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Ulnar Nerve - Location, Function, Possible Nerve Disorders, and Treatment

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The ulnar nerve is an important nerve located in the arm. It helps move the forearm, hand, and fingers and sends feelings from the arms back into the brain.

Written by

Dr. Jayasree S

Medically reviewed by

Dr. Abhishek Juneja

Published At December 29, 2022
Reviewed AtDecember 29, 2022

What Is the Ulnar Nerve, and Where Is It Located?

The ulnar nerve is one of the major nerves present in one’s arm. There are two ulnar nerves in the body on either arm. It comes out of a network of nerves called the brachial plexus present in one’s neck and shoulders. All of these nerves emerge from the spinal cord, which is a downward extension of the brain protected by the bones of the spine. The ulnar nerve helps one move the hands, forearms, and fingers. It also carries the sensations one feels from these parts to the brain. When the nerve gets compressed or injured, one faces pain, numbness, and trouble using the arms.

What Is the Function of the Ulnar Nerve?

The ulnar nerve controls most of the small muscles in the arms. It starts from the armpit area and runs down to reach the muscles of the forearm, hand, and fingers. It branches out to form three additional nerves (muscular branch, dorsal cutaneous branch, and palmar cutaneous branch). The branches of the ulnar nerve communicate the commands sent from the brain to the muscles so that they can move in the desired manner. It also helps pass on feelings like touch, pain, pressure, vibration, heat, and cold to the brain. This nerve enables one:

  • To grip and hold things.

  • Write with a pen, button up a shirt, and turn the pages of a book.

  • Bend and straighten the little finger and ring finger.

  • Give feelings to the palm, little finger, part of the ring finger, and outer half of the hand towards the side of the little finger.

What Are the Disease Conditions Affecting the Ulnar Nerve?

Injuries can happen to the ulnar nerve anywhere on its path. A sudden traumatic injury may damage the nerve affecting its functions. Whereas long-term wear and tear in the body causing injury to the nerve displays slow progress of symptoms. Major causes of ulnar nerve injury are:

  1. Dislocation of the elbow joint.

  2. Fracture and formation of bony spikes around the nerve.

  3. Arthritis and diabetes.

  4. Leaning on the elbow or sleeping with the elbow in a bent position for a long time.

  5. Tumors or cysts around the nerve.

  6. As a result of surgical complications (a carpal tunnel or shoulder fracture repair).

What Are the Major Disorders Affecting the Ulnar Nerve?

  • Cubital Tunnel Syndrome - This is caused by compression of the ulnar nerve (compression neuropathy) behind the elbow of the arm.

  • Guyon Canal Syndrome - Also known as handlebar palsy, it often affects cyclists while gripping the handlebar of the cycle. Compression of the ulnar nerve in the wrist region is the reason behind this condition. One may develop small fluid-filled lumps (ganglion cysts) within the wrist, which may compress the nerve. Fractures in the small bones of the wrist can also result in nerve compression.

  • Contusion Injuries to the Ulnar Nerve- Also known as funny bone injuries. One may experience a strange sensation of sharp electric shock-like pain, tingling, and numbness along the ulnar nerve after getting hit at a certain area behind the elbow.

  • Traumatic Injuries to the Nerve - The trauma may be from a motor vehicle collision, falls, or sharp objects like a knife or broken glass. And it usually causes a cut, tears, or crushing injury to the nerve. The ulnar nerve suffers sudden severe damage in such events and loses its function.

Compression or injury to the ulnar nerve at the level of the elbow or wrist may cause:

  1. Pain and weakness in the hand. Inability to write, type or grasp objects.

  2. Pain in the elbow joint and wrist.

  3. Tingling and numbness inside the palm and on the ring finger and little finger. Those two fingers tend to curl in like a claw.

  4. The hand may become extremely sensitive to cold.

How Are the Ulnar Nerve Disorders Clinically Diagnosed?

