Ulnar Tunnel Syndrome

Ulnar tunnel tyndrome (UTS) is a painful syndrome which involves the arm and fingers. It is seen more often in women than men, and usually occurs between 40-60 years of age. Several nerves travel from the spine, down the arm and into the hand which allow hand grip strength and fine movements of the hand and fingers (i.e.: handwriting, buttoning, and fine coordination). One of these nerves, called the "ulnar nerve" is the one effected in UTS. The ulnar nerve travels through a very small space at the elbow, between the bones of the joint. The nerve is surrounded by a ligament which is a thick band of fiber which gives strength and support to the elbow and arm. When this ligament hardens, the nerve is pressed into the small space of the groove. The nerve then becomes trapped in the groove, causing the symptoms you may experience. Symptoms

Numbness in the third or little fingers, which is often worse at night, and may awaken the person from sleep
Pain from the elbow down the arm and into the third and little fingers, which often gets worse with use of the hand or arm. The pain is usually described as aching or burning.
Numbness in the fingertips which may feel like "pins and needles" or tingling
Weakness of the little finger, or weakness of the hand grip
In severe cases, the fingers may contract (or draw up) and become difficult to extend

Causes

Repetitive motion of the arm or elbow (i.e.: carpentry, construction work, poultry workers and factory line work)
Arthritis of the elbow joint
Injury to the elbow or arm
Being overweight
Sometimes occurs during pregnancy (will usually resolve after pregnancy)

Diagnostic tests

If your health care provider suspects you have UTS, the following tests may be performed:

Strength and sensation testing
Your health care provider will examine your strength by having you grip an object, hold the fingers apart, or move the arm against resistance. Sensation is tested with gentle pinprick to determine if there is any numbness.

Palpation of the nerve in the elbow groove
May be very tender to touch.

Tinels sign
Tapping on the elbow causes pain, tingling or shock-like sensation down the arm into the fingers.

Electromyogram (EMG), and Nerve Conduction
These tests use small needles to test the amount of time it takes for the stimulus (pinprick) to get a response. The more delayed the response, the greater chance of having UTS.

Treatment

Antiinflammatory medications
Drugs such as Ibuprofen may help reduce some of the inflammation around the nerve and joint.

Injections of steroid into the tunnel space
May help to reduce the inflammation temporarily.

Surgery
Treatment with surgery involves an incision in the elbow area to release the ulnar nerve from the trapped space. This is usually done in outpatient surgery, and the patient may go home the same day. The arm will be placed in a splint, with a large dressing. Following surgery, it is important to keep the arm immobilized and avoid any strain on the fingers, hand, or joint. Move the fingers and thumb frequently to keep the muscles strong and flexible. The dressing should be kept dry and clean until removed by the health care provider. The arm should be kept dry until the stitches are removed in about 14 days. Avoid any injury or strain on the incision even after the stitches are removed.

Prevention

If you have a job that requires repetitive motion with the arm, make sure you have adequate support (i.e. elbow pads)
Avoid repetitive leaning on your elbow when using the telephone.
Avoid resting your elbow on the window or door frame while driving
Perform frequent stretching exercises i.e.: stretch the arm 10 times every hour, or squeezing a small rubber ball several times per day.
Keep your weight within normal limits for your age and height
Avoid injury to the elbow (ie: wear protective equipment when roller-skating)
Try using an arm support at the keyboard or typewriter if you type often
If you are diabetic, try to keep your blood sugar under adequate control