Elbow Injuries
ulnar nerve
The ulnar nerve is a large nerve that runs behind the
elbow, along the inner side, just behind the prominent bone known as the medial
humeral epicondyle. It is the “funny bone” nerve, and when struck it causes the
familiar painful burning in the hand and ring/little finger. In throwers, this
nerve may become irritated by the repetitive strain placed on the nerve during
the flexion, extension, and torque on the elbow. The nerve is adjacent to the
ulnar collateral ligament and is subject to similar stresses. In fact, if the
UCL is stretched out or torn, the ulnar nerve is subject to more stress and
often becomes irritated because of the looseness of the ligament. So, any
thrower with ulnar nerve symptoms must have a careful evaluation of his
UCL. It is possible that
the nerve problem is coming from a ligament problem, and both may need to be
treated.
..symptoms from ulnar nerve irritation are pain and/or
numbness in the ring/little fingers.
The symptoms from ulnar nerve irritation are pain and/or
numbness in the ring/little fingers. Often rest is all that is needed, along
with use of an elbow pad to minimize irritation to the nerve while resting the
elbow on a table, desk, etc. If that does not resolve the problem, surgery may
be needed. This is unusual. The surgery is simple in concept: the nerve is
re-routed from its normal position behind the elbow to a new position in front
of the epicondyle. The idea is that the nerve get stretched during elbow flexion
and perhaps kinked. By bringing it in front of the elbow, the nerve no longer
needs to turn a corner, and the kink is eliminated. It is the same principle as
cutting a dogleg in golf—the shortest distance between two points is a straight
line.
The recovery from
this surgery is much shorter than from a Tommy John surgery. Usually within a
few months the athlete is ready to begin throwing. Dr. Dan Keefe and I wrote a
chapter about this injury and other nerve problems in thrower’s elbows. It is
published in Clinics in Sports Medicine:
Nerve Injuries in
the Throwing Elbow. Keefe, DT and Lintner DM. In Clinics in Sports Medicine,
Marc Saffron Ed. Volume 23, 723-742
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