Ulnar Nerve Entrapment

The ulnar nerve carries sensation to your ring and pinky finger, so symptoms tend to be felt in your hands.

The most common place for ulnar nerve entrapment is on the inside part of your elbow, under a bump of bone known as the medial epicondyle. It’s also known as your funny bone. Ulnar tunnel syndrome, on the other hand, is less common.

They may come and go throughout the day or become worse at night. Your actual symptoms will depend on the location of the entrapment.

Symptoms of entrapment at the elbow

Ulnar nerve entrapment at the elbow sometimes causes an aching pain on the inside of your elbow.

Symptoms in the hand include:

• loss of feeling in your ring and pinky fingers
• weakened grip
• pins and needles sensation
• trouble moving fingers
• numbness, pain, and tingling

In advanced cases, it can also cause:

• muscle wasting in your hand or forearm
• claw-like deformity of ring finger and pinky

Symptoms of entrapment at the wrist

Entrapment at the wrist usually only causes symptoms in your hand, including:

• pain
• weakness
• numbness
• tingling in your ring finger and pinkie
• weakened grip
• trouble moving your fingers

It can also cause muscle weakness or wasting in advanced cases.

Several things can place pressure on your ulnar nerve. In some cases, there’s no clear cause.

Many cases are caused by doing repetitive movements with your arm or hand. But other things can also cause it. These generally depend on the location of the entrapment.

Causes of entrapment at the elbow

Bending your elbow stretches your ulnar nerve. This can cause irritation as the nerve stretches and slides back and forth behind the bump of your funny bone. If you keep your elbow bent for long periods or sleep with your elbow bent, the irritation can become painful.

For some perspective, bending your elbow puts about 20 times more pressure on the area than keeping it at rest.

Movements that contribute to ulnar nerve entrapment at the elbow include:

• driving with a bent elbow resting on an open window
• holding a phone up to your ear for long periods of time
• leaning on your elbows at your desk for long periods
• holding a tool in a constant position

Other potential causes include:

• a cyst at your elbow
• prior injury to your elbow
• fluid buildup and swelling after an injury
• arthritis in your elbow

Causes of entrapment at wrist

The most frequent cause of entrapment at the wrist is a benign cyst on your wrist joint. As the cyst grows, it can put increasing pressure on the nerve.

Other possible causes include:

• repetitive activity at work, such as using a jackhammer or a hammer
• repetitive activity in sports, such as pressing your hand against bicycle handlebars or swinging a golf club

Several things can increase your risk of ulnar nerve entrapment in either your elbow or wrist. These include:

• diabetes
• obesity
• autoimmune conditions
• thyroid conditions
• high blood pressure
• pregnancy

If you have symptoms of ulnar nerve entrapment, some simple nerve gliding exercises can offer relief. These work to help stretch the ulnar nerve. Just make sure to check in with your doctor first. They might instead refer you to a physical therapist to develop an exercise and stretching routine that’s right for you.

If you have pain when doing these exercises, talk to your doctor or therapist. Using ice on the affected area before you exercise may be helpful.

Exercises for ulnar nerve entrapment at the elbow

Exercise 1

1. Start with your arm extended straight and your palm up.
2. Curl your fingers inward.
3. Bend your elbow, bringing your curled fist up toward your shoulder.
4. Return to your starting position.
5. Repeat the exercise 3 to 5 times, 2 to 3 times a day.

Exercise 2

1. Extend your arm out to the side at shoulder level, with your palm facing the floor.
2. Flex your hand upward, pulling your fingers toward the ceiling
3. Bend your elbow, bringing your hand toward your shoulders.
4. Repeat the exercise slowly 5 times.

Exercises for ulnar nerve entrapment at the wrist

Exercise 1

1. Stand straight with your arms at your side.
2. Raise the affected arm and rest your palm on your forehead.
3. Hold your hand there for a few seconds and then bring your hand down slowly.
4. Repeat the exercise a few times a day, gradually increasing the number of repetitions you do in each session.

Exercise 2

1. Stand or sit tall with your arm held straight out to the front of you and your palm facing up.
2. Curl your wrist and fingers toward your body.
3. Bend your hand away from the body to gently stretch your wrist.
4. Bend your elbow and raise your hand upward.
5. Repeat the exercise a few times a day, gradually increasing the number of repetitions you do in each session.

Nerve gliding exercises can provide some relief, but there are several nonsurgical treatments that can relieve pain by reducing inflammation and pressure on the nerve.

If you have mild to moderate symptoms, nonsurgical treatment will likely be enough. But if you have more severe symptoms, you may eventually need surgery if other treatments don’t work.

The treatment recommended by your doctor will depend on your symptoms and the underlying cause. But they’ll likely start by finding ways you can adjust your posture when using your affected arm.

These include:

• not resting your elbows on hard surfaces
• using your phone on speakerphone or with headphones
• avoiding resting your elbow on the door while driving or riding in a car

Nonsteroidal anti-inflammatory drugs may also provide temporary pain relief.

If you have entrapment at your elbow, you can also try wrapping a towel around your extended arm at night. This should stop you from sleeping with your elbow bent at more than 45 degrees. Do this for three to six months.

For entrapment at the wrist, try using a wrist splint to keep your wrist in a neutral position while still allowing for use of your fingers. Try to wear it at night for 1 to 12 weeks.

If gentle exercises and nonsurgical treatments aren’t helping, your doctor might recommend considering surgery.

When recommending a surgical approach, they’ll take into account:

• how long you’ve had the symptoms
• the severity of your symptoms
• what’s causing your symptoms

Surgery for entrapment at the elbow

Several procedures can help with ulnar nerve entrapment at the elbow.

Two of the main ones include:

• Decompression. This procedure involves expanding the area through which the nerve passes.
• Anterior transposition. In this procedure, your surgeon will relocate your ulnar nerve, either by removing your funny bone or repositioning it so that it’s closer to your skin.

Both procedures are usually done in an outpatient setting under general anesthesia. You’ll likely have a splint to immobilize the arm for the first couple of days. After that, you’ll begin physical therapy exercises to restore your range of motion.

You should start to notice some improvement within about six weeks, though it can take about a year to notice the full effects.

Surgery for entrapment at the wrist

Most ulnar nerve compression at the wrist is usually caused by a growth at the wrist that must be removed. This is often done by a hand surgeon in an outpatient setting.

Once the growth is gone, you should notice an improvement in your symptoms. But the healing process may take several months. You may also need to do physical therapy to help you regain full use of your wrist joint and hand.

Ulnar nerve entrapment at the wrist is fairly rare, so there isn’t much data about success rates and recovery periods. You doctor can give you a better idea of what to expect from the procedure.

Ulnar nerve entrapment can be painful and get in the way of everyday activities. But most people find at least some relief through resting the affected arm and doing gentle exercises.

If exercises don’t work, surgery can usually help. Work with your doctor to figure out the most effective treatment plan for you.