Ulnar groove syndrome or sulcus ulnaris syndrome refers to pressure damage to the ulnar nerve. The nerve runs relatively exposed at the elbow in a narrow groove, the ulnar groove – also known as the funny bone – and can be damaged by constant incorrect stress or other irritations. Symptomatically, ulnar groove syndrome manifests as tingling on the little finger, the inside of the ring finger, and the corresponding parts of the back of the hand.
What is ulnar groove syndrome?
Schematic diagram showing the anatomy of the elbow in sulcus ulnaris syndrome. Click to enlarge. The ulnar nerve runs along the elbow in a narrow groove in the ulnar bone just under the skin and is poorly protected from pressure or traction injuries by surrounding connective tissue. It supplies nerves to the little finger, the inside of the ring finger and the corresponding part of the palm up to the wrist. Damage to the nerve has a direct effect on the above-mentioned regions of the hand and ranges from slight tingling or burning sensations to numbness, loss of strength or even restricted movement and claw-like positions of the little finger and ring finger. Short pressures on the ulnar nerve, such as those caused by unintentionally bumping the elbow against a hard object, cause the typical pain at the “funny bone,” which usually subsides after several seconds.
Causes
There are several causes that can trigger ulnar groove syndrome. In people with normal mobility and dexterity, the nerve can be damaged by repetitive misuse of the forearm (golfer’s elbow) or by leaning on the elbow, which is repetitive. In professional drivers, the habit of frequently resting the left elbow on the window frame of the door or on an existing protrusion of the door while driving can gradually cause damage to the ulnar nerve and trigger the typical symptoms. In immobile bedridden individuals, repeated incorrect positioning that constantly applies pressure to the ulnar groove area leads to a lesion of the ulnar nerve and can thereby cause ulnar groove syndrome. Injuries to the forearm tissue in the area where the ulnar nerve runs can also obstruct and damage the nerve by constant traction or pressure if there is severe scarring and formation of tissue induration, resulting in the typical symptoms.
Symptoms, complaints and signs
Ulinaris groove syndrome causes sensory disturbances and pain in the hand. If treatment is rejected, one can only move the hand in everyday life to a limited extent. A distinction must be made between initial symptoms and signs that appear after some time and are permanent in nature. Affected persons usually describe a tingling sensation in the ring and little finger in the initial stage. The impression arises that a colony of ants is running over the corresponding areas. Other patients report that both fingers are numb. The unusual sensation sometimes extends to the inside of the elbow. A stress situation – for example, by lifting heavy objects – not infrequently favors the symptoms mentioned. These disappear after a few seconds or minutes on their own. In the further course, the Ulinaris groove syndrome occurs permanently. The gripping side of the hand feels constantly numb in everyday situations. Some patients also interpret the signs as a burning sensation. Motor skills are limited as a result. The so-called claw hand is characteristic. The ring and little fingers are permanently in a flexed position. Spreading the fingers is only possible with pain. If no treatment is taken up, muscle atrophy (muscular dystrophy) sets in due to the avoidance of painful movements. Persistent motor weakness then makes everyday life difficult.
Diagnosis and progression
An initial diagnosis of the presence of ulnar groove syndrome can be made based on the symptoms of tingling, burning, or numbness that occur in the little finger and ring finger. With verification of the so-called Froment sign (paper strip test), the diagnosis of damage or complete paralysis of the ulnar nerve can be confirmed or refuted with a simple exercise.If the suspicion of damage to or total loss of the ulnar nerve is confirmed, a differential diagnosis must be made to determine whether the nerve is already damaged from the ulnar groove or only from the wrist (Loge-de-Guyon syndrome). Further electrophysiological diagnostic procedures allow conclusions to be drawn about the conductivity of the ulnar nerve and the transmission speed of impulses. If the causes for triggering the ulnar nerve syndrome are not eliminated, in the further course of the disease, in addition to numbness, motor weakness occurs and gradual muscle atrophy sets in. Limited mobility of the hand up to the typical claw hand are then the consequences.
Complications
Ulnar groove syndrome leads to a number of different complaints, all of which have a negative impact on the patient’s daily life and quality of life. Most affected individuals suffer from various sensory disturbances in the area of the little finger. This feels numb and can tingle or hurt. These sensory disturbances often spread to the neighboring regions and can also lead to complaints in the other fingers or at the wrist. The position of the little finger is claw-like, so that there are considerable restrictions in the daily life of the affected person. The muscles are also significantly weakened in this case, so that discomfort can occur during work due to ulnar groove syndrome. The entire mobility of the hand is restricted due to the disease. In most cases, ulnar groove syndrome can be treated. Complications usually only occur if the condition is not treated. Recovery takes place by immobilizing the finger or arm. Although the affected person must take care of the finger, there are no permanent limitations. The patient’s life expectancy is also not negatively affected by ulnar groove syndrome.