The doctor will listen to all the symptoms one experiences, including their duration and progress. If there was an event of trauma leading to the nerve disorder, the doctor needs to know that too. Understanding the underlying cause of nerve injury is very important in planning the treatment. Secondly, the doctor will perform a neurological examination to identify the level of nerve function. There are various tests to evaluate the performance of the ulnar nerve from the muscle movements and pattern of response to stimulations. One may also conduct the following:

  • Test for Tinel Sign - Where tapping on the area of suspected nerve injury may cause pain, numbness, or tingling along the path of the nerve.

  • X-ray - Of the arm to look for bone fractures, bony spikes (bone spur), or other abnormalities compressing the nerve.

  • Computed Tomography (CT) Scans and Magnetic Resonance Imaging (MRI) - These techniques give a better view of the underlying causes, such as tumors, lumps, or ganglions which may compress the nerve. A high-resolution ultrasound scan (USG) is helpful too.

  • Electromyography (EMG) - This test helps measure the strength and speed of electrical signals passed from the nerve to the muscles. One can understand the level of nerve function from this test.

What Is the Treatment for Ulnar Nerve Disorders?

The first priority in treating ulnar nerve injury is to relieve the pressure and tension on the nerve. The doctor will treat the symptoms as well. One may adopt the following method of treatment:

  1. Restrict the movement of the affected arm, joints, and wrist using protective padding or splints. One should avoid activities and movements that put pressure on the ulnar nerve.

  2. Doctors may prescribe anti-inflammatory or steroid medications to control inflammation in the nerve. This also helps to reduce symptoms like pain.

  3. Severe damage to the nerve requires surgical repair. The doctor may rejoin the severed nerve or do a nerve graft. One may repair a fractured bone that pinches the ulnar nerve or remove a mass or growth by compressing it, as per requirement.

  4. One may perform an ulnar nerve transposition. It is a process where the nerve is relocated from the back of the elbow to the front so that it does not suffer strain while bending the elbow.

  5. Physical therapy and occupational therapy exercises also help with weakness and mobility issues.

Conclusion:

Activities that put frequent heavy pressure on the elbows and wrists may injure the ulnar nerve. This is why certain people are at a higher risk of ulnar nerve compression. For instance, tennis players, golfers, bicyclists, and baseball players are at a higher risk. Smokers, construction workers, longtime keyboard users, and weightlifters also belong to a risk category. One should make the necessary lifestyle changes at home and work to relieve the pressure on the ulnar nerve. And seek medical help at the earliest if there is pain, weakness, or numbness in the arm.

Frequently Asked Questions

1.

What Are the Clinical Signs of Ulnar Nerve Damage?

Damage or an injury to the ulnar nerve may cause the following clinical manifestations.
- The affected individual may have numbness along the distal side of the ulnar aspect of the hand.
- Pain along the wrist and elbow joint.
- The patient may experience clumsiness and difficulty holding objects and there is a loss of ability to perform tasks with hands.
- Sensitivity to cold. 
- The ring finger and little finger tend to curl in like a claw.  

2.

Where Does the Course of the Ulnar Nerve Start?

The ulnar nerve is present in both arms. They arise from the network of vessels called the brachial plexus that are present in the neck and shoulders. The brachial plexus supplies the muscles and skin of the upper arm. The ulnar nerve is responsible for hand movements, including the fingers and forearm.

3.

Explain the Course of the Ulnar Nerve?

The ulnar nerve belongs to the branches of the brachial plexus. This nerve begins from the brachial plexus present in the axillary region (armpit). They connect to the middle of the brachial plexus along with cervical vertebrae (C8) and thoracic vertebrae (T1). They run down to the elbow by running beneath the muscles of the forearm. Finally, they divide into smaller branches and enter the palm through an opening called the Guyon’s canal.

4.

Which Finger Does the Ulnar Nerve Supply?

The ulnar nerve contains three branches, and the third branch is called the palmar cutaneous nerve. This part of the ulnar nerve reaches the palm through an opening called the Guyon’s canal. They provide sensory information to the little finger and half of the fourth digit. They help in the fine movements of these fingers.

5.

What Is the Primary Function of the Ulnar Nerve?

