Nerve Injuries around the Elbow

There are three major nerves of the arm that cross the elbow joint on their way to the hand and fingers. These nerves are the ulnar, median and radial nerve. As these nerves run past the elbow, they may be at risk for injury from compression, blunt injury, or associated fractures.

What is the most common nerve injury around the elbow?

The ulnar nerve is the most commonly injured nerve around the elbow. This nerve wraps around the back and inside of the elbow as it travels down the forearm to innervate the small muscles of the hand, as well as sensation to the ring finger and small finger. As a result of wrapping around the back of the elbow, this nerve can be at risk for compression and chronic stretching (neuropathy). When this occurs, it is referred to as “cubital tunnel syndrome.” Most patients complain of numbness and pain in the small and ring finger, difficulty sleeping, and sensitivity along the inside of the elbow. These patients will require a nerve conduction study, called and EMG, to evaluate the nerve and assess the degree to which the nerve is injured.

How is ulnar nerve compression (cubital tunnel syndrome) treated?

The goal of cubital tunnel treatment is to relieve compression on the nerve. Initially, this can be done by bracing the elbow at night to prevent bending the elbow while asleep which stretches the nerve. Patients can also use modalities such as ice, rest, anti-inflammatory medications or pain creams to diminish swelling and inflammation around the nerve. For patients whose symptoms do not improve with bracing and modalities, surgical intervention may be necessary. This surgery consists of finding the ulnar nerve around the inside of the elbow and moving it to the front of the elbow. This is called an “ulnar nerve transposition,” and acts to remove the stretch on the nerve when the elbow bends. Sometimes the nerve is put directly under the skin (subcutaneous transposition), and other times the nerve can be placed under the muscle in the forearm to provide added protection (sub muscular transposition).

What other nerve injuries are encountered around the elbow?

Although the ulnar nerve accounts for the majority of nerve injuries around the elbow, the radial nerve and median nerve can also be injured. Injury to the radial nerve can result in pain along the upper forearm (radial tunnel syndrome) or even weakness to the muscles that straighten the wrist and fingers (PIN palsy). The median is the least commonly injured nerve around the elbow, but can be injured with specific fractures (distal humerus) or during certain surgeries.