What is ulnar nerve palsy?
Your ulnar nerve runs all the way from your shoulder to your little finger. The ulnar nerve manages the muscles that allow you to make fine movements with your fingers. It also controls some of the muscles of your forearm that allow you to grip things tightly. Unlike most of your other nerves, the ulnar nerve isn’t protected by muscle or bone throughout its course. In some areas, it’s near the surface of your skin. This means that injuries to the ulnar nerve aren’t uncommon.
The ulnar nerve is what creates the shock-like sensation when you hit the funny bone in your elbow.
You may lose sensation and have muscle weakness in your hand if you damage your ulnar nerve. This is known as ulnar nerve palsy or ulnar neuropathy. This condition can affect your ability to make fine movements and perform many routine tasks. In severe cases, ulnar nerve palsy can cause muscle wasting, or atrophy, that makes the hand look like a claw. Surgery is sometimes necessary to correct this.
Ulnar nerve palsy is typically a progressive condition, meaning it gets worse over time.
The symptoms associated with ulnar nerve palsy include:
- a loss of sensation in your hand, especially in your ring and little fingers
- a loss of coordination in your fingers
- a tingling or burning sensation in your hand
- pain
- hand weakness that may get worse with physical activity
- a loss of grip strength
The lack of strength in your hand can affect your daily activities, such as gripping a glass and holding a pencil.
Over time, the lack of control and sensation can cause the muscles in your hand to tighten, leading to a claw-like deformity. This usually only occurs in severe cases of ulnar nerve palsy.
Ulnar nerve palsy can make it difficult to work with your hands, so it may be harder to complete tasks that were once easy. Activities that put strain on your hands and lower arms, such as golf or tennis, may make the pain worse.
The cause of ulnar nerve palsy isn’t always known. However, damage to the ulnar nerve can occur due to:
- an illness that damages your nerve
- an injury to the nerve
- excess pressure on the nerve
- nerve pressure due to swelling
- an elbow fracture or dislocation
Damaging the ulnar nerve is like cutting a telephone cord. The messages from your brain can’t be properly transmitted to their targets in your hand and arm, and they can’t be received from the hand.
Your doctor will first examine you and ask you about your symptoms. Make sure to tell your doctor if your symptoms began after an injury to your hand. This can help your doctor determine potential causes of your condition more easily. They’ll want to know how the injury occurred, how long symptoms have been present, and what makes your symptoms worse or better.
During the exam, your doctor will assess the condition of your hand and evaluate how well you can move your fingers.
In addition to a physical examination, testing can include:
- blood tests
- imaging tests, such as a CT scan or MRI
- nerve conduction tests
- X-rays
These tests help detect swelling and measure nerve function in the ulnar nerve. They can also help to localize the area of the nerve that isn’t functioning properly. A nerve conduction study can help determine the severity of the dysfunction.
Nerve tissues usually heal much more slowly than other types of tissues. However, some ulnar nerve palsy symptoms may get better without treatment.
There are a number of possible treatments for ulnar nerve palsy, including:
- over-the-counter pain relievers
- medications to reduce nerve spasms, such as gabapentin (Neurontin), carbamazepine (Tegretol), or phenytoin (Dilantin)
- corticosteroids to reduce inflammation
- a splint to support the hand and reduce painful symptoms
- physical therapy to increase muscle strength and function
- occupational therapy to minimize further injury
Your doctor may also recommend surgery if the nerve damage is extensive, extremely painful, or not improving. Surgery is also often necessary if you find it difficult to go about your daily life due to the nerve palsy. If the cause of your ulnar nerve palsy is compressed nerve at the elbow, moving the nerve from the back of the elbow to the front of the elbow may be necessary.
If your doctor determines that the nerve isn’t going to restore its normal function, they may recommend a surgical procedure that involves tendon transfer. During a tendon transfer surgery, a functioning tendon is moved from its original bone attachment to a new one. This can help restore muscle function, allowing you to perform routine activities once again.
The results of surgery are generally good, but nerves heal slowly. A full restoration of wrist and hand function can take months. Even after surgery, you may still have a loss of sensation and movement in your hands.
Getting medical treatment as soon as you notice symptoms of ulnar nerve palsy is vital to preventing more serious complications, such as a permanent hand deformity. The most common cause is pressure on the nerve at the elbow. If the condition is progressive, then moving the nerve from the back of the elbow to the front takes pressure off the nerve and allows it to function normally.
Call your doctor right away if you’re experiencing tingling, numbness, or pain in your fourth and fifth fingers. You may also want to meet with an occupational therapist to determine whether your daily work habits are placing excess pressure on your ulnar nerve.
To prevent further injury, you may need to wear a cast, splint, or brace for support.
