Ulnar nerve compression at the elbow

What is ulnar nerve compression at the elbow?

This is an irritation of the ulnar nerve, which is compressed at the elbow. The ulnar nerve gives sensitivity to part of the hand and moves many of the muscles in the hand responsible for fine finger movements. Typical symptoms are tingling in the ring finger and especially the little finger. At first, symptoms are present at night, but discomfort may then appear during the day, and finger sensitivity may diminish. Tingling usually occurs when the elbow is bent, for example when making a phone call or reading a book. Lack of hand dexterity and strength can also occur in more severe cases.

What tests are required?

Most of the time, the precise description of the complaints and the examination by the surgeon are sufficient to make the diagnosis. Additional tests may be required to confirm the diagnosis or assess the severity of the compression.

• ENMG

This examination, carried out by a neurologist, evaluates nerve function using electrical stimulation. It allows us to pinpoint the location of nerve compression and the severity of the damage. The examination takes around thirty minutes, and you’ll feel small electric shocks similar to those you feel when you touch an electrified fence. The examination is generally painless.

• Ultrasound

This is a painless examination lasting around fifteen minutes, which assesses the appearance of the ulnar nerve at the elbow. This examination can also be used to assess the position of the nerve involved in elbow flexion and extension.

What treatments are available for ulnar nerve compression in the elbow?

• Non-surgical

Except in the most severe cases, initial treatment consists of avoiding prolonged elbow flexion. Simple measures such as wrapping a cloth around the elbow or wearing a rigid splint are often effective during the night. During the day, avoid leaning directly on the elbow and limit flexion. This treatment is usually tried for two to three months.

• Surgical

Surgery is proposed if non-surgical treatment fails, or if nerve damage is severe. Its aim is to free the site of nerve compression and, in some cases, move it to a more suitable position. The procedure is performed on an outpatient basis, under local anesthesia. It lasts about an hour.

After the operation, a well-padded dressing is applied and worn for a few days. In the days following surgery, it is possible to move the elbow, avoiding extreme positions. The dressing must be kept dry. Tingling in the fingers may take several weeks or months to disappear. The length of time off work depends on the profession, but generally varies between two and six weeks. Sports involving the use of the operated limb are forbidden for six weeks.

What are the possible complications ?

Common to all surgeries

Infection of the wound may occur, but is usually cured by local care and the prescription of antibiotics. Surgical drainage is rare.

Hematoma corresponds to an accumulation of blood under the skin. It’s not a problem if it’s small, but if it’s larger, surgical evacuation may be necessary.

Healing problems (delayed healing, thick scars) occur more frequently in patients who smoke.

Inadvertent injury to an artery, nerve, ligament or tendon is always possible, although rare. These structures can be repaired, but recovery may be prolonged or even incomplete.

Chronic regional pain syndrome is a disproportionate inflammatory reaction of the body following surgery. It causes pain, swelling and stiffness, requiring treatment that can last several months.

Complications specific to ulnar nerve compression at the elbow

Recurrence of nerve compression is rare, but may require a second operation several months or years down the line.

When the nerve is decompressed during surgery, it may subsequently develop instability, leading to electrifying elbow pain and persistent or recurrent tingling. The nerve slides over the bone as the elbow moves from extension to flexion. Sometimes, further surgery is required to relocate the nerve so that the phenomenon disappears.