Nerve compression at the elbow
On the inside of the elbow, the ulnar nerve (n. ulnaris, "fool's bone") runs through the ulnar sulcus. This bony canal is spanned by a ligament, creating a tunnel. Due to the large range of motion of the elbow, the nerve must be able to glide freely in the canal.
In ulnar sulcus syndrome, pressure is exerted on the nerve in the area of this canal. The ulnar nerve supplies the little finger, the ulnar side of the ring finger and the ulnar edge of the hand with sensitivity and controls a large part of the musculature in the hand (intrinsic hand musculature).
The superficial location of the ulnar nerve makes it susceptible to external damage. Possible causes that can lead to pressure being exerted on the ulnar nerve are
Typical symptoms are falling asleep, tingling and numbness in the area of the little finger, the ulnar side of the ring finger and the ulnar edge of the hand. These sensations may initially only occur with certain movements or direct external pressure on the nerve. With increasing pressure, however, the discomfort does not disappear. If pressure is exerted for a long time, this also leads to a reduction in strength in the hand and ultimately to muscle atrophy. At this stage, the fingers can no longer be spread vigorously.
A suspected diagnosis is made on the basis of the patient’s medical history and clinical findings. To confirm the diagnosis, the neurologist will carry out an electrophysiological examination to test how well the nerve still conducts electrical impulses. If there is a suspicion that a degenerative change in the joint is responsible for the increase in pressure, an X-ray or ultrasound can be performed.
The prognosis depends on the damage to the nerve at the time of the operation. As long as there is no permanent damage, sensitivity and strength can fully recover. However, this can take several weeks to months, especially in terms of sensitivity. In the case of prolonged compression with permanent damage to the nerve, the symptoms will not recover completely.
Occasionally, even after an initially successful simple decompression, pressure can be exerted again with nerve compression. During a re-operation, the nerve is carefully freed from scarring and adhesions and relocated to the front of the elbow. Accordingly, the recovery time after these operations is longer than with primary surgery.
If the symptoms and electrophysiological changes are only minor, conservative therapy can be carried out without surgery. If conservative treatment is of no use, or if there are already pronounced sensory disturbances, muscle atrophy and/or a significant deterioration in the nerve’s conduction capacity, surgery is necessary.
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