Ulnar Neuropathy

Ulnar Nerve
The nerve that transmits sensation from the 4th and 5th digits (the "ring finger" and "pinky finger" , and supplies the hand muscles that allow you to spread your fingers an tighten the  straightened fingers together.   The nerve is most commonly injured at the elbow, but can also be injured at the wrist, and rarely in the shoulder.
Ulnar Neuropathy at the elbow/ Cubital Tunnel Syndrome / Tardy Ulnar Palsy
The ulnar nerve is most often compressed at the elbow.  Most of us have experienced the sense of hitting our "funny bone" at the elbow and getting a "Zinging" sensation going down to the 4th and 5th fingers of the hand.  This is from transient compression of the ulnar nerve at the elbow.  Sometimes an injury to the elbow can be severe enough that scar tissue or arthritis occurs over time in this area that can compress the ulnar nerve at the elbow, causing a delayed (or "Tardy") ulnar palsy at the elbow.  Some people tend to compress the ulnar nerve habitually - particularly the left ulnar nerve when driving, and resting the right elbow on the driver's window sill while driving with the window open, or resting on an armrest

Risk Factors: Diabetes, Alcoholism, HIV, malnutrition (as the fatty protective pad over the nerve wastes away), trauma to the elbow, tumors, av fistula for dialysis, general anesthesia (due to risk of prolonged compression during anesthesia or transient occlusion of the brachial artery during surgery), males (presumably due less of a fat pad over the nerve at the elbow, and possibly due to occupational risks, and the bony area called tubercle of the coronoid process is larger in men), cigarette smoking, 

DIAGNOSIS:  Clinical History- Numbness and tingling in the 4th and 5th digit. Weakness in the fingers. 
Examination:  Numbness in the 4th and 5th digits, typically extending to the wrist, but not above the wrist.   Weakness in the spreading apart of the fingers.  Clawing of the 4th and 5th digits can develop.
NCV/EMG : Nerve conductions show slowing of conduction in the Ulnar nerve across the elbow, and EMG may show denervation of the ulnar innervated muscles of the hand.  NCV/EMG can also help to check if the ulnar nerve is pinched at the wrist (Guyon Canal), or at the shoulder (brachial plexopathy or thoracic outlet syndrome) which can sometimes imitate ulnar neuropathy at the elbow.  
Optional: Ultrasound or Magnetic resonance imaging if suggestion of a tumor or cyst in the area. Lab tests if suspicion for other metabolic factors (diabetes, etc)

Orthotic devises - Cushions to decrease compression of the nerve during sleep
Occupational or Physical Therapy- may provide exercises to increase muscles strength
Surgical decompression of the nerve or transposition of the nerve at the elbow may resolve the symptoms, but not always.  

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