Ulnar tunnel syndrom

What is ulnar tunnel syndrome?

Ulnar tunnel syndrome refers to a constriction of the ulnar nerve in the elbow area. As the nerve passes through the so-called ulnar groove of the elbow, the resulting symptoms are described as ulnar tunnel syndrome.  

There are different nerves passing through our forearm and hand, and they are responsible for controlling different muscles as well as providing sensation. The sensory system enables us to perceive touch, for instance, which is essential for the function of the hand and especially the fingers.  

The ulnar nerve belongs to the largest nerves of the forearm and hand. It extends from the shoulder area and passes the elbow to the hand as it carries out many functions thanks to its various fibers. Among these are the control of most hand muscles as well as sensory functions of the hand on the side of the little finger.  

Ulnar tunnel syndrome is characterized by restricted function of the ulnar nerve due to compression, giving rise to specific symptoms.    

Cause: How does ulnar tunnel syndrome develop?

Ulnar tunnel syndrome may be caused by various factors. While these mainly include mechanical reasons, some systemic diseases that involve several areas of the body can also cause ulnar tunnel syndrome.  

Mechanical causes irritate the nerve due to pressure or traction. This is often the result of a fracture in the elbow area. If this also affects the ulnar groove, the nerve can become constricted.  

Over time, resting frequently on the arm or bumping the elbow may also lead to ulnar tunnel syndrome.  

A variety of systemic diseases can also cause damage to the ulnar nerve. Among others, these include hormonal disturbances, for example as part of the menopause, or diseases such as diabetes or rheumatoid arthritis.  

Occasionally, it is not possible to find a cause for the compression of the ulnar nerve. This is referred to as idiopathic ulnar tunnel syndrome.  

Symptoms: How is the traction or compression damage characterized?

Symptoms result from the ulnar nerve's function, that can no longer be met in the case of ulnar tunnel syndrome. This includes the innervation of various hand muscles as well as the sensory function.  

Patients usually feel tingling or have a complete lack of sensation in the area of the little finger side of the hand as well as the little finger and ring finger. These symptoms are due to impaired sensory nerve fibers.  

Motor symptoms arise due to impairment of the hand muscles which are supplied by the ulnar nerve. This causes a claw-like curvature of the little and ring finger, which is known as claw hand. As the ulnar nerve also supplies an important muscle of the thumb, patients can no longer move their thumb towards their hand. They have trouble holding a sheet of paper between their thumb and index finger, for example.  

At an advanced stage, the respective muscles become increasingly degenerated. If muscles are no longer innervated and engaged, the muscle mass slowly decreases, leading to a condition known as atrophy.  

Even though the symptoms of ulnar tunnel syndrome may be very specific, the severity of the symptoms can vary. Usually, at first only sensory deficits occur, which are only temporary at first and only later on will become permanent. Motor deficits often occur after some time.  

Diagnosis: How is ulnar tunnel syndrome diagnosed by a doctor?

Once symptoms of ulnar tunnel syndrome arise, the first step is usually to consult an orthopaedist or hand surgeon. They will begin the diagnostic process with a detailed medical history and a thorough examination of the hand. The physical examination includes checking the function of the various hand muscles and the sensation to touch.  

In most cases, ulnar tunnel syndrome is suspected rather quickly.  

A neurologist will then carry out further diagnostics and confirm the suspicion. and will also measure the so-called nerve conduction speed of the ulnar nerve. This checks how quickly the nerve responds to a certain stimulation and relays the signal to a muscle. If the nerve is injured by ulnar tunnel syndrome, its conduction velocity is usually reduced. In other words, the nerve reacts to a stimulus with a delay.  

To exclude other suspected conditions, different imaging procedures may be employed. For example, this includes MRI examination or an ultrasound scan.   

Treatment: Which type of therapy makes sense?

Both conservative and surgical treatment are generally possible for ulnar tunnel syndrome. However, conservative treatment should generally be performed first and surgery not considered until the symptoms fail to improve.  

Conservative treatment ideally depends on the cause. Physical rest of the elbow and therefore also of the ulnar nerve is often helpful. In this way, there is a chance for the irritation to disappear and the nerve to regenerate. Occasionally, an elbow splint worn at night can also promote the healing process.  

Administering cortisone can also be helpful. This drug has an anti-inflammatory effect that can reduce any irritation of the ulnar nerve. Many patients also benefit from additional physiotherapy or occupational therapy.    

Surgery: procedure and indication for ulnar tunnel syndrome surgery?

If the conservative measures fail to improve the symptoms sufficiently, surgery should be considered.  

The operation involves exposing the ulnar nerve in the elbow area and then releasing it from any structures that are constricting it. This could be caused by bony fragments or ligament structures.  

It is possible to perform open or endoscopic surgery. During open surgery, the nerve is exposed directly through a skin incision in the area of the ulnar groove. In the case of elbow endoscopy, smaller skin incisions are made through which a endoscope with a small camera and a light source is inserted.    

It is important that the patient and surgeon discuss the type of surgical technique in advance and it largely depends on the surgeon's experience.  

Usually, the operation is performed on an outpatient basis, using either general anesthesia or anesthesia of the arm. Afterwards, the arm is immobilized in a bandage or a small splint. After around 10-14 days, the suture material is removed and the arm can gradually resume full weight-bearing.  

Will ulnar tunnel syndrome resolve on its own?

Whether ulnar tunnel syndrome goes away without therapy largely depends on the extent of the disease and which factors trigger the syndrome.  

If symptoms persist for a short period of time and if they are relatively mild in nature and only minor sensory deficits and intact hand muscle function are present, patients can wait and see with regular medical check-ups and no further measures need to be taken.  

Is it possible to treat ulnar tunnel syndrome yourself?

If you have ulnar tunnel syndrome and feel symptoms, always consult a doctor. The doctor should always make a precise diagnosis and assess the extent of the condition.  

Patients can, however, also take action themselves to speed up the healing process. Above all, they must protect the elbow and avoid mechanical irritation of the ulnar nerve. For example, they should lean less on the arm or pad it appropriately. 

In any case, however, it is advisable to consult a specialist before taking any independent therapeutic measures.  

Which doctors & clinics specialize in ulnar tunnel syndrome? 

When it comes to treating ulnar tunnel syndrome, hand surgeons, general surgeons and neurologists collaborate to make a detailed diagnosis and create an individual treatment plan for each patient.  

Looking for the right specialists can often be very difficult and time-consuming. Our aim is to help make this process easier and bring patients together with competent specialists.  

All specialists listed here are experts in their field and have extensive experience in the treatment of ulnar tunnel syndrome. You can benefit from their experience and schedule an initial appointment with one of our specialists.