One of the largest joints in your body is the elbow. The elbow contributes to the arm’s adaptability mobility, and durability along with the wrist and shoulder joint. The elbow joint, a synovial junction between the arm and the forearm, is located in the upper limb. Three bones—the humerus of the arm, the radius, and the ulna of the forearm—all come into contact at the elbow (Dwyer, 2009).

The elbow is one of the most active parts of the human body. We utilise the elbow for typing, writing, cooking, and more. It is a key component of the arm since it allows us to straighten and rotate our arm and forearm. Elbow pain can significantly interfere with daily activities, affecting our daily chores or work. Elbow nerve pain treatment is available in Singapore. This is a comprehensive guide to elbow pain causes and treatment which aims to educate people about the elbow as an essential component of the musculoskeletal system.

Introduction to Elbow Nerve Pain

The elbow is stabilised by ligaments on the inside and outside of the joint. It is surrounded by muscles and tendons that support wrist and elbow movements. Blood arteries and nerves that supply the forearm and wrist also flow around the joint. There are three important nerves that cross the elbow joint. The median nerve, radial nerve, and ulnar nerve work to supply sensation and control the muscles in the hand and forearm. The ulnar nerve is superficially located in the elbow in an anatomical structure known as the cubital tunnel. Among the three nerves, the ulnar nerve is most vulnerable to injury because it is near the top of the hard elbow.

Elbow nerve pain may refer to cubital tunnel syndrome. Cubital tunnel syndrome is a condition in which the ulna nerve which is a superficial nerve located on the inner part of the elbow is impinged.

It happens when the ulnar nerve becomes inflamed, swollen, or irritated because of stress or injury. It is a major nerve that extends in your arm and into your hand. It enables us perform functions such as squeezing and grasping objects. People may experience motor and sensory loss if the ulnar nerve is damaged (Johns Hopkins Medicine, 2021).

(image source: anatomytool.org)

Causes of Elbow Nerve Pain

The exact cause of elbow nerve pain is unknown. The ulnar nerve is particularly susceptible to compression because there is not enough soft tissue to protect it. There are several actions that can cause pressure on elbow nerves:

1. Bending your elbow frequently
2. Bending your elbow for extended periods of time
3. Sleeping with elbows bent
4. Nerve sliding in and out from behind the medical epicondyle
5. Leaning on your elbow too much
6. Fluids building up on the elbow
7. A direct blow to the elbow

Signs and Symptoms of Elbow Nerve Pain

People experience varying degrees of ulnar nerve entrapment symptoms. When you engage in activities that stretch or put pressure on your elbow or wrist, your symptoms may worsen. Symptoms include pain over the inside of the elbow and pain radiating down the forearm to the fingers. It is usually present with numbness on the little and ring fingers on the palmar side.

1. Numbness and tingling in the little and ring fingers
2. Curved little and ring fingers
3. An aching pain in the elbow or hand
4. The sensation of your little and ring fingers “falling asleep”
5. Difficulties in manipulating objects or move fingers
6. Weakness and difficulties doing hand-related tasks
7. Muscle loss in the little and ring fingers
8. Medial sided elbow pain radiating to forearm
9. Numbness over the ulna border of wrist

Elbow nerve pan may also be related to compression of the nerve elsewhere such as the Guyon’s canal in the wrist and the cervical nerve roots (OrthoInfo, 2020). Remember, every person has a different reaction to elbow nerve pain. Some of these symptoms may be related to an entirely different ailment. It is best to consult with your orthopaedic surgeon to diagnose your condition.

(image source: commons.wikimedia.org)

Risk Factors That Contribute to Elbow Nerve Pain

A risk factor is a characteristic linked to a higher risk of illness or infection. There are some pre-disposing conditions that increases the likelihood of developing cubital tunnel syndrome.

1. Pre-disposing conditions such as an elbow deformity (cubitus varus or valgus)
2. Prior elbow fractures or dislocations
3. Arthritis of the elbow (bone spurs)
4. Swollen elbow joint
5. Cysts near the elbow joint
6. Hypermobile ulna nerve which dislocates with elbow movements

(image source: commons.wikimedia.org)

Ulnar nerve entrapment commonly occurs in men who perform jobs, activities, and hobbies that require the use of the elbow. These movements expose patients to extrinsic compression of the nerve near the point of the elbow. Activities like weightlifting, biking, golfing, and tennis put too much pressure on the elbow. Factory workers, construction workers, typists, and other workers who use tools and machines are also prone to experiencing elbow nerve pain (OrthoInfo, 2020).

