Ulnar Neuritis

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Ulnar neuritis, known in medical terminology also as Cubital Tunnel Syndrome, is one of the most frequently appearing and annoying conditions of chronic nerve pressure and entrapment in the upper limb, right after carpal tunnel syndrome. It is a condition that can significantly downgrade the patient’s quality of life, as it directly affects the sensation and functionality of the hand, making even the simplest daily activities difficult. To understand the condition, it is important to know a few elements about the anatomy of the region. The ulnar nerve is one of the three main nerves of the hand. It starts from the neck region, crosses the arm, passes through the elbow, and ends in the hand, giving sensation to the little finger and half of the ring finger, while controlling most of the small (intrinsic) muscles of the palm that are responsible for delicate movements. In the elbow region, the ulnar nerve passes through a very narrow, bony and ligamentous “tunnel” on the inner surface of the joint, the cubital tunnel. At this point, the nerve is located exactly under the skin, having minimal protective fat or muscle tissue around it (it is the well-known spot that when we hit it accidentally we feel a sharp pain like an “electric current”). This exact anatomical position renders it exceptionally vulnerable, exposed to direct injuries, friction, and various mechanical strains.

When the nerve is compressed, stretched excessively, or becomes inflamed within this tunnel, ulnar neuritis is caused.

Ulnar Neuritis: Causes and Risk Factors

Ulnar neuritis is not the result of a single cause, but usually arises from a combination of anatomical, mechanical, and daily factors. The main causes and mechanisms of appearance of ulnar neuritis are the following:

Prolonged or Repetitive Elbow Flexion

When we bend our elbow, the ulnar nerve stretches around the bony prominence (the medial epicondyle) like a guitar string. Prolonged or continuously repetitive movements that mandate flexion of the elbow over 90 degrees reduce the space in the cubital tunnel and interrupt the smooth blood supply to the nerve. This is frequently observed in:

People who talk for a long time on the mobile phone holding it to their ear (the so-called “cell phone elbow”).
Individuals who sleep in a fetal position or with their arms folded under their head/pillow.
Occupations requiring continuous flexion, such as musicians, drivers, or computer workers who rest their elbows at the wrong height.

Direct Pressure

Because the nerve is completely superficial, continuous direct pressure on hard surfaces causes ischemia (lack of blood) to the nerve. Resting the elbow on the armrest of the chair, on the desk, or on the car door by drivers, is among the most frequent causes of its irritation.

Elbow Fractures and Anatomical Abnormalities

Elbow fractures that had arisen in the past (even during childhood) may have changed the geometry of the joint (e.g., creation of valgus deformity), resulting in the nerve stretching at an unnatural angle. In addition, bone spurs (osteophytes) from pre-existing osteoarthritis or the creation of scars from old injuries can narrow the tunnel.

Nerve Instability

In some people, the anatomical sheath of the nerve is loose. During flexion of the elbow, the nerve “slips” (subluxates) out of its position and “snaps” over the bone. This continuous friction, over the passage of time, causes severe inflammation and thickening of the nerve.

Presence of Edema in the Joint

Any condition causing a accumulation of fluid in the elbow joint, such as olecranon bursitis, rheumatoid arthritis, or even a ganglion cyst, can increase the pressure inside the cubital tunnel and crush the ulnar nerve.

Ο μόνος Ορθοπαιδικός στην Ελλάδα στην χειρουργική ώμου και άνω άκρου με προϋπηρεσία μόνιμης διευθυντικής θέσης (substantive Consultant ) για 10 συναπτά έτη στην Μεγάλη Βρετανία

Ulnar Neuritis: Symptoms

The clinical picture of Cubital Tunnel Syndrome usually develops gradually. If ignored, symptoms become more intense, permanent, and, ultimately, irreversible. The symptoms plaguing a person suffering from ulnar neuritis are divided into sensory and motor ones:

Sensory Symptoms (In initial stages)

Numbness and Tingling: The most characteristic indication. The patient feels “pins and needles” exclusively in the little finger and half of the ring finger.
Pain: A deep, dull or even burning pain located on the inner side of the elbow which can radiate downward (to the forearm) or upward (to the arm). The pain is frequently combined with numbness and they take the form of continuous discomfort, primarily when the patient attempts to bend their elbow.
Night Symptoms: Patients frequently wake up at night with their hand “dead” or completely numb, being forced to shake it to restore sensation, mainly because they sleep with bent elbows.

Motor Symptoms (In advanced stages)

If the pressure remains, the nerve begins to undergo structural damage, affecting the muscles it controls:

Weak Grip and Dropping Objects: The strength of the hand decreases dramatically. The patient finds it difficult to grasp objects (such as a jar) or notices that things drop from their hands without them realizing it.
Loss of Fine Motor Skills: Difficulty in movements requiring precision, such as buttoning clothes, tying shoelaces, typing, or playing musical instruments.
Muscle Atrophy: In severe and chronic cases, the muscles between the fingers and the muscle mass (thenar/hypothenar) in the palm begin to “melt”. The hand can take the form of a “claw” (ulnar clawing), a situation showing extensive and frequently permanent nerve damage.

