What are the symptoms and treatment options for ulnar nerve (UN) entrapment?

From the Guidelines

Ulnar Nerve Entrapment Symptoms and Treatment

The symptoms of ulnar nerve entrapment typically include numbness, tingling, and weakness in the hand and arm, and treatment options often involve a combination of physical therapy, medication, and in some cases, surgery.

• Common symptoms of ulnar nerve entrapment include:
  • Numbness or tingling in the ring and little fingers
  • Weakness in the hand and arm
  • Pain or burning sensation in the elbow or arm
• Diagnosis is typically made using T2-weighted MR neurography, which is the reference standard for imaging ulnar nerve entrapment 1, and can show high signal intensity and nerve enlargement.
• Treatment options may include:
  • Physical therapy to relieve pressure on the nerve
  • Medication to reduce pain and inflammation
  • Surgery to release the compressed nerve, in severe cases
• It's worth noting that while 3T MRI can be used to evaluate ulnar nerve entrapment, it has only fair-to-moderate agreement for localization of compression points 1.

From the Research

Symptoms of Ulnar Nerve Entrapment

• Numbness in the ring and little fingers 2
• Weakness of the intrinsic muscles in the hand 2
• Altered sensation at the fourth and fifth digits 3
• Weakness of the intrinsic muscles of the palm 3

Treatment Options for Ulnar Nerve Entrapment

• Nonsurgical treatment:
  • Physical therapy 2
  • Bracing 2
  • Injection 2
  • Conservative treatment, such as rest, change in work environment and patterns, and splints 3
  • Information on avoiding prolonged movements or positions 4, 5
  • Night splinting and nerve gliding exercises 4, 5
• Surgical treatment:
  • Simple decompression of the ulnar nerve 2, 4, 5, 6
  • Decompression with submuscular or subcutaneous transposition 4, 5, 6
  • Medial epicondylectomy 4, 5
  • Anterior transposition 4, 5, 6
  • Endoscopic decompression 4

Effectiveness of Treatment Options

• Simple decompression and decompression with transposition are equally effective in idiopathic ulnar neuropathy at the elbow, including when the nerve impairment is severe 4, 5
• Transposition is associated with more deep and superficial wound infections than simple decompression 4, 5
• Information on avoiding prolonged movements or positions may reduce subjective discomfort in mild cases 4, 5
• Submuscular anterior transposition may be recommended for patients with habitual ulnar luxation or subluxation of the ulnar nerve 6