Ulnar tunnel syndrome can cause numbness and tingling that is confined to the little finger and along the outside of the ring finger. It is seen more common in women than men, usually occurs between 40-60 years of age.The ulnar nerve, one of the three major nerves supplying the hand, travels through a small space in the elbow, runs in the forearm, and to the heel of hand. It then branches out in the palm and into the ring and little fingers. Excessive compression of the nerve can lead to muscle weakness and lost of feeling in the hands.
Symptoms
You may experience the following symptoms:
- Numbness and tingling in your little and ring finger
- Muscle weakness in the hand
- Pain may or may not present
The degree of muscle weakness and numbness depends on the precise location of the entrapment – sensory or motor involvement. As the condition progresses, this may cause difficulty in performing daily activities such as: holding objects, opening jars, washing plates and actions in which torque is applied to a tool.
Causes
Anatomical: Ganglion, soft-tissue masses, hook of hamate fracture, distal radius fracture, hypertrophic synovium.
Inflammatory conditions: Rheumatoid arthritis, tenosynovitis, oedema secondary to burns, gout, co-existent carpal tunnel syndrome.
Vascular conditions: Ulnar artery thrombosis, ulnar artery pseudoaneurysm.
Neuropathic conditions: Diabetes, alcoholism, proximal lesion of ulnar nerve.Occupation-related: Vibration exposure, repetitive blunt trauma, direct pressure on ulnar nerve with wrist extended, typing, cycling.
Risk Factors
Risk factors include repetitive movement, mechanical stress and abnormal posturing of the wrist.
Investigations
If your doctor suspects you have ulnar tunnel syndrome, the following may be performed:
Physical Examination: Your doctor examines your hand for any weakness, wasting and sensation. He / She may also tap a finger over the ulnar nerve to see whether this causes a tingling or shock-like sensation into the little and ring finger (Tinel’s sign). Your doctor may also examine your elbow as the ulnar nerve travels through a narrow tunnel in the elbow, and pressure at this area can cause symptoms in the hands.Tests: Your doctor may order an x-ray if he suspects a fragment of fractured bone, bone spurs or arthritis as the cause of compression. A nerve conduction test is also done to determine how well the nerve is working and also ascertain the area of compression. A CT scan / MRI may also be used to see whether a cyst or other structures is pressing on the nerve.
Complications
Failure to treat this condition can result in permanent nerve damage, loss of function of the hands and wrist, and loss of muscle mass.
Chronic hand pain may progress to regional pain syndrome.
Depression may develop in individuals if this condition severely interferes with their occupational or recreational activities.
Treatment
Treatment of ulnar tunnel syndrome depends on what is causing the pressure on the nerve. Treatment can be non-surgical or surgical:
Non – surgical treatment: Anti-inflammatory medications such as ibuprofen or aspirin can be given, this will reduce swelling and inflammation around the nerve and wrist joint. Short term use of wrist splint may be beneficial. Steroid injections are generally not recommended as there is a risk of damaging the ulnar nerve.Surgical treatment: Your doctor may recommend surgery if there is severe nerve compression, muscle wasting, or non-surgical methods do not improve the condition. The surgeon will make a zigzag incision at the base of the palm, opening the roof of the Guyton’s canal to relieve pressure on the nerve. At the same time he / she may also remove cysts, scar tissue, or other growth if they are compressing on the nerve.The surgery is usually done on an outpatient basis or with an overnight stay in hospital.
Seeking Advice
Your Family Doctor (GP)
Your Family Doctor will be able to diagnose and help treat your problem. He or she will be able to:
- tell you about your problem
- advise you of the best treatment methods
- prescribe you medications
- and if necessary, refer you to Specialists (Consultants) for further treatment
Prevention
- Try using an arm support when using the keyboard or typewriter
- Perform frequent wrist stretching – squeeze a small rubber ball several times a day
- If diabetic, try to keep a good control of your blood sugar
- Avoid injury to the wrist (wear protective equipment when skating)
F.A.Q. | Frequently Asked Questions
What is the prognosis?
Results from the surgery are generally good. However, if the nerve is severely compressed, or there is muscle wasting, the nerve may not return to normal and some symptoms may even remain. Nerves recover slowly and it may take some time to know how well the nerve will do after surgery.
What happens after surgery?
You may need to wear a splint for a few weeks. The dressing should be kept clean and dry until removed by a health care provider. Avoid any strain on the fingers, hand or joint.
Rehabilitation
Your surgeon may recommend physical therapy and exercise to regain strength and improve motion in the wrist.