Ulnar Neuropathies – the numb hand that is not carpal tunnel

Of the 3 nerves going to the forearm and hand that make the hand move, the ulnar nerve is arguably the most important as it provides all of the fine finger control, and much of the thumb movement. This nerve supplies the sensation to the 4th and 5th fingers, both the top and palm surface of the hand, and also the sensation of the hand just below the 5 finger.

The most common symptoms associated with a damaged ulnar nerve is numbness on the 5th finger side of the hand, aching in the hand, a feeling of coldness of the 4th and 5th fingers and possibly finger weakness. If the nerve damage is severe, the back of the hand will have a “hollowed out” appearance between the thumb and index finger because of muscle atrophy. Very severe ulnar nerve damage would cause the hand to look flat with the 4th and 5th fingers curled down.

The most common injury associated with the ulnar nerve is when the nerve is compressed as it travels around the elbow, either by direct pressure or prolonged positioning of the elbow joint at a 90 degree angle. Cellphone use is a common cause of ulnar nerve problems, as is sitting for long periods of time with the elbows on a hard surface.

Less commonly, the ulnar nerve can be compressed at the wrist, in which case the hand will be very weak but without the associated numbness that occurs with compression at the elbow.

Usually conservative treatment is the option of choice, but in cases of severe injury, a surgical consultation may be indicated. An electromyography (EMG) is a diagnostic for evaluating and recording the activation signal of muscles and is the preferred method of properly assessing an ulnar nerve injury, which can be facilitated by an EMG Board Certified neurologist.