Methods to Diagnose Elbow Nerve Pain

Before anything else, your orthopaedic surgeon will ask you about your symptoms and specific functional needs during a medical interview. To provide an initial diagnosis, the doctor will then perform a physical examination on the elbow and nearby areas. The doctor may also request certain orthopaedic imaging based on the findings of the initial clinical evaluation.

1. Imaging modalities – Orthopaedic imaging includes x-rays, CT scans, MRIs, bone scans, and ultrasounds. Radiology techniques are used to assess the presence of any structural damage of the body.
2. Nerve conduction studies – This test measures the speed at which electrical signals pass through a nerve. A recording electrode will be put on your skin. After that, your nerve will be stimulated by a light electrical shock delivered by the stimulating electrode.
3. Electromyography – This test measures muscle response. One or several thin needles will be inserted into the muscle. The muscle activity is recorded while the patient contracts their muscles.

During your physical exam, your orthopaedic surgeon may run several tests to assess your symptoms. These can range from imaging tests or physical tests that will aid your doctor in determining the strength of your fingers and hands (OrthoInfo, 2020).

Surgical and Non-Surgical Treatments for Elbow Nerve Pain

Your orthopaedic surgeon may ask about your general health, medical history, and past treatments. They will ask about your activities in work, school, chores, hobbies, and other pertinent information about your daily lifestyle. Your doctor may suggest a variety of treatments depending on the underlying cause of your pain (OrthoInfo, 2020). These treatments may include:

• Surgical Treatments – Yourdoctor may advise you to undergo surgery if non-interventional treatments do not work. If your ulnar nerve is severely compressed, it may have caused muscle weakness or damage. Surgery will be an option for severe cases with muscle loss. Some invasive open surgery techniques include:

1. Anterior transposition of ulna nerve – This method involves moving the ulnar nerve to a different position in the elbow.
2. Cubital tunnel release – The surgeon will cut and divide the ligament roof of the cubital tunnel to alleviate pressure on the nerve.

• Non-Surgical Treatments –In mild cases, doctors prescribe non-surgical treatments such as medications and physiotherapy. Your treatment plan may include a combination of several methods.

1. Medications – Common medications for elbow nerve pain are ibuprofen, aspirin, naproxen, and diclofenac. Your doctor may also prescribe nerve modulators (pregabalin and gabapentin) and nerve supplements (B-complex, Vitamin E, and Alpha lipoic acid).
2. Injections of steroid and local anaesthetic – In cases of ulnar nerve entrapment, injections may be used as a minimally-invasive treatment. Although this method can be effective, there is a risk of nerve damage at the site.
3. Physiotherapy – Physiotherapy sessions may be needed to improve the elbow’s motion, strength, and durability. This may include exercise, stretching, thermal packs, and activity moderation.
4. Massage techniques – This type of technique is performed by skin rolling, soft tissue massage, nerve stretching, and joint mobilisation. The frequency of massages will depend on the condition of the patient.
5. Bracing or splinting – In order to keep your elbow in a straight position at night, your doctor could advise wearing a cushioned brace or splint. This device is used to immobilise a specific joint or body part to facilitate quicker healing.

Prevention Strategies to Reduce the Risk of Developing Elbow Nerve Injury

People of all ages can develop elbow nerve injuries, particularly older individuals who have stiffer joints. The elbow enables us to perform everyday activities including eating meals, walking the dog, and carrying groceries. There are certain general precautions that you can follow, regardless of your work, tasks, and hobbies to protect your elbows (Hecht, 2018).

1. Go for a consultation – If you are experiencing discomfort or pain in the elbow area, a trained orthopaedic surgeon can diagnose your condition.
2. Protect your joints – Pad elbow when doing office work the requires pressure over the nerve.
3. Identify old injuries – Take note of old elbow injuries sustained in childhood as this might predispose to nerve injury.
4. Warm up and stretching – Warm up your muscles before playing or exercising and do stretching before and after these activities.
5. Take breaks and prevent elbow overuse – Take break from your continuous regular routine and try to divide a one-hour task into two 30-minute sessions.

