Ulnar Neuritis / Cubital Tunnel Syndrome

My little finger goes numb

If you are suffering from pins and needles or numbness in your little finger and one half of the ring the ring finger, you probably have ulnar neuritis (cubital tunnel syndrome).

What is ulnar neuritis?

The ulnar nerve is one of three major nerves that provide the arm with muscle innervation and sensation. It runs close to the surface at the inside of your elbow behind a bony prominence (epicondyle) in a bony groove (‘cubital tunnel’). You probably have accidentally bumped that spot before and have noticed ‘electric shocks’ into the little finger (funny bone). Ulnar neuritis describes the impingement of the nerve in this area.

Who gets ulnar neuritis?

Direct trauma to the cubital tunnel can cause ulnar neuritis. Repetitive and monotonous tasks often lead to the condition. Chronic elbow instability which sometimes happen in sports athletes in tennis, baseball or cricket can also cause stretching of the nerve which results in similar symptoms. Also some constitutional or anatomical variants can cause the nerve to be impinged resulting in ulnar neuritis. Approximate 7% of the general population have an unstable ulnar nerve meaning that it slips out of the groove when being the elbow. This might also contribute to irritation and ulnar neuritis.

What are the symptoms of ulnar neuritis?

Local pain at the inside is a first symptom. Advanced cases develop ‘pins and needles’ (paraesthesia) in the little finger and one half of ring finger. When the compression persists small hand muscles start to waste away which results in deep gutters at the back of the hand as well as flattened ‘hypothenar’ (group of muscles on the little finger side of the palm). The wasting can result in a clawing deformity of little and ring finger as well as noticeable weakness in power grip.

How is ulnar neuritis treated?

Avoidance of pressure to the ulnar nerve at the inside of your elbow is an important first step. It is often helpful to hug a large pillow when falling asleep to cushion that area. Hand- and physiotherapists can help with nerve glide exercises and protective devices such as neoprene sleeves. Cortisone 4 injections under ultrasound guidance can alleviate symptoms and sometimes aid in recovery. If the symptoms fail to achieve comfort, surgery is an option.

Surgery for ulnar neuritis

Surgery for ulnar neuritis is required when all non operative measure fail. It’s usually done as a day case under general anaesthesia. Through a direct approach at the inside of the elbow the nerve is identified and released in order to remove any compression. The compressed segment of nerve is visible and confirms the diagnosis. In some case of severe entrapment or where the nerve has a tendency to slip out of the cubital tunnel a part of the bony prominence can be removed (partial medial epicondylectomy). In performing this step the nerve has a wider room to live in and forms a smooth curve rather than a sharp kink when bending the elbow.

Preparing for surgery for ulnar nerve release

If required we will arrange for a bulk billed pre-admission clinic at the hospital. This is run by a specialist anaesthetist who will gather information and request investigations that are required for safe anaesthesia. Our reception staff will advise of costs, hospital and admission details.

Recovery after ulnar nerve release

At the end of the procedure local anaesthetic will be injected to the surgical field and compression bandage will be placed. The inside of the forearm into the little finger will be numb due to the local aesthetic but this will provide comfort post operative. Exercises can be commenced a few days after the procedure and in between the arm can be used for light activities of daily living. Dressings can be removed 10-12 days after the surgery, sutures are internally and absorbable, hence nothing needs to be removed. Relief of symptoms is in most cases instantaneous and once the local anaesthetic has worn off the paraesthesia is gone. Full recovery with regaining full range of motion and strength can be expected at the four to six week mark.