What is it?
Most people are familiar with carpal tunnel syndrome, which can cause numbness and tingling in the hand. A similar condition, called Ulnar Tunnel Syndrome, can cause numbness and tingling that is confined to your little finger and the outside of your ring finger. The ulnar nerve is one of three major nerves that provide feeling and movement to the hand. It runs down the inside of your forearm to the heel of your hand. Then it branches out across the palm and into the little and ring fingers. Excessive pressure on this nerve can result in a loss of feeling and/or muscle weakness in the hand.
What are the symptoms?
You may or may not have pain in your hand, but you will probably experience weakness and increasing numbness, particularly on the little finger side of the hand. You may experience sensory (feeling) or motor (power) changes or both, depending on the location of the pressure point. Symptoms develop gradually and can lead to difficulties in opening jars, holding objects, or coordinating your fingers while typing or playing a musical instrument.
How is it diagnosed?
I will ask you questions about your symptoms and examine your hand. I may arrange a nerve conduction study to see if the nerve is working properly. A computed tomography scan or a magnetic resonance image (MRI) may be useful in identifying whether a cyst or other growth is putting pressure on the nerve. X-rays can show if you’ve fractured (broken) a bone that is now pressing on the nerve. The ulnar nerve also passes through a narrow tunnel at the elbow. Pressure at that point can cause similar symptoms in your hand, so I will examine that area as well.
What are nerve conduction studies?
A nerve conduction study is a test to measure the ability of a nerve to transmit messages (electrical impulses) to and from the brain. If a nerve is compressed it will not be able to transmit the impulse normally. As well as the ulnar nerve, other nerves are tested at the same time to be certain that the abnormality is in the ulnar nerve and that your symptoms are not the result of some other cause.
Treatment depends on what’s causing the pressure on the nerve. If pressure results from the way you rest your wrist when typing, a change in position or the addition of some padding may help. Your doctor may prescribe anti-inflammatory medications such as aspirin or ibuprofen to help alleviate your symptoms, and may recommend that you wear a wrist splint for a time. However, most cases of Ulnar Tunnel Syndrome are caused by a growth in the wrist and must be treated with surgery to remove the growth. An experienced hand surgeon can remove cysts, scar tissue, or other causes of compression on a day case surgery basis. Once the pressure point is removed, you’ll notice an improvement in sensation with a decrease in the numbness and tingling. However, it will take several months for the nerve to regrow and heal completely. I will make recommendations for postoperative rehabilitation and exercises.
What happens after surgery?
You will have a bandage around your wrist when you leave hospital. This will be removed at you first follow-up visit, normally between 10 and14 days later. It is important that you try to use your arm and hand for light activities even whilst the bandage is on.
What are the risks of surgery?
The risk of surgery is very small but includes bleeding, infection, stiffness, nerve injury and increased sensitivity of the skin. I will discuss these with you.
How successful is the surgery?
This depends on how severe the nerve is compressed. For mild compression, excellent results are achieved in close to 100 percent of patients. For severe compression, excellent results are achieved in less than 50 percent and the recurrence rate (chance of the symptoms reoccurring) is close to 70 percent.
Do I have to have an operation?
No. However, when the nerve is severely compressed or has been compressed for a long time, the chance of surgery being successful is reduced. Therefore, unless your symptoms are mild, I will normally recommend surgery to you to give your nerve the best chance of recovering its normal function. I will discuss this with you.