What is it?

Irritation and inflammation of the nerve (“neuritis”) on the inside portion of the elbow (the ulnar nerve) can lead to elbow pain, and numbness, tingling, and weakness of the involved hand. If diagnosed early, the treatment is usually straightforward. However, if the condition is diagnosed very late, then surgery may be required.

Causes

When the elbow is bent, the ulnar nerve is pulled over the bony portion of the elbow known as the medial epicondyle, sometimes called the “funny bone”. Keeping the elbow bent or leaning on it for long periods of time, as well as repetitively bending the elbow, can cause irritation of the nerve. Also, in some people, the nerve slides in and out behind the bone leading to irritation.

Risk Factors

• Prolonged or repetitive activities that cause the elbow to be bent
• Swelling of the elbow joint
• Arthritis of the elbow
• Previous fractures or dislocations of the elbow

Symptoms

• Numbness or tingling in the little and ring finger
• Pain on the inside of the elbow
• Grip weakness or difficulty with small movements such as typing

Diagnosis

A sports medicine physician will ask an athlete questions about their symptoms and sports activities. A careful physical exam will be performed, usually of the neck, shoulder, elbow, and hand. Tapping the area over the “funny bone” may cause electric-like shocks or feeling in the fingers if the nerve is irritated. X-rays may be taken to help exclude other causes for the patient’s symptoms. Sometimes, a nerve conduction test may be used to help make the diagnosis.

Treatment

• Anti-inflammatory medications will often be prescribed to help reduce swelling around the nerve.
• A brace may be used at night to help keep the arm in a straight position.
• Exercises may be given to help the nerve slide normally in the groove.
• If the above treatments do not work or if the nerve is compressed, the doctor may recommend surgical treatment.

Prevention

• Activities that lead to repetitive bending at the elbow, or activities that cause the elbow to be bent for long periods of time, should be avoided.
• The elbow should not be rested in a bent position for long periods, like when using a computer or driving a car, with the arm resting on the open window.
• If symptoms are mild, a towel loosely wrapped around the elbow at night can help keep the elbow from bending.

Return to Play

• After a 2-3 week pain-free period, athletes may begin to gradually return to their activities.

AMSSM Member Authors
Dustin W. Lash, DO and Tracy Ray, MD

References
Harris JD, Lintner DM. Nerve injuries about the elbow in the athlete. Sports Med Arthrosc. 2014 Sep;22(3):e7-15
Patel RM, Lynch TS, Amin NH, Calabrese G, Gryzlo SM, Schickendantz MS. The thrower’s elbow. Orthop Clin North Am. 2014 Jul;45(3):355-76