Ulnar Neuritis: Diagnosis

Timely and accurate diagnosis is the key to saving the nerve. To perform an exceptionally detailed diagnosis of ulnar neuritis, it will be necessary for the patient to brief the attending doctor regarding their medical history, their daily routine, their sleeping habits, and any old injuries.

Clinical and Neurological Examination

In combination with the history, a neurological assessment by the specialized surgeon is deemed necessary. Mr. Polyzois will examine the sensation in the fingers and the muscle strength of the hand. He will use specific clinical tests, such as:

Tinel’s Sign: Light percussion (tapping) over the ulnar nerve at the elbow. If this causes “electricity” in the fingers, the test is positive.
Elbow Flexion Test: The doctor will ask you to hold your elbow in full flexion for 1-2 minutes to see if this causes the appearance of numbness.
Subluxation check: Palpation of the nerve during flexion and extension to determine if it comes out of its anatomical groove.

Electromyogram (EMG)

In cases of chronic appearance of the condition, or when confirmation of severity is required before a surgery, it is important for the patient to additionally perform an electromyogram. This test measures the speed and quality with which electrical signals travel through the nerve, as well as the response of the muscles.

The positive answer of the electromyogram (reduced conduction velocity at the elbow) signals the existence of ulnar neuritis, while demonstrating whether the lesion is already in a severe form. It also helps to rule out the probability of the nerve being compressed higher up, in the neck (cervical radiculopathy).

Imaging Examinations

Finally, plain X-ray contributes to a great extent to making apparent a fracture that had arisen in the past, the existence of osteoarthritis, or some bone deformity (valgus/varus) that possibly affected the patient and brought as a result the creation of ulnar neuritis. In certain cases, an ultrasound or a Magnetic Resonance Imaging (MRI) can reveal inflammation, cysts, or compressive phenomena around the nerve.

Ulnar Neuritis: Treatment Method

As in most conditions, so in this one, the medical approach depends on the severity of the symptoms and the results of the electromyogram. Management can be either conservative or surgical.

Conservative Management

If symptoms are mild, intermittent (appear and disappear) and the EMG does not show severe damage, conservative treatment is preferred. Conservative management consists of:

Rest of the upper limb & Ergonomics: Modification of daily activities. Avoidance of resting the elbow on hard surfaces, avoidance of bending the elbow for a long time, and use of hands-free earphones instead of holding the phone.
Placement of Splints: The use of a soft splint or elbow sleeve during the night, which holds the elbow in a straight posture, prevents the patient from unconsciously bending their arm in their sleep. (A simple trick is tying a towel loosely around the elbow).
Taking Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can reduce the inflammation of the tissue around the nerve. In contrast to other conditions, a cortisone injection is not frequently recommended for ulnar neuritis, due to the risk of direct injury to the nerve by the needle.
Physiotherapy (Nerve Gliding): It can be accompanied by a series of physiotherapy programs. Specific exercises (nerve gliding) help the nerve “glide” smoothly within the tunnel, preventing the creation of adhesions and reducing pressure.

Management of this form helps the patient temporarily and relieves them from persistent symptoms and pain, without however – in advanced situations – giving a definitive solution to ulnar neuritis, if the space remains anatomically narrow.

Surgical Management

In cases of patients where symptoms (such as numbness) do not subside with conservative treatment, when the pain is unbearable, or when muscle weakness and atrophy are observed (which means the nerve is dying), surgical intervention constitutes a one-way street.

The main advantages of surgical management are the rapid and safe decompression of the nerve, preventing its further destruction. Various surgical techniques exist, and the doctor will choose the appropriate one depending on the case:

Simple Decompression in situ: The surgeon opens the “roof” (the ligamentous tissue) of the cubital tunnel, giving the nerve more space, without moving it from its position.
Anterior Transposition: In cases where the nerve subluxates or when a large bone deformity exists, the surgeon releases the nerve and moves it from the back part of the elbow to the front (either under the skin, or inside/under the muscles). In this way, the nerve ceases to stretch when the elbow bends.
Medial Epicondylectomy: A part of the bony prominence (the medial epicondyle) is removed to stop the friction of the nerve over the bone.

The results of the operation are not immediately visible (regarding the numbness), as the biological restoration and regeneration of the nerve needs a period of time in order to be achieved (nerves regenerate at a rate of just 1 millimeter per day). The pain, however, usually subsides immediately.

After the Surgery

The course followed after the surgical operation is characterized by partial immobilization of the upper limb. A soft dressing or a light splint is placed for a period of a few days, so that the incision is protected and (in the case of anterior transposition) the nerve is stabilized in its new position.

