Elbow pain in athletes is extremely common in a variety of sports. Specifically, pain coming from the ulnar nerve (funny bone) on the inner aspect of the elbow. An athlete can develop compression of the nerve at the elbow due to a condition called cubital tunnel syndrome. Basically the nerve becomes irritated as it courses around the bend of the elbow on the inner side.
Ulnar Nerve Subluxation
However, athletes can also report the sensation of the ulnar nerve snapping or moving with bending of the elbow. In this situation, the nerve is actual slipping out of its grove and moving out and around the edge of the bone (subluxation). The video below is a great example of what occurs with subluxation of the ulnar nerve.
Interestingly, many athletes may be totally asymptomatic and only have the snapping sensation when the elbow is flexed and extended. However, others can have significant irritation of the nerve due to this snapping sensation. Just like with most nerve irritations, the symptoms can be both motor and sensory and present with weakness and or/numbness and tingling. The ulnar nerve at the level of the elbow is involved in the following functions:
1. Bring the Fingers Together
2. Spread the Fingers Apart
3. Bend at the Large Knuckle of Ring and Pinky Finger
4. Pinch Grip
5. Sensation to Pinky and Half the Ringer Finger
6. Adduction of Thumb (Not Pictured)
Functions of Ulnar Nerve
Treatment Plan
If the patient is asymptomatic it is generally recommended to just monitor the condition. If the patient is having irritation of the nerve, limiting activities that cause the snapping such as triceps extension or throwing should be limited. The most difficult part of the whole situation is that there is not much that can be done to expedite the healing process. If the nerve has been chronically irritated then the function may take weeks or months to return to normal as the nerve is very slow to heal itself.
The main treatment is resting the elbow in approximately 50 degrees of flexion where the nerve is under the least stress. Anti-inflammatory medications such as ice, or NSAIDS to treat inflammation. Physical therapy can also be considered in working on ulnar glide exercises as well as tapping techniques to limit the movement of the nerve. If the pain does not resolve over a period of months a surgical repositioning of the nerve can be performed; but nonsurgical treatment should be attempted first. Below is an intraoperative look at the exposed ulnar nerve and its position on the posterior medial elbow.
