What are the treatment options for ulna (ulnar) nerve damage on my left arm?

Treatment of Ulnar Nerve Damage

For ulnar nerve damage on your left arm, begin immediately with protective positioning and padding at the elbow, combined with paracetamol for pain control, while obtaining electrodiagnostic studies to determine whether you need surgical decompression or can manage conservatively with positioning modifications alone. 1, 2, 3

Immediate Protective Measures

• Apply foam or gel padding at the elbow to prevent further compression of the ulnar nerve, as this decreases ulnar neuropathy risk according to consensus guidelines 1
• Avoid tight padding that creates a tourniquet effect, which paradoxically increases nerve injury risk 1
• Maintain neutral forearm position when your arm is at your side 1, 2
• Limit elbow flexion to less than 90°, as excessive flexion increases ulnar neuropathy risk 1, 2, 3
• Avoid prolonged pressure on the ulnar groove (the bony groove behind your elbow) 1, 2

Diagnostic Workup to Guide Treatment

You need electrodiagnostic studies (nerve conduction studies and EMG) to determine the severity and location of nerve damage, which dictates whether you need surgery or conservative management 2, 3, 4

• Electrodiagnostic studies differentiate between two critical patterns: entrapment under the humeroulnar aponeurosis (requires surgical release) versus extrinsic compression in the retrocondylar groove (requires positioning modifications only) 5, 4
• MRI without IV contrast is the reference standard if diagnosis remains unclear, showing high signal intensity and nerve enlargement on T2-weighted neurography 2, 3
• Ultrasound is an effective alternative with 77-79% sensitivity and 94-98% specificity for assessing nerve cross-sectional area and thickness 1, 2, 3

Pain Management Algorithm

Start with paracetamol as first-line therapy, escalating only if inadequate relief:

1. Paracetamol up to 4g daily as first-line oral analgesic due to favorable efficacy and safety profile 1, 2, 3
2. Topical NSAIDs for localized pain to minimize systemic side effects 1, 2, 3
3. Oral NSAIDs at lowest effective dose for shortest duration only if paracetamol provides inadequate relief 2, 3

Physical Therapy Protocol

• Range of motion and strengthening exercises to maintain elbow and wrist function 1, 2, 3
• Apply local heat before exercise to enhance tissue flexibility and reduce discomfort 2, 3

Treatment Decision Based on Nerve Study Results

The treatment approach must be tailored to the specific location of nerve compression identified on electrodiagnostic studies:

• If entrapment is under the humeroulnar aponeurosis: surgical decompression is indicated, with 83% of patients reporting improvement at 2.5 years 5
• If compression is in the retrocondylar groove: conservative management with positioning modifications alone, with 84% of patients reporting improvement at 2.5 years 5

Both approaches show similar improvement rates in nerve conduction velocity, compound muscle action potential amplitude, and reduction in nerve cross-sectional area on ultrasound 5

Critical Pitfalls to Avoid

• Do not assume all ulnar nerve damage requires surgery – the location of compression determines treatment, and many cases improve with conservative management alone 5, 4
• Do not delay electrodiagnostic studies – early identification of nerve injury type prevents permanent damage, especially in trauma cases 6, 7
• Do not use padding that is too tight – this creates a tourniquet effect and worsens nerve compression 1
• Examine nerve function both before and after any reduction procedures if your injury involved trauma, as nerve palsy can develop after fracture reduction 7

Monitoring Strategy

• Repeat electrodiagnostic studies if symptoms worsen to assess for progression from demyelinating to axonal injury 3
• Regular follow-up is essential to monitor for progression or improvement of symptoms 1
• Expect gradual improvement over 2-3 months with appropriate treatment, whether surgical or conservative 5

Special Consideration for Trauma Cases

If your ulnar nerve damage occurred from trauma (fracture or high-velocity accident), surgical exploration may be needed urgently if nerve function does not improve, as bone fragments can directly compress the nerve 6, 7