, leading to neuropathy. Pain in the elbow might be caused by ulnar neuropathy.

This pain can also radiate into the forearm and part of the hand, where the nerve resides. Experiencing pain in this location can have a significant impact on daily life. Treating this condition is necessary to return to a normal life.

This article will discuss brief anatomy of the elbow, what neuropathy is, how it is diagnosed and treated, surgical options, and finally, an alternative form of therapy that may alleviate the symptoms of ulnar neuropathy without the need for surgery.

Anatomy of the Elbow and Neuropathy

The elbow consists of three bones, the Radius, and Ulna in the forearm, and the Humerus in the upper arm. The joint that is formed by these bones is protected by muscle groups, tendons, and ligaments. These soft tissues around the bone also help to protect the ulnar nerve. This nerve is also protected by what is called the cubital tunnel. Ulnar neuropathy is sometimes also referred to as cubital tunnel syndrome, and is similar to carpal tunnel syndrome but in a different location.

Nerves that exist outside of the brain and spinal cord are referred to as peripheral nerves. Their purpose is to send signals from all over the body to the brain. This, in turn, allows for motion and sensation to occur. These nerves are all over the body and a crucial part of everyday life.

The ulnar nerve begins at the top of the arm and extends down to the hand. In the hand, it extends into the pinky and ring fingers. The ulnar nerve is sometimes referred to as the “funny bone” nerve. The sensation of hitting the ‘funny bone’ is actually caused by the ulnar nerve, which is why hitting it can also cause tingling in the hand or forearm. When peripheral nerves become damaged, this is called neuropathy.

Neuropathy can be caused by a nerve being pinched, damaged as if from injury, or overuse of the nerve. There are two types of neuropathy, mononeuropathy, and polyneuropathy. Each type is classified by the number of nerves that have been damaged. Mononeuropathy refers to when only one nerve is damaged – the most common cause is from a traumatic injury. Polyneuropathy occurs when more than one nerve is damaged and is more common.

Neuropathy is most likely to occur after the age of 55 but can occur at any time to anyone. People who are at a greater risk of developing ulnar neuropathy are:

  • Manual Laborers: continuous, repetitive motion can pinch the nerve over time.
  • Poor Nutrition: vitamin B has been linked to nerve damage. People who are deficient in vitamin B may be at greater risk of developing neuropathy.
  • Diabetes: nerve damage is associated with the diabetic condition, and having diabetes could exacerbate ulnar neuropathy.
  • High Blood Pressure: swelling inside the body can pinch the ulnar nerve.
  • Arthritis: advanced arthritis can alter the structure of joints, which may lead to a pinched nerve.

There are other behaviors and conditions which may also lead to ulnar neuropathy, these are the most common.

Signs and Symptoms of Ulnar Neuropathy at the Elbow

The area affected by this form of neuropathy is the forearm and ring and pinky fingers. Most symptoms will be felt in this area. These symptoms include:

  • Tingling
  • Pain
  • Loss or change in sensation
  • Numbness
  • Weakness

Certain activities can worsen these symptoms, as sometimes the nerve can become more pinched in certain positions. Activities such as bending or straightening the arm, grasping objects, and typing can all contribute to symptoms.

If these symptoms begin to cause interference in day-to-day activities, it may be necessary to consult a doctor.

Diagnosing Ulnar Neuropathy at the Elbow

The diagnosis of any ailment typically begins with a visit to the doctor. He or she will ask questions about family history, any history of traumatic injury, daily activity level, profession, and more. This will give them an idea of what factors may be contributing to recurring pain. They will then evaluate the range of motion of the arm, as well as the location of the pain. It is important, to be honest about pain level and location during an evaluation, as it will give doctors a better idea of what may be happening.

Pain in the elbow, forearm, or hand can be caused by many factors, so it is important that doctors make an accurate diagnosis. Symptoms in the ring and pinky fingers can be indicative of ulnar neuropathy, but often doctors will suggest that a patient goes through certain testing to ensure an accurate diagnosis. These tests include:

  • MRI: Magnetic Resonance Imaging, or MRIs, is able to capture a picture of the soft tissues in the elbow. Getting an MRI may indicate if there is pressure being placed on the ulnar nerve.
  • Ultrasound: this form of imaging can also capture the soft tissues of the elbow, potentially indicating the cause of pain.
  • X-Ray: this imaging technique is used to gather an image of the bone structure. It is not typically used to diagnose ulnar neuropathy but may be ordered if the doctor is suspicious of misaligned bones that could be causing pain, or exacerbating pressure on the ulnar nerve.
  • Nerve Conduction Study: this form of diagnosis involves sending a signal down the ulnar nerve and testing how long it takes to reach the hand. The speed at which the signal travels can indicate the health of the nerve, i.e. a faster signal indicates a healthier nerve.

These are the most commonly performed diagnostic techniques for ulnar neuropathy at the elbow. A doctor’s decision to recommend any of these will be specific to each patient and their needs. Once a proper diagnosis has been made, doctors will begin to create a treatment plan that is specific to each patient.

