What Is Ulnar Nerve Palsy?
Your ulnar nerve runs all the way from your shoulder to your little
finger. The ulnar nerve manages the muscles that allow you to make fine
movements with your fingers. It also controls some of the muscles of your
forearm that allow you to grip things tightly. Unlike most of your other nerves,
the ulnar nerve isn’t protected by muscle or bone throughout its course. In
some areas, it’s near the surface of your skin. This means that injuries to the
ulnar nerve aren’t uncommon. The ulnar nerve is what creates the shock-like
sensation when you hit the funny bone in your elbow.
You may lose sensation and have muscle weakness in your hand if
you damage your ulnar nerve. This is known as ulnar nerve palsy or ulnar
neuropathy. This condition can affect your ability to make fine movements and
perform many routine tasks. In severe cases, ulnar nerve palsy can cause muscle
wasting, or atrophy, that makes the hand look like a claw. Surgery is sometimes
necessary to correct this.
What Are the Symptoms of Ulnar Nerve Palsy?
Ulnar nerve palsy is typically a progressive condition, meaning
it gets worse over time.
The symptoms associated with ulnar nerve palsy include:
- a loss of sensation in your hand, especially in
your ring and little fingers
- a loss of coordination in your fingers
- a tingling or burning sensation in your hand
- hand weakness that may get worse with physical
- a loss of grip strength
The lack of strength in your hand can affect your daily activities,
such as gripping a glass and holding a pencil.
Over time, the lack of control and sensation can cause the
muscles in your hand to tighten, leading to a claw-like deformity. This usually
only occurs in severe cases of ulnar nerve palsy.
Ulnar nerve palsy can make it difficult to work with your hands,
so you may struggle to complete tasks that were once easy. Activities that put
strain on your hands and lower arms, such as golf or tennis, may make the pain
What Causes Ulnar Nerve Palsy?
The cause of ulnar nerve palsy isn’t always known. However,
damage to the ulnar nerve can occur due to:
- an illness that damages your nerve
- an injury to the nerve
- excess pressure on the nerve
- nerve pressure due to swelling
- an elbow fracture or dislocation
Damage to the ulnar nerve is like cutting a telephone cord. The
messages from your brain can’t be properly transmitted to their targets in your
hand and arm nor can they be received from the hand.
How Is Ulnar Nerve Palsy Diagnosed?
Your doctor will first examine you and ask you about your
symptoms. Make sure to tell your doctor if your symptoms began after an injury
to your hand. This can help your doctor determine potential causes of your
condition more easily.
During the exam, your doctor will evaluate how well you can move
your fingers and assess the condition of your hand.
In addition to a physical examination, testing can include:
- blood tests
- imaging tests, such as a CT or MRI scan
- nerve conduction tests
These tests help detect swelling and measure nerve function in
the ulnar nerve and can help to localize the area of the nerve that isn’t
functioning properly. A nerve conduction study can help determine the severity
of the dysfunction.
How Is Ulnar Nerve Palsy Treated?
Nerve tissues usually heal much more slowly than other types of tissues.
However, some ulnar nerve palsy symptoms may get better without treatment.
There are a number of possible treatments for ulnar nerve palsy,
- over-the-counter pain relievers
- medications to reduce nerve spasms, such as gabapentin,
- corticosteroids to reduce inflammation
- a splint to support the hand and reduce painful
- physical therapy to increase muscle strength and
- occupational therapy to minimize further injury
Your doctor may also recommend surgery if the nerve damage is
extensive, extremely painful, or not improving. Surgery is also often necessary
if you find it difficult to go about your daily life due to the nerve palsy.
One surgical procedure involves tendon transfer. During a tendon
transfer surgery, a functioning tendon is moved from its original bone attachment
to a new one. This can help restore muscle function, allowing you to perform routine
activities once again.
The results of surgery are generally good, but nerves heal
slowly, so a full restoration of wrist and hand function can take months. Even
after surgery, you may still have a loss of sensation and movement in your
How Is Ulnar Nerve Palsy Prevented?
Getting medical treatment as soon as you notice symptoms of ulnar
nerve palsy is vital to preventing more serious complications, such as a
permanent hand deformity. The most common cause is pressure on the nerve at the
elbow. If this is progressive, then moving the nerve from the back of the elbow
to the front takes pressure off the nerve and allows it to function normally.
Call your doctor right away if you’re experiencing tingling,
numbness, or pain in your fourth and fifth fingers. You may also want to meet
with an occupational therapist to determine whether your daily work habits are
placing excess pressure on your ulnar nerve.
To prevent further injury, you may need to wear a cast, splint,
or brace for support.