An Ulnar nerve compression is caused either by a direct blow to the inside of the elbow, or from repetitive trauma. It causes numbness and tingling down the forearm and into the forth and fifth fingers. Sometimes it is referred to as ‘hitting your funny bone’.
- Pain on the inside/back of the elbow.
- Sensations of tingling or numbness in your ring finger, little finger and possibly along the inside of the forearm.
- Pain radiates to the outer two fingers of the hand, but not the other fingers.
- A sports injury professional might use a test which involves tapping over the inside of your forearm. If symptoms are reproduced then the tests is positive and Ulnar nerve contusion is confirmed.
What is Ulnar nerve compression?
The ulnar nerve starts in the neck and runs down the inside of the elbow and into the wrist and hand. It is part of the brachial plexus nerve system and is one the major nerves supplying the arm. It is called the ulnar nerve because it runs close to the ulna bone in the forearm. The ulna is on the little finger (pinky finger) side of the forearm with the radius bone alongside.
It provides sensation to the forearm and fourth and fifth fingers. It also innervates (stimulates) the flexor muscles of the hand, allowing it to bend and move.
What causes an Ulnar nerve compression?
If you knock the inside of the elbow you can get numbness or buzzing down the forearm into the fourth and fifth fingers. This is often referred to as ‘hitting your funny bone’. It is a result of the ulnar nerve being hit, sometimes known as an Ulnar nerve contusion. The nerve is compressed suddenly, therefore causing nerve compression and symptoms such as tingling and numbness when it happens.
Ulnar nerve compression may be caused by compression of the Ulnar nerve at the wrist. This tends to affect cyclists1 who lean on handlebars for very long periods of time. It is especially likely if they have a poor bike set up or do not adjust their riding position occasionally. This is also known as hypothenar hammer syndrome or ‘Handlebar palsy‘.
It is also known to affect Baseball players2. Repetitive trauma from catching fast moving baseballs.
Ulnar nerve compression may also be caused from becoming entrapped, compressed or damaged. This might be for several reasons, including:
- Traction injuries – common in throwers, especially if you throw with a very fast arm and your arm is not yet accustomed to the strain.
- Progressive compression – due to inflammation and adhesions caused by repetitive strain.
- Bony growths – in a part of the ulna bone called the ulnar groove.
Sometimes the symptoms of ulnar nerve entrapment might be similar to that of golfer’s elbow (medial epicondylitis).
Treatment for Ulnar nerve compression
Treatment will depend on the cause. For acute Ulnar nerve contusions, these usually pass after a few minutes. For gradual onset and long term nerve compression injuries then identifying the cause is important, alongside treating the immediate symptoms.
What can the athlete do?
- Rest your arm.
- Apply cold therapy. Cold reduces pain and inflammation.
- If you are a cyclist then consider having the way your bike is set up looked at by an experienced cycling coach. Make sure you adjust your position on the handlebars occasionally on long rides.
What can a doctor do?
- A doctor may prescribe anti-inflammatory medication. For example, Ibuprofen – but always check with a doctor before taking medication. If you have asthma you should not take Ibuprofen.
- In severe cases they may immobilize your arm for a short period.
- Use soft tissue therapy such as massage or myofascial release techniques. This is done in order to break down adhesions that may be restricting the nerve.
- Demonstrate neural stretching exercises.
- Operate in severe or persistent cases, where surgery is indicated.
References & further reading
- Capitani D, Beer S. Handlebar palsy—a compression syndrome of the deep terminal (motor) branch of the ulnar nerve in biking. J Neurol 2002;249(10):1441–5.
- Ginn TA, Smith AM, Snyder JR et al. Vascular changes of the hand in professional baseball players with emphasis on digital ischemia in catchers. J Bone Joint Surg Am 2005;87(7):1464–9.