DIAGNOSIS:

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Numbness or tingling of the little and ring fingers are usually the earliest symptom. It is frequently intermittent, but may later become constant. Often the symptoms can be provoked by leaning on the elbow or holding the elbow in a bent position (e.g. on the telephone). Sleeping with the elbow habitually bent can also aggravate the symptoms.

In the later stages, the numbness is constant and the hand becomes weak. There may be visible loss of muscle bulk in severe cases, particularly noticeable on the back of the hand between the thumb and first finger.

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The diagnosis is made by examining your arm, assessing for nerve irritability and function of the nerve.

You will be sent for nerve conduction studies which assess the electrical conduction of the nerve.

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TREATMENT:

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Night time splints: 

If your symptoms are mild and worse at night this could be due to bending your elbows whilst sleeping or for prolonged periods due to reading whilst in bed a elbow splint can help.

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Surgery:

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Generally for most patients with persistent pins and needles, progressive numbness of the little finger or weakness of grip will need surgery. 

If severe Ulnar nerve compression is not treating you will be left with a 'claw hand' due loss of function of the muscles of the hand.

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Surgery is performed under General anaesthetic. A small incision is made on the inner side of your elbow and the ulnar nerve is released of tight bands and scarring. The allows the nerve to regenerate and improve its ability to conduct signals. 

5% of patients may have instability of the nerve after releasing and require a anterior transposition, which involved moving the nerve out of its tunnel on top of the forearms muscles. 

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Risks of surgery include infection, nerve and vessel damage (less then 1%), Persistent symptoms depending on severity and duration of symptoms,

Complex regional pain syndrome.

Anaesthetic risk include Heart attack, Stroke, clots (less than 1%) 

 

Recovery:

Surgery is performed as a day case. You will be in a sling for 2 -3 days. You can use you hands and elbow as soon as possible. Outer bulky dressings are removed at day 5 and the wound is checked at 2 weeks.

If your nerve is moved (anterior transposition you will be in a sling for 5 days and have bulky dressing for 10 days.

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Nerve recovery 

The nerve recovers 1 mm a day.  Full recovery may take up to 9 months. Generally if the tingling / burning of the little finger has improved by week 6 the nerve will recover. 

However, severe and chronic nerve compression, diabetes , smoking and alcohol will impair nerve recovery.