Ulnar neuropathy

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Ulnar neuropathy is damage to the ulnar nerve causing numbness and weakness of the hand.

The ulnar nerve is a nerve in the arm responsible for sensation and movement in the hand. It is formed from multiple nerve roots arising from the upper spinal cord (a structure known as the brachial plexus). It travels down the arm, and is able to be felt at the elbow, where it lies just under the skin. It then continues down the forearm and into the hand.

It is most susceptible to damage at the elbow, where it can easily be compressed. When this happens, the patient will experience tingling or numbness over the 4th and 5th fingers and this side of the hand. The grip may become weak, and the patient may have difficulty using the hand.

Who to refer, who not to refer, how to refer

Causes:
Compression – This can occur simply by leaning on the elbows habitually. With repeated activity such as
golf or tennis, the nerve may become entrapped by surrounding structures
Trauma – A simple blow to the elbow may cause very short lived ulnar nerve symptoms (this is why the elbow is called ‘the funny bone’.) More severe trauma, especially when there is a fracture near the elbow, may damage the nerve.
Neuropathy – Rarely, other medical problems may cause Ulnar neuropathy. In this case, there are often other nerves affected.

Investigations:
Usually none are needed. If there has been a significant injury to the elbow, then an xray may be needed to exclude a fracture or dislocation. If other nerves are affected (there is numbness, tingling or weakness outside the ulnar nerve area) then some blood tests or scans may be required.

Treatment:
Treatment of ulnar neuropathy is aimed at the underlying cause. This usually means avoiding the activity which has caused the problem and improving positioning of the hands and elbows at work/home. Occasionally, surgery may be required. The prognosis of most ulnar neuropathies is good – the symptoms often resolve over weeks to months. If the nerve has been severely damaged by trauma, or the hand has been weak for a long time, the prognosis is less certain.

 

Referrals should be completed via SCI Gateway

Primary care management

Treatment of ulnar neuropathy is aimed at the underlying cause. This usually means avoiding the activity
which has caused the problem and improving positioning of the hands and elbows at work/home. Occasionally, surgery may be required. The prognosis of most ulnar neuropathies is good – the symptoms often resolve over weeks to months. If the nerve has been severely damaged by trauma, or the hand has been weak for a long time, the prognosis is less certain.

Editorial Information

Last reviewed: 13/03/2025

Next review date: 13/03/2027

Author(s): Dr David Simpson.

Author email(s): David.simpson@borders.scot.nhs.uk.