Medicines for Ulnar nerve entrapment

What it is

Ulnar nerve entrapment is compression or irritation of the ulnar nerve — one of the main nerves of the arm, which supplies feeling to the little finger and half of the ring finger, and controls many of the small muscles of the hand. The nerve is most commonly compressed at the elbow, where it passes through a narrow channel behind the inner elbow (the "funny bone" area) — a condition called cubital tunnel syndrome; less commonly it is compressed at the wrist. Symptoms include tingling, pins and needles, or numbness in the little and ring fingers (often worse when the elbow is bent for long periods, such as during sleep or when holding a phone), and, if the compression is more significant or prolonged, weakness of the hand, clumsiness, difficulty with grip and fine movements, and, in advanced cases, wasting of the small hand muscles. It can result from prolonged or repeated bending of the elbow, leaning on the elbow, previous injury, or anatomical factors, and sometimes no clear cause is found. Many cases are mild and improve with simple measures, but because ongoing compression can cause lasting nerve and muscle problems, it is worth assessing, particularly if there is weakness.

How it is treated

Management depends on the severity, and many mild cases improve with conservative measures. These focus on reducing pressure and stretch on the nerve at the elbow: avoiding prolonged or repeated elbow bending and leaning on the elbow, using an elbow splint or pad (particularly at night, to keep the elbow straighter during sleep), and adjusting activities and posture; a physiotherapist can advise on this and on nerve-gliding exercises. Symptoms are monitored, and nerve tests (nerve conduction studies) may be done to confirm the diagnosis, locate the compression, and assess its severity, particularly if surgery is being considered. Where symptoms are more severe, persistent despite conservative measures, or there is weakness or muscle wasting (indicating more significant nerve involvement), surgery to relieve the pressure on the nerve at the elbow is considered, which can prevent progression and improve symptoms; the outcome is generally better when done before significant muscle wasting develops, which is a reason not to ignore worsening symptoms. The reassuring message is that ulnar nerve entrapment often improves with simple measures to reduce pressure on the nerve, and that surgery is effective for more significant cases, especially when not left too long.