Ulnar Neuropathy

Neuropathy simply refers to an injured nerve.  The most common medical (i.e.  non-surgical) neuropathy are those seen in Diabetes,  The most common surgical neuropathy is the compressive neuropathy of the Median Nerve as seen in Carpal tunnel Syndrome.   Ulnar Neuropathy most frequently occurs at that point where the Ulnar Nerve passes through the Olecranon Notch of the elbow.  But the Ulnar Nerve can also get compressed in the wrist as it Passes through Guyon’s Canal.

We will focus this section on the most common form of Ulnar Neuropathy known as Tardy Ulnar Neuropathy.

I. Anatomy:

Look at your right arm with your Palm facing up.  Feel the bone on the inside of your elbow.  The Ulnar N. hooks under this portion of your elbow. You can feel the groove the nerve lays in.   This in fact, is your “funny bone.”  If you gently tap with your finger along this groove you can often get an electrical sensation.  this electrical sensation is generally abnormal and is not normally present in healthy nerves.  If you have a mild twinge, it  is indicative of early compression of your Ulnar nerve.   An exquisite or prominent electrical twinge (known as a Positive Tinel’s Sign) is characteristic of significant nerve compression.

II.Signs & Symptoms:

Most people with Tardy Ulnar Neuropathy will have varying degrees of numbness or “pins & needles” sensation from their elbow down into and/or only in the little and ring fingers of the hand.  This can be quite painful, but most commonly is only annoying.  The inability to spread ones fingers (as if playing the piano) is the most common form of muscle weakness seen in Ulnar compression.  This can also be associated with atrophy (shrinkage or withering) of the interosseous muscles of the hand.  Are the the muscles on the top of your hand shrunken so that the tends are very prominent?   Compare both hands.  The tendons on your hand should be seen, but only mildly grooved between.

III.  Indications for Surgery:

The most common indication is pain.  Most people can easily cope with mild weakness. Significant weakness which interferes with hand function is the second most commonly seen reason to consider surgery.

IV. Surgery:

The surgical procedure of choice is referred to as an Ulnar Transposition.  As constant stretching and compression of the nerve in the Olecranon notch is the culprit, simply moving the nerve to the topside of the elbow, is often sufficient in stopping pain.  This transposing of the nerve will often stop further muscle wasting as well, but any atrophy present in the hand, is generally irreversible.