Sulcus ulnaris syndrome

Entrapment of the ulnar nerve (elbow nerve) on the inside of the elbow, caused by repeated injury, compression or inflammation of the elbow region and/or physical strain in this area. Sometimes, the cause remains unknown.

Symptoms

Patients complain of tingling, altered sensation and a feeling of numbness in the little finger and on the outer side of the ring finger, the ulnar side of the hand and/or the lower arm. Symptoms are not uncommonly also felt in the upper arm. Percussion or pressure over the inside of the elbow causes a radiating tingling feeling (funny bone).

Where the damage is severe, weakness (paresis) and atrophy (muscle loss) occur of the intrinsic muscles of the hand. "Claw hand" can often develop too, where the metacarpophalangeal joints are extended and / or atrophy occurs of the muscles between the thumb and index finger (Froment's sign).

Electrophysiological investigations can indicate the presence of Sulcus ulnaris syndrome and its severity.

Treatment

In mild cases, simply resting the joint, bandages, Voltarol gel, taking pain-relieving or anti-inflammatory medication, the use of injections that include cortisone preparations and physiotherapy are sufficient to relieve the symptoms of this condition.

If the symptoms last more than 6 weeks, or if the symptoms become unbearable, or if neurological deficits are present, then surgical decompression is required. The procedure can be carried out under local anaesthetics, plexus anaesthesia or under general anaesthetics, again either as an outpatient or as an in-patient. A small skin incision is all that's required to expose the nerve and create more space.

A protection time of 2 weeks is recommended post-operatively. Physiotherapy should then be commenced.