The ulnar nerve supplies most of the small muscles present in the hand. The motor functions of the ulnar nerve include:
- Hand flexion.
- Flexion and extension of the little finger and the fourth finger,
- To hold objects in hand and perform tasks.
The sensory branches of the ulnar nerve innervate
- Regions of the palm near the little finger.
- Little finger and half of the fourth finger.

6.

Name the Branches of the Ulnar Nerve

The ulnar nerve is a member of the five branches of the brachial plexus. There are three branches of the ulnar nerve. 
- The first branch is the muscular branch, which is responsible for controlling the movements of the forearm.
- The second is the dorsal cutaneous branch, which is responsible for supplying sensation to the hand and the fingers.  
- The third branch is the palmar cutaneous branch, which is responsible for supplying sensation to the skin at the base of the palm.  

7.

Is It Possible to Cure an Injured Ulnar Nerve?

 
Treatment for an injured nerve depends on the type of injury and the underlying cause of it. However, when there is an excessive injury to the ulnar nerve, it may require a nerve grafting procedure to fix the uninjured areas of the ulnar nerve. Sometimes, when the injury is due to compression, it may require relieving the pressure over the injured site. The doctor may advise restricting movements on the hand. 

8.

Does an Injured Ulnar Nerve Repair Without Treatment?

 
Compression over the ulnar nerve may injure the nerve and cause numbness, and tingling sensation, and result in loss of grasp strength. Mild cases of compression due to inflammation can be managed with conservative treatment options. The patient may be asked to do ice application, take non-steroidal anti-inflammatory drugs, and may be referred to a physical therapist for physiotherapy. 

9.

Where Does Ulnar Nerve Injury Occur More Frequently?

An injury to the ulnar nerve occurs more frequently over the elbow region. Particularly in the regions of the cubital tunnel (a tunnel of tissues that runs inside the elbow) and ulnar groove. Next to the elbow region, injury occurs more frequently in the wrist region in the area of opening called Guyon’s canal. But, an injury can also occur in the hand, above the elbow, and in the forearm regions.

10.

What Are the Examination Techniques for an Ulnar Nerve?

It is usually difficult to examine conditions of the ulnar nerve. The doctor may perform some provocative tests like Tinel’s sign to test for the abnormalities of the ulnar nerve. The examiner taps over the suspected area of the injured site and it is considered positive when the patient reacts with discomfort along the course of the nerve. The doctor may also perform other investigation techniques like ultrasound, X-ray, and nerve conduction studies.

11.

What Is the Management Option for Ulnar Nerve Damage?

The first treatment option is focused on relieving pressure over the compressed nerve. The healthcare provider will give treatment based on the patient's symptoms. They may immobilize the affected arm with the help of splints or braces. Doctors may recommend medications to reduce pain. In severe cases, the patient may require surgical interventions.

12.

What Is Ulnar Nerve Neuropathy?

Pressure or compression exerted over the ulnar nerve may injure the nerve and result in pain, numbness, and loss of sensation over the course of the affected nerve. It may occur as a result of repetitive movements of the elbow, arthritic changes, or structural deformities of the elbow making them more prone to ulnar neuropathy. Symptoms of this condition like pain are often described to be shooting pain.

13.

Is Ulnar Neuropathy a Serious Condition?

 
Ulnar neuropathy is not a serious condition; however, in severe cases, it may result in loss of sensation and muscle mass in the affected arm. Hence, immediate diagnosis and early interventions are recommended for this condition. Studies show that with proper treatment, individuals affected with this condition are able to make a complete recovery. Patients are asked to perform physical therapy exercises to maintain the muscle strength of the affected arm. 

14.

Which Doctor Is Specialized in Treating Ulnar Neuropathy?

 
Ulnar neuropathy can be treated by doctors referred to as orthopedists who are specialized in treating arm and elbow conditions. In severe cases, when the affected individuals require surgical intervention, the surgical procedure will be carried out by a doctor who specializes in neurosurgery. The orthopedic doctor will carry out the initial evaluation of the patient and propose the diagnosis. 
Dr. Abhishek Juneja
Dr. Abhishek Juneja

Neurology

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ulnar nerve
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