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The ulnar nerve lies near the surface of the skin as it passes by the elbow. This location causes it to be susceptible to injury. An ulnar nerve contusion is a bruise of the nerve. It is the result of direct trauma to the elbow. Ulnar nerve contusions are characterized by pain, weakness, and loss of feeling in the hand.SYMPTOMS
- Signs of nerve damage include: tingling, numbness, weakness, and/or loss of feeling in the hand, specifically the little finger and ring finger.
- Sharp pains that may shoot from the elbow to the wrist and hand.
- Decreased hand function.
- Tenderness and/ or inflammation in the elbow.
- Muscle wasting (atrophy) in the hand.
CAUSES
Ulnar nerve contusions are caused by direct trauma to the elbow that results in bleeding which enters the nerve.RISK INCREASES WITH:
- Contact sports (football, soccer, or rugby).
- Bleeding disorders.
- Taking blood thinning medicine (warfarin [Coumadin], aspirin, or nonsteroidal anti-inflammatory medications).
- Diabetes mellitus.
- Underactive thyroid gland (hypothyroidism).
PREVENTION
- Wear properly fitted and padded protective equipment.
- Only take blood thinning medication when necessary.
PROGNOSIS
Ulnar nerve contusions usually heal within 6 weeks. Healing often occurs spontaneously, but treatment helps reduce symptoms.RELATED COMPLICATIONS
- Permanent nerve damage, including pain, numbness, tingling, or weakness in the hand (rare).
- Weak grip.
- Prolonged healing time, if improperly treated or re-injured.
TREATMENT
Treatment initially involves resting from any activities that aggravate the symptoms, and the use of ice and medications to help reduce pain and inflammation. The use of strengthening and stretching exercises may help reduce pain with activity. These exercises may be performed at home or with referral to a therapist. Your caregiver may recommend that you splint the elbow at night to help healing of the nerve. If symptoms persist despite conservative (non-surgical) treatment, then surgery may be recommended to free the nerve.MEDICATION
- If pain medication is necessary, then nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.
- Do not take pain medication within 7 days before surgery.
- Prescription pain relievers may be given if deemed necessary by your caregiver. Use only as directed and only as much as you need.
COLD THERAPY
Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or massage the area with a piece of ice (ice massage).SEEK MEDICAL CARE IF:
- Treatment seems to offer no benefit, or the condition worsens.
- Any medications produce adverse side effects.
EXERCISES
RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Ulnar Nerve ContusionThese exercises may help you when beginning to rehabilitate your injury. Do not begin these exercises until your physician, physical therapist or athletic trainer advises you to do so. Discontinue any exercise that worsens your symptoms. Contact your physician with instructions on how to continue. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:
- Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.
- An effective stretch should be held for at least 30 seconds.
- A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.
RANGE OF MOTION – Extension - Hold your right / left arm at your side and straighten your elbow as far as you can using your right / left arm muscles.
- Straighten the right / left elbow farther by gently pushing down on your forearm until you feel a gentle stretch on the inside of your elbow. Hold this position for __________ seconds.
- Slowly return to the starting position.
RANGE OF MOTION – Flexion - Hold your right / left arm at your side and bend your elbow as far as you can using your right / left arm muscles.
- Bend the right / left elbow farther by gently pushing up on your forearm until you feel a gentle stretch on the outside of your elbow. Hold this position for __________ seconds.
- Slowly return to the starting position.
RANGE OF MOTION – Wrist Flexion, Active-Assisted - Extend your right / left elbow with your fingers pointing down.*
- Gently pull the back of your hand towards you until you feel a gentle stretch on the top of your forearm.
- Hold this position for __________ seconds.
*If directed by your physician, physical therapist or athletic trainer, complete this stretch with your elbow bent rather than extended.
RANGE OF MOTION – Wrist Extension, Active-Assisted - Extend your right / left elbow and turn your palm upwards.*
- Gently pull your palm/fingertips back so your wrist extends and your fingers point more toward the ground.
- You should feel a gentle stretch on the inside of your forearm.
- Hold this position for __________ seconds.
*If directed by your physician, physical therapist or athletic trainer, complete this stretch with your elbow bent, rather than extended.
RANGE OF MOTION – Supination, Active - Stand or sit with your elbows at your side. Bend your right / left elbow to 90 degrees.
- Turn your palm upward until you feel a gentle stretch on the inside of your forearm.
- Hold this position for __________ seconds. Slowly release and return to the starting position.
RANGE OF MOTION – Pronation, Active - Stand or sit with your elbows at your side. Bend your right / left elbow to 90 degrees.
- Turn your palm downward until you feel a gentle stretch on the top of your forearm.
- Hold this position for __________ seconds. Slowly release and return to the starting position.
STRETCH - Wrist Flexion - Place the back of your right / left hand on a tabletop leaving your elbow slightly bent. Your fingers should point away from your body.
- Gently press the back of your hand down onto the table by straightening your elbow. You should feel a stretch on the top of your forearm.
- Hold this position for __________ seconds.
STRETCH – Wrist Extension
- Place your right / left fingertips on a tabletop leaving your elbow slightly bent. Your fingers should point backwards.
Gently press your fingers and palm down onto the table by straightening your elbow. You should feel a stretch on the inside of your forearm. - Hold this position for __________ seconds.
STRENGTHENING EXERCISES - Ulnar Nerve Contusion
These exercises may help you when beginning to rehabilitate your injury. Do not begin these exercises until your physician, physical therapist or athletic trainer advises you to do so. Discontinue any exercise that worsens your symptoms. Contact your physician for instructions on how to continue. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:
- Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.
- Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Progress with the resistance and repetition exercises only as your caregiver advises.
STRENGTH – Wrist Flexors - Sit with your right / left forearm palm-up and fully supported. Your elbow should be resting below the height of your shoulder. Allow your wrist to extend over the edge of the surface.
- Loosely holding a __________ weight or a piece of rubber exercise band/tubing, slowly curl your hand up toward your forearm.
- Hold this position for __________ seconds. Slowly lower the wrist back to the starting position in a controlled manner.
STRENGTH – Wrist Extensors - Sit with your right / left forearm palm-down and fully supported. Your elbow should be resting below the height of your shoulder. Allow your wrist to extend over the edge of the surface.
- Loosely holding a __________ weight or a piece of rubber exercise band/tubing, slowly curl your hand up toward your forearm.
- Hold this position for __________ seconds. Slowly lower the wrist back to the starting position in a controlled manner.
STRENGTH - Ulnar Deviators - Stand with a ____________________ weight in your right / left hand or sit holding on to the rubber exercise band/tubing with your opposite arm supported.
- Move your wrist so that your pinkie travels toward your forearm and your thumb moves away from your forearm.
- Hold this position for __________ seconds and then slowly lower the wrist back to the starting position.
STRENGTH - Radial Deviators - Stand with a ____________________ weight in your right / left hand or sit holding on to the rubber exercise band/tubing with your arm supported.
- Raise your hand upward in front of you or pull up on the rubber tubing.
- Hold this position for __________ seconds and then slowly lower the wrist back to the starting position.
STRENGTH - Grip - Grasp a tennis ball, a dense sponge, or a large, rolled sock in your hand.
- Squeeze as hard as you can without increasing any pain.
- Hold this position for __________ seconds. Release your grip slowly.
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