Lifestyle Changes to Manage Elbow Pain

Your treatment plan will be based on the symptoms you’re experiencing and the underlying medical condition. However, your orthopaedic surgeon will most likely recommend strategies to modify your posture when working with the affected arm. Simple lifestyle changes may include avoiding extrinsic pressure to the elbow especially over the point of the elbow. Since the ulnar nerve is prone to compression, you can avoid resting your elbow on hard surfaces and on car doors while driving or riding in a vehicle.

Rehabilitation Techniques to Help Gain Strength with Post-Injury Recovery

Recovery after musculoskeletal surgery can be aided by participating in an orthopaedic rehabilitation programme under the watchful eye of a medical professional. Rehabilitation techniques can help alleviate discomfort and get you back on your daily routine. Potential methods may include:

1. Physical Therapy comes in the form of strength training, stretching, massage, heat and cold therapy, electrical stimulation, and a home exercise plan. These methods can help you recover and gain mobility.
2. Occupational therapy aims to simplify your lifestyle and tasks for work or chores. You may also be recommended to use splints, canes, and other assistive devices.
3. Sports rehabilitation includes sports physical therapy, which specialises in the treatment of injuries and conditions brought on by physical activity.

Final Words

If you’re experiencing pain and discomfort in your elbow, seeing a doctor is your best bet for getting proper treatment and making lifestyle changes. The first step is determining the source of elbow pain, which your doctor can discover through imaging techniques and nerve examinations. Whether you need surgery, medicine, injections, or physical therapy, your orthopaedic surgeon can provide you a personalised treatment plan for your specific needs. Pain management can help you regain mobility and maintain productivity. Modifying your workspace, doing exercises, and making other lifestyle adjustments can also prevent future complications. Seeking medical attention is key to maintaining long-term health benefits.

Frequently Asked Questions

Dr Yong Ren profile

Dr Yong Ren graduated from the National University of Singapore’s Medical faculty and embarked on his orthopaedic career soon after. Upon completion of his training locally, he served briefly as an orthopaedic trauma surgeon in Khoo Teck Puat hospital before embarking on sub-specialty training in Switzerland at the famed Inselspital in Bern.

He underwent sub-specialty training in pelvic and spinal surgery, and upon his return to Singapore served as head of the orthopaedic trauma team till 2019. He continues to serve as Visiting Consultant to Khoo Teck Puat Hospital.

Well versed in a variety of orthopaedic surgeries, he also served as a member of the country council for the local branch of the Arbeitsgemeinschaft für Osteosynthesefragen (Trauma) in Singapore. He was also involved in the training of many of the young doctors in Singapore and was appointed as an Assistant Professor by the Yong Loo Lin School of Medicine. Prior to his entry into the private sector, he also served as core faculty for orthopaedic resident training by the National Healthcare Group.

Dr Yong Ren brings to the table his years of experience as a teacher and trainer in orthopaedic surgery. With his expertise in minimally invasive fracture surgery, pelvic reconstructive surgery, hip and knee surgery as well as spinal surgery, he is uniquely equipped with the tools and expertise necessary to help you on your road to recovery.

References

Dwyer, T. (2009). The Bone School. Retrieved from http://www.boneschool.com/

Hecht, M. (2018). Ulnar Nerve Entrapment. Retrieved from
https://www.healthline.com/health/lunar-nerve-entrapment#nonsurgical-treatment

Johns Hopkins Medicine. (2021). Cubital Tunnel Syndrome. Retrieved from
https://www.hopkinsmedicine.org/health/conditions-and-diseases/cubital-tunnel-syndrome

Lloyd, W. (2020). Orthopedic Rehabilitation. Retrieved from
https://www.healthgrades.com/right-care/bones-joints-and-muscles/orthopedic-rehabilitation

OrthoInfo. (2020). Ulnar Nerve Entrapment at the Elbow (Cubital Tunnel Syndrome). Retrieved
from https://orthoinfo.aaos.org/en/diseases–conditions/ulnar-nerve-entrapment-at-the-elbow-cubital-tunnel-syndrome/