When should you see a doctor?
In ulnar groove syndrome, the affected person is dependent on treatment by a physician. Only proper treatment and, above all, a quick and early diagnosis can prevent further complications or a further worsening of the symptoms. Therefore, a doctor should be contacted at the first symptoms and signs of ulnar groove syndrome in order to treat the condition properly. A doctor should be consulted if the affected person suffers from severe disturbances in sensitivity. In most cases, the hands can hardly be moved, which can have a very negative effect on the patient’s daily life. Furthermore, a permanent tingling sensation in the affected regions can also indicate ulnar groove syndrome and should also be examined by a doctor if it occurs over a longer period of time and does not disappear again on its own. Lifting heavy objects can also cause these symptoms and indicate the disease. Usually, ulnar groove syndrome can be detected by a general practitioner or by an orthopedic surgeon. Further treatment depends on the exact symptoms and how severe they are. As a rule, the patient’s life expectancy is not reduced by this disease.
Treatment and therapy
When diagnosing ulnar groove syndrome, in simple cases it is enough to stop the causative circumstances. Bad postures can be corrected or certain habits of constantly supporting the elbow in certain ways can be changed. After stopping the causative factors and applying conservative treatment methods such as relief by elevating and cooling the inside of the elbow, it may become necessary to immobilize the affected elbow for a certain period of time. It may even be necessary to temporarily immobilize the arm using a cast to allow regeneration of the ulnar nerve. In chronic and advanced cases, where conservative therapy has not brought the desired success, a conventional and a minimally invasive surgical procedure are available. In the conventional surgical method, the nerve is exposed in the area of the ulnar groove and interfering tissue is removed to relieve pressure. In individual cases, it may be necessary to relocate the ulnar nerve. A modern and gentler alternative to open surgery is the endoscopic minimally invasive method.Through a small incision, the endoscope and cutting tool are placed on the ulnar nerve and disturbing tissue that has triggered the lesion of the nerve can be removed. The minimally invasive method can cover an area from mid-humerus to mid-forearm.
Prevention
Ulnar groove syndrome is usually triggered by mechanical stimuli rather than physiologic or nutritional processes. Therefore, the most important preventive measure is to avoid incorrect stresses and/or (bad) habits that may lead to ulnar nerve lesion in the longer term. The first signs of ulnar nerve impairment, indicated by tingling or burning sensations in the little finger or ring finger, for example, should be taken seriously, and any causes should be analyzed and then remedied.
Follow-up
Follow-up care is required when ulnar groove syndrome is treated by surgery. Sometimes, a slight burning sensation may appear at the wound after surgery. In such cases, the physician administers analgesic and decongestant medications. As a rule, the painful discomfort disappears after a few days. Likewise, the sensitivity on the fingers returns after a few weeks at the latest. To accelerate wound healing and counteract swelling of the limb, it is important to immobilize and rest the arm. However, complete immobilization with a cast is only necessary after open surgery. If, on the other hand, a minimally invasive procedure is performed using an endoscope, the patient receives a pressure bandage and is allowed to move the elbow gently. After about ten to fourteen days, the stitches or staples on the skin of the operated arm are removed again by the doctor if the wound has healed well. After only one to three days, the small drainage tube, which is used to drain blood and wound fluid, is also removed. In the case of an outpatient operation, the doctor gives the patient precise instructions on how to behave before he is discharged. He also informs him when the first control examination must be performed. Normally, the operating physician carries out the follow-up treatment himself.
You can do this yourself
Ulnar groove syndrome is treated by means of splinting or padding of the elbow region. Supportively, the movement behavior must be changed. For example, support of the bent elbow should be avoided. The physiotherapist or sports physician can name measures with which the patient can adapt the movement patterns. The exercises should be performed regularly so that ulnar groove syndrome does not develop into a chronic condition. In cases of severe pain or nerve interference, surgical decompression of the ulnar nerve is necessary. After surgery, the surgical wound must be carefully monitored, as bleeding and other discomfort may occur due to repeated bending movements of the elbow. A splint is usually applied, which must be adjusted regularly. Individuals diagnosed with ulnar groove syndrome must initially refrain from any athletic activity that involves the affected arm or elbow. Alternatives include physical therapy and physiotherapy. Massages, cool or warm compresses and soothing baths support the healing process. Which self-help measures are useful and necessary in detail always depends on the severity of the condition. Patients are best advised to contact the responsible physician, who can name suitable measures based on the symptom picture.
