Bone & Joint Expert Care

Ulnar nerve contusion

What is an ulnar nerve contusion?

Ulnar nerve contusion is a bruising injury to the ulnar nerve, close to the skin’s surface at the elbow, from a direct blow. Contusions cause bleeding from ruptured capillaries that allow blood to infiltrate the nerve. Direct injury to the nerve causes damage even if bleeding of capillaries is not a factor. The contusion causes pain, hand weakness, and loss of feeling, often in the fourth and fifth fingers. Ulnar nerve dysfunction or inflammation may greatly decrease athletic performance in sports that require strong hand or wrist action.

What increases the risk of developing ulnar nerve contusion?

• Ulnar nerve contusion occurs via a direct blow to the nerve at the elbow or falling on the elbow.
• Risk for this kind of injury increases with contact sports such as football, soccer or rugby
• Bleeding disorder or medications that thin the blood (such as warfarin [Coumadin], aspirin, and nonsteroidal anti-inflammatory medications)
• Diabetes mellitus
• Hypothyroidism (underactive thyroid gland)

What are the symptoms of ulnar nerve contusion?

• Tingling, numbness or burning in part of the hand or fingers
• Sharp pains that may shoot from the elbow to the wrist and hand
• Hand weakness, clumsiness and heaviness
• Poor dexterity (fine hand function)
• Weak grip, especially power grip, and weak pinch
• Swelling in the elbow
• Tenderness of the inner elbow
• Atrophy of muscles of the hand
• Reduced performance in any sport requiring a strong grip

How is ulnar nerve contusion treated?

Non-operative treatment is indicated for most patients, who are able to successfully resume all pre-injury activities.

Non-operative treatment: Initial treatment consists of rest from the activity that causes pain and medications and ice to help reduce pain and inflammation. Your physician may recommend elbow splinting (usually only at night). Stretching and strengthening exercises of the muscles of the forearm and elbow are important. You may receive a referral to physical therapy or an athletic trainer.

Medication may include:

• Nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen (do not take within seven days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician. Contact your physician immediately if any bleeding, stomach upset or signs of an allergic reaction occur.
• Your physician may prescribe pain relievers as necessary. Use only as directed and only as much as you need.

Operative treatment is usually reserved for the small number of patients. If the non-surgical treatment is not successful, surgery may be necessary to free the pinched nerve, but this is rare.

What are the treatment complications?

Possible complications of non-operative treatment include:

• Persistent symptoms of pain and impairment

• Occasionally, muscle atrophy

Possible complications of operative treatment include:

• Surgical complications not specifically associated with the elbow, such as pain, bleeding, infection, nerve injury, stiffness, problems with anesthesia and inability to return to previous level of pre-injury activity. Some of these complications are uncommon.
• Complications specific to surgical treatment of this condition include injury to the ulnar nerve, with numbing, tingling and possible weakness of the muscles innervated by this nerve. 

Possible complications of either treatment include:

• Permanent numbness and weakness of the ring and little fingers
• Weak grip
• Permanent paralysis of some of the hand and finger muscles
• Prolonged healing time if usual activities are resumed too soon

When can I return to my sport or activity?

This condition is usually curable with appropriate treatment and often heals spontaneously. Complete healing may take up to six weeks, depending on the extent of injury. Rarely, symptoms may be permanent.

How can an ulnar nerve contusion be prevented?

Wear proper protective equipment, including elbow pads, while engaging in contact sports.