From the Guidelines
Ulnar nerve irritation should be managed with a combination of conservative treatments, including avoiding aggravating activities, using an elbow pad or splint, anti-inflammatory medications, physical therapy, and applying ice, with surgical intervention considered if symptoms persist or worsen, as recommended by recent guidelines 1. When managing ular nerve irritation, it is essential to prioritize conservative treatments to alleviate symptoms and prevent further nerve damage.
- Avoid activities that aggravate symptoms, particularly those involving elbow flexion or direct pressure on the nerve.
- Use an elbow pad or splint at night to keep the elbow straight, reducing pressure on the nerve.
- Anti-inflammatory medications like ibuprofen (400-600mg three times daily with food) or naproxen (250-500mg twice daily with food) can help reduce pain and inflammation, as suggested by recent studies 1.
- Physical therapy exercises focusing on nerve gliding and strengthening the surrounding muscles may improve symptoms.
- Apply ice for 15-20 minutes several times daily to reduce inflammation. Ulnar nerve irritation occurs when the nerve becomes compressed or stretched, particularly at the elbow where it passes through the cubital tunnel, and can be diagnosed with imaging studies such as radiographs and MRI, as noted in recent research 1. This compression disrupts normal nerve function, causing symptoms like tingling or numbness in the ring and little fingers, hand weakness, and elbow pain. Early intervention is crucial to prevent permanent nerve damage and muscle wasting, and surgical decompression may be necessary if symptoms persist beyond 6-8 weeks of conservative treatment or if there's muscle weakness or atrophy, as indicated by recent guidelines 1.
From the Research
Ulnar Nerve Irritation
- Ulnar nerve entrapment is a relatively common entrapment syndrome, second only in prevalence to carpal tunnel syndrome 2.
- The potential anatomic locations for entrapment include the brachial plexus, cubital tunnel, and Guyon's canal 2.
- Patients typically present with sensory deficits of the palmar aspect of the fourth and fifth digits, followed by motor symptoms, including decreased pinch strength and difficulty fastening shirt buttons or opening bottles 2.
- Diagnosis can be aided by X-ray, CT, MRI, electromyography, and nerve conduction studies, depending on the suspected cause of the entrapment 2.
- Medical management, in conjunction with physical therapy, shows limited promise, but minimally invasive techniques and surgical options, such as endoscopic ulnar decompression, have shown great promise 2.
Treatment Options
- Minimally invasive techniques, including peripheral percutaneous electrode placement and ultrasound-guided electrode placement, have been recently studied and show great promise 2.
- Surgical options, such as decompression, can be done endoscopically or through an open incision, and endoscopic ulnar decompression shows great promise as a surgical option with minimal incisions 2.
- Antiepileptic drugs, such as gabapentin and pregabalin, have been found to be effective in treating neuropathic pain, including ulnar nerve irritation 3, 4.
- However, the use of oral nonsteroidal anti-inflammatory drugs (NSAIDs) for neuropathic pain is not supported by evidence 5.
Management of Ulnar Nerve Injuries
- Early neurorrhaphy of acute nerve injuries provides the best outcome, but consideration should also be given to performing distal motor nerve transfers to preserve hand intrinsic motor function when injuries occur at or above the proximal forearm 6.
- Advances in imaging modalities may provide earlier means of identifying and diagnosing closed nerve injuries 6.