Overview

What is ulnar tunnel syndrome?

Ulnar tunnel syndrome is pain, tingling, or numbness in the hand caused by pressure on the nerve within the wrist. It isn t pleasant, but a variety of treatments and simple changes to the daily routine can alleviate the symptoms quickly.

The ulnar nerve originates near where your neck meets your shoulder. It then travels down the back of your elbow to the little finger side of your hand on the back of your wrist. It is one of three major nerves responsible for feeling and movement in your hand.

Ulnar tunnel syndrome is a carpal tunnel's less-practiced cousin. How the median nerve travels through the carpal tunnel in your hand, the ulnar nerve also passes through Guyon's canal at your wrist. You may even hear your physician refer to it as Guyon's canal syndrome.

What are the symptoms of ulnar tunnel syndrome?

When this nerve is compressed on one side, you feel that something's going on in your hand on the pinky and ringside. Common symptoms include:

• A tingling sensation as if your fingers are going to sleep
• Numbness in your hand when you wake up
• Weakness in your grip
• Difficulty with activities that require coordination, such as typing
• Pain in your wrist, which worsens as the condition progresses

What causes ulnar tunnel syndrome?

The most common cause of ulnar tunnel syndrome is a soft tissue tumor that presses against the nerve. Most often this is a benign or noncancerous cyst called a ganglion, which arises from the wrist joint. Ganglion cysts are filled with a thick jelly and can fluctuate in size.

Some people's body anatomy predisposes them to ulnar tunnel syndrome. On its journey out of the wrist and into the hand, the ulnar nerve becomes compressed within this small canal known as Guyon's canal.

Another type of transference of trauma or chronic pressure applied to that part of the hand at the site where the ulnar nerve enters from the wrist causes ulnar tunnel syndrome, too. In particular, it is the area at the palmar surface near the part where the wrist meets the hand at the little finger side.

• A common example of causing repeated trauma is the use of a jackhammer or other types of power tools.
• A common example of chronic stress is cycling many miles with the body weight bearing through the palm on a handlebar.

Patients who have been exposed to repeated and chronic trauma to the palm can also develop problems with blood flow to their hand and form a condition known as hypothenar hammer syndrome. Here again, impaired circulation of blood to the fingers for example, blue or white fingers-can co-exist with the paresthesias and numbness.

How do healthcare providers diagnose ulnar tunnel syndrome?

Your doctor will examine your hand, looking for common signs of ulnar tunnel syndrome.

• They'll look for that you have reduced sensation in the little and ring fingers, and may instruct you to try to distinguish the difference when they touch your fingertips with two small points versus one small point. This sense can be decreased in patients with ulnar tunnel syndrome.
• They will observe for the presence of evidence that would indicate wasting of the muscles in your hand, such as a loss in size or atrophy, and weakness.
• Sometimes, muscle weakness can even be appreciated by observing patients' failure to withdraw their small finger inwards in an attempt to touch their ring finger (Wartenberg's sign).
• Weakness can also present by an inability to pinch a paper between the thumb and the index finger without flexion of the last joint on each digit (Froment's sign).
• They may press down over the ulnar nerve at your wrist to see whether this aggravates your numbness and tingling.
• They may tap their finger over the ulnar nerve at the wrist to see whether this elicits a tingling sensation (Tinel sign). This is an indicator of nerve compression.
• The ulnar nerve also passes through a narrow tunnel near the elbow, so your doctor might also examine that site. Compression of the ulnar nerve near the elbow can also cause symptoms in the hand.

What tests are done to diagnose ulnar tunnel syndrome?

• A nerve conduction study/electromyography may be conducted to see whether the nerve is functioning properly.
• A CT scan, MRI scan, or US can help determine if a mass is compressing on the nerve, such as a cyst.
• X-rays could be utilized to check whether a part of the broken bone has bent against the nerve.

What are treatments for ulnar tunnel syndrome?

Nonsurgical Treatment

Nonsurgical intervention would depend on the cause of the pressure. Maybe the method in which a person types with their wrists puts pressure on the nerve, and a change in the positioning or some added padding would be a cure. For the jackhammer operator it would be something like eliminating the repetitive trauma by changing their technique, using padding, or changing careers. Alternate hand position on the handlebars, changing frequently, may help alleviate chronic pressure on the nerves; or protective padding between the wrist and handlebar can be used.

NSAIDs, such as naproxen or ibuprofen, have helped alleviate symptoms in many cases of ulnar tunnel syndrome; short-term use of a wrist splint also is helpful.

Surgery

Many cases of ulnar tunnel syndrome are caused by a growth at the wrist or a narrow ulnar tunnel through which the nerve runs from the wrist into the hand. In such cases, surgical intervention is necessary to excise the growth or enlarge the tunnel.

The experienced hand surgeon can remove cysts, scar tissue, and other causes of compression on an outpatient basis and open up the ulnar tunnel so that normal blood flow to the nerve may be reestablished and consequently the nerve's function may be recovered.

What are the complications of ulnar tunnel syndrome surgery?

Complications from surgery are rare but could include infections, healing problems of the wound, or damage to the surrounding tissue like nerves, vessels, and tendons. These risks and benefits should be discussed with your physician before deciding to undergo the surgery.

What are the outlooks for ulnar tunnel syndrome?

Ulnar tunnel syndrome provokes certain sensations in the hand and fingers, such as pain, weakness, or numbness; if not treated, the symptoms will get worse, and in extreme situations, a person won't be able to grip with his hand.

The specific treatment applied depends upon the cause of ulnar tunnel syndrome. Treatment is important because if left untreated, permanent damage could be caused, such as paralysis or loss of feeling in areas of the arm or even parts of the hand.

A cyst or growth in the wrist area commonly causes ulnar tunnel syndrome. This condition can often be easily corrected with surgery.

If this is so, then it may be due to irritation of the nerves by repetitive movement. In such a instances, the disease can be cured even through nonsurgical measures. Examples include a wrist brace and ulnar nerve exercises.

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