Colorado Springs Orthopedic News

Ulnar Tunnel Syndrome

Ulnar Tunnel Syndrome

Wrist pain can keep you from doing both things you love to do and things you need to do to go about life. Ulnar tunnel syndrome can cause debilitating pain that can prevent you from doing that. Caused by a pinched nerve in the wrist, ulnar tunnel syndrome can also cause tingling and numbness in the hand. There is no reason to suffer from the pain and disability of ulnar tunnel syndrome when you can get help at the Colorado Center of Orthopaedic Excellence in Colorado Springs, Colorado. The orthopedic specialists at CCOE have extensive experience and are well-trained in treating ulnar tunnel syndrome. In their care, you can get back to your normal routine.


Ulnar tunnel syndrome occurs when the ulnar nerve is compressed at the wrist. This reduces blood flow to the nerve and can harm its function. When compressed at the wrist, the malfunction of the nerve can cause numbness and tingling in the little finger (pinky) and the outside of the ring finger. As the median nerve passes through the carpal tunnel in your hand, the ulnar nerve passes through Guyon’s canal at your wrist. For this reason, it may be called Guyon’s canal syndrome. Because of how it affects grip, it is often called handlebar palsy.


The ulnar nerve is one of the arm’s primary nerves. It controls nearly all of the small muscles in the hand. Although the ulnar nerve begins at the armpit, it doesn’t perform a function until it enters the forearm. As a motor (movement) nerve, the ulnar nerve stimulates muscles in the forearm, hand, and fingers, so you can bend and straighten the pinky and ring fingers, grip and hold items and perform fine motor tasks like writing with a pen, buttoning a shirt or turning pages in a magazine. As a sensory nerve, the ulnar nerve gives feeling to the pinky finger, the side of the ring finger closest to the pinky finger, and the palm and back of the hand on the pinky side. As the largest nerve in the body that is not protected by muscle or bone, the ulnar nerve is prone to injury.


Ulnar tunnel syndrome occurs when the ulnar nerve becomes compressed as it passes through Guyon’s canal, where the wrist meets the palm. This is not to be confused with cubital tunnel syndrome, which occurs when the ulnar nerve compression is at the elbow. When the ulnar nerve is compressed at the wrist, it reduces blood flow to the nerve and can harm its function. Over time, permanent damage to the ulnar nerve may develop, which can lead to permanent numbness, weakness, pain, and tingling in the wrist or hand.


The most common cause of ulnar tunnel syndrome is the presence of a ganglion cyst. This benign (noncancerous) soft tissue tumor filled with fluid develops on the wrist and can press on the ulnar nerve. One is more likely to get ulnar tunnel syndrome working with hands bent down and out, using vibrating machinery like a jackhammer, or participating in an activity that involves constantly applying grip pressure, like bicycling or weightlifting. Arthritis can cause ulnar tunnel syndrome.  A broken bone in the wrist can also bring it on. Baseball players might break this bone while batting. Golfers could break it if missing the ball and slamming the club into the ground.


Common symptoms of ulnar tunnel syndrome include:

  • Tingling, like the fingers are falling asleep—especially in the little and ring fingers
  • Numbness in the hand upon waking
  • Weakness in the grip
  • Hand and fingers forming a claw
  • Difficulty separating and/or closing the fingers
  • Pain in the wrist

As the disease progresses, it may become more difficult to open jars, hold objects or coordinate the fingers during certain tasks, such as typing or playing a musical instrument.


The non-surgical options for treating ulnar tunnel syndrome first involve identifying what’s causing the pressure or trauma to the hand or wrist. Based upon this, the following are the more conservative approaches:

  • Using ergonomic and padded tools
  • Holding wrists in a different way
  • Physical therapy
  • Occupational therapy
  • Massage therapy
  • OTC pain relievers or anti-inflammatory medications
  • Corticosteroid injections
  • Wearing a splint or wrist brace
  • Avoiding activities that aggravate the symptoms
  • Avoiding resting the elbow on furniture or armrests


If all non-surgical interventions fail to alleviate symptoms, outpatient surgery may be performed to release pressure or remove any ganglion cysts or scar tissue causing the compression. The ligament that covers Guyon’s canal may be cut to release pressure. As the wrist heals, the gap created grows together, leaving more room for the ulnar nerve. This can restore normal blood flow to the nerve and allow for recovery of nerve function. The surgery usually takes no more than 30 to 45 minutes.


As with any illness or injury, it’s important to rule out the possibility of other medical problems that could be causing your symptoms. Not all doctors are trained or qualified to treat conditions like ulnar tunnel syndrome, which could lead to a wrong diagnosis. This could result in either no treatment or the wrong treatment. The highly trained surgeons at the Colorado Center of Orthopaedic Excellence in Colorado Springs, Colorado, have a wealth of experience treating ulnar tunnel syndrome. In addition to a comprehensive medical history, review of symptoms and activity, your physician will perform a physical examination of the affected hand and wrist to determine the site of compression. They may tap their fingers over the ulnar nerve to observe if tingling is caused. This is called Tinel’s test. They will also be looking for muscle atrophy (wasting) and weakness in the hand or fingers to determine if the cause of symptoms is in the wrist, not the elbow. X-rays of the wrist can rule out bone involvement. MRI (magnetic resonance imaging) or CT (computed tomography) scan can rule out tissue growths that may be exerting pressure on the nerve. Electromyography and nerve conduction studies may also help determine a definitive diagnosis. Another thing they bring to your exam is an unwavering and caring focus on getting you back to yourself, pain-free and fully functional. If you think you might be suffering from Ulnar Tunnel Sydrome, schedule an appointment today.


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