This is done in combination with physiotherapies, which start shortly after the removal of the splint, in order to achieve full strengthening of the elbow as soon as possible and the avoidance of stiffness.

The patient is able to return to their daily activities after the end of the second postoperative week, when the sutures are removed. Despite this, approximately 3 months (or even more in severe cases) are needed after the end of the operation in order for a significant reduction of neurological symptoms and numbness to present.

A Few Words About the Doctor (Dr. Polyzois)

Surgery of the peripheral nerves of the upper limb, and particularly the anterior transposition of the ulnar nerve, requires microsurgical precision and huge specialization.

Orthopedic Surgeon Ioannis Polyzois is the only Orthopedic surgeon in Greece in shoulder and upper limb surgery with prior service in a permanent directorial position (substantive Consultant) for 10 consecutive years in Great Britain. Through his multi-year, high-level surgical experience in the strict National Health System (NHS) of the United Kingdom, he is judged as the most suitable doctor for managing ulnar neuritis.

Possessing a huge plethora of successful surgeries and managing even the most neglected and complex cases of nerve entrapment, the doctor numbers over 400 reviews from satisfied patients, who explicitly state that they would trust him again for any other orthopedic problem of theirs. The doctor’s philosophy is based on the thorough, honest briefing of the patient and the implementation of the most modern, safe, and minimally invasive techniques.

Schedule your appointment with the doctor today for a highly personalized and effective treatment.

Cost and Prices for the Management of Ulnar Neuritis

The decision for the treatment of ulnar neuritis is naturally accompanied by the question of financial cost. In our clinic, the primary goal is providing medical services of excellence, maintaining at the same time the cost completely affordable, fair, and with full transparency.

The final cost of management depends strictly on the therapeutic plan that will be chosen. If the condition is in an initial stage, the cost concerns exclusively the clinical examination, the evaluation of tests (EMG) and designing the conservative treatment.

In the case where surgical decompression is deemed necessary, the total cost depends on the type of operation (simple decompression versus the more complex anterior transposition) and the days of hospitalization. However, as these operations are usually conducted as day cases (Day Clinic, without need for an overnight stay), total hospitalization expenses are compressed to a minimum.

In addition, our team maintains excellent cooperation with all private insurance companies, while the option to use the state insurance body (EOPYY) is also provided for drastically reducing the financial burden on hospital expenses. During your visit, a detailed discussion will take place and you will be given a clear, personalized financial brief, without absolutely any unpleasant or “hidden” charge.

Movement is life! Contact the doctor for specialized orthopedic care, tailored to your needs.

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Συχνές ερωτήσεις

Can ulnar neuritis worsen over the passage of time?

Absolutely. If the causes causing pressure on the nerve are not addressed, the ulnar nerve is subject to chronic wear, ischemia, and inflammation. Over the passage of time, simple sensory discomfort (the numbness) progresses into irreversible destruction of nerve fibers. This leads to severe loss of sensation, weakness, atrophy (the “melting” of the palm muscles) and, finally, to permanent disability of the hand. That is why early diagnosis is critical.

Is ulnar neuritis reversible?

If diagnosed and treated timely – in its initial stages – ulnar neuritis is fully reversible, either through conservative treatment or through timely surgical decompression. The pain usually disappears immediately. However, if compression is neglected for years and the hand muscles have already undergone severe atrophy, full reversibility (especially regarding muscle strength) is not guaranteed. Surgery, in these delayed cases, is done mainly to “brake” and prevent further worsening.

Can ulnar neuritis affect the daily functionality of the hand?

Yes, to a dramatic degree. Because the ulnar nerve supplies most of the small muscles of the palm, patients lose the capacity for delicate movements. Activities such as tying shoelaces, turning a key, picking up a coin, writing with a pen or buttoning clothes become from difficult to impossible. The grip loses its strength, with the result that objects drop frequently from the hands.

Is it normal for symptoms to be more intense at night?

It is absolutely normal and perhaps the most frequent complaint of patients. When we sleep, we have the unconscious tendency to take a fetal position or fold our arms tightly across the chest or under the head. This posture causes intense, prolonged flexion of the elbow, which stretches the nerve to the maximum, drastically reducing the blood supply to it. The result of this is the “cry” of the nerve, namely the intense numbness and pain that wake the patient.

Can exercise help or worsen the condition?

Exercise can function in both ways, depending on its kind. Gym exercises requiring a tight grasp of the bar and flexion of the elbow under great resistance (e.g., biceps exercises, weightlifting) increase pressure on the nerve and clearly worsen the condition. Conversely, targeted physiotherapy exercises, known as “nerve gliding exercises” (nerve gliding / flossing), significantly help the nerve move freely within the cubital tunnel, reducing adhesions and relieving symptoms. They should always be executed under the guidance of a specialist.

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