Conventional Treatment of Ulnar Neuropathy

Treatment of chronic pain typically begins with minimally invasive techniques and gradually becomes more invasive if the treatments are not producing results, i.e. reducing pain. The treatment process typically involves:

  • Rest: using the elbow less could allow it to heal itself. Resting it in a specific position may allow pressure on the ulnar nerve to be relieved.
  • Anti-inflammatory Measures: over-the-counter NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) such as Ibuprofen can relieve pain by reducing inflammation which may be causing pressure on the ulnar nerve.
  • Physical Therapy: certain exercises can relieve pressure on the ulnar nerve. Consulting with an expert can lead to a regimen of such exercises. Physical therapy also has the potential to restore a range of motion that has been lost, improve circulation, and strengthen the muscles that support the elbow.
  • Wearing a Brace or Splint: keeping the arm as straight as possible during certain activities, such as sleeping or working, may prevent further impingement.
  • Adjustment of Activities: sleeping in a different position, adjusting a workspace, driving in a different way, are all adjustments that can be made to prevent the ulnar nerve from becoming pinched. In many cases, activity adjustment involves keeping the arm as straight as possible.
  • Corticosteroid Injections: these deliver a high dose of anti-inflammatory Cortisol into the area of impingement. These injections do help with pain in the short-term but have been proven to cause nerve damage over time and are not typically used for the treatment of ulnar neuropathy at the elbow due to the high risk of nerve damage.

Each of these treatments will be recommended to a patient based on their specific needs. Some of the factors which determine what treatments will be used include activity level, finances, daily activities, and a patient’s own willingness to do them.

When these conventional treatment options fail to relieve pain and other symptoms of ulnar neuropathy, doctors may begin to consider surgery.

Ulnar Neuropathy Surgery

There are two types of surgery which a doctor may consider to treat a patient’s ulnar neuropathy at the elbow. These include:

  • Cubital Tunnel Release Surgery: this form of surgery involves cutting away the bits of soft tissue that may be causing impingement of the ulnar nerve. Doing so can relieve pressure, allowing signals from the brain to be sent correctly once again, ideally relieving symptoms. This procedure is minimally invasive and is almost always performed as an outpatient procedure, meaning that a hospital stay is most often unnecessary.
  • Ulnar Nerve Transposition Surgery: this form of surgery involves relocating the ulnar nerve to the front of the elbow, where it is less likely to be pinched. This procedure is also mostly an outpatient procedure.

Both types of surgery may include anesthesia. For these procedures, a localized anesthetic is most often used, but depending on the patient’s comfort level, sometimes general anesthesia is used instead.

Both forms of surgery are minimally invasive and are not considered major surgeries. There is, however, a list of risks associated with any surgery, including blood clots, infection, and complications involving anesthesia.

These surgeries are elective, meaning that it is the patient’s decision to undergo one or the other. When making the decision to undergo surgery, patients should consider all of the potential treatment options, as there may be a treatment that could minimize the need for surgery.

The Role of Regenerative Medicine in Treating Ulnar Neuropathy at the Elbow

The field of regenerative medicine and therapies seek to help patients with chronic pain. These forms of therapy have a relatively high success rate with patients all around the world. CELLAXYS offers two of these forms of therapy:

  • Stem Cell Therapy: this form of therapy begins with the extraction of a patient’s own stem cells. They may come from blood cells, fat cells, or bone marrow. They are then processed so that the stem cells are more concentrated. The cells are then injected into the site of pain. Stem cells contain healing properties and are able to call to other surrounding cells that contain healing properties as well.
  • Platelet-Rich Plasma Therapy: this form of therapy begins with a simple blood draw. The blood is then placed into a centrifuge, which separates the platelets in the blood from other components. Once the platelets are concentrated, they are injected into the pain site, similar to stem cell therapy. Platelets contain proteins and healing factors that are already used in the body’s natural healing process.

In both forms of therapy, a doctor will use an imaging technique such as ultrasound or MRI to locate the exact area where these injections should go.

These are outpatient procedures and do not typically take longer than two hours. The risk associated with these procedures is low due to the fact that they are using the patient’s own cells. There is a very low risk of infection and pain in the injection site, but this pain typically goes away in a matter of days.

Patients who have used stem cell or PRP therapy to treat chronic pain typically see results in a matter of days.

This may be an effective treatment for ulnar neuropathy at the elbow, as a higher concentration of healing cells could help the nerve heal. By enhancing the body’s natural healing processes, it is possible that the impingement of the ulnar nerve is reduced. If the nerve can heal on its own, surgery may no longer be necessary.

It is imperative that patients seeking treatment for chronic pain consider all of the treatment options available to them, including regenerative medicine.

Conclusion

Elbow pain can be debilitating. In the case of ulnar neuropathy, it can impact so many aspects of daily life. The complex and intricate network of muscles, tendons, and ligaments make a cushion for the ulnar nerve, which is protected by the cubital tunnel. This nerve is a crucial part of the body, but it can become damaged or pinched, which leads to neuropathy.

The diagnosis process for neuropathy ensures that patients are treated in the most effective way possible. When minimally invasive treatments fail to relieve a patient of their symptoms, surgery may become an option. Surgery for ulnar neuropathy at the elbow is minimally invasive, but surgery can have risks and difficult recovery.

Patients who are faced with chronic pain in the elbow, forearm, or hand should consider alternative medicine such as regenerative therapies due to the low risk and high success rate. On top of that, short recovery time can allow patients to return to doing what they love.

Dr. Matthew HC Otten

Dr. Matthew HC Otten

Director of Orthopedic & Orthobiologics
Fellowship-trained & Board Certified in Sports medicine
Director Angiography at Harvard Clinical Research Institute
Michigan Stage University Alumni