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Ulnar Nerve: The Not-So-Funny-Anymore Bone

By Alan Williams, PT, OTR/L, ATC, CSCS

We’ve probably all played Operation before. The game – where you try to remove tiny plastic organs (whichever ones you hadn’t misplaced already, that is) without touching the metallic barriers lest you further upset an already traumatized-looking patient – has certainly inspired many 3 and 4 year-olds to proudly proclaim they were going to be “operators” when they grew up. The worst one was always the “funny bone” – that absurdly thin little piece was almost impossible to remove without being punished by a loud BZZZZT!

While Operation has never claimed to be anatomically correct (Butterflies in the stomach? Not unless you swallowed them!), there’s still a common misconception that the searing pain sometimes experienced after hitting your elbow a certain way is due to the funny bone. Well, ladies and gentlemen, I’m here to unmask the funny bone and call it by its true name – the ulnar nerve. Yes, it turns out it’s not actually a bone at all! This very important nerve, which is responsible for receiving sensations of touch and temperature in the underside of the forearm, the palm, and the ring and little fingers, is the largest unprotected nerve in the body, and thus, it receives much abuse in the course of performing its job.

The ulnar nerve stretches from the shoulder to the elbow, then runs along the ulna (the forearm bone on the pinky finger side) before reaching the wrist. Along the way, it must pass through two tunnels – the cubital tunnel at the elbow and Guyon’s canal at the base of the hand. The ulnar nerve is called “unprotected” because it is not covered by bone or muscle. In fact, the nerve can be felt by lightly pressing the groove on the underside of your elbow.

Because it is so exposed, the ulnar nerve is vulnerable to pinching, crushing, and other types of injuries, especially as it passes through the two tunnels. When hit, it produces the severe (and thankfully temporary) throbbing, burning sensation familiar to us all. But prolonged pressure, pinching, or constriction – such as happens when leaning on your elbows or when resting your forearms on a desk – may lead to chronic nerve entrapment or ulnar neuropathy.

The symptoms associated with ulnar neuropathy (tingling, burning, pain, and even muscle weakness felt in the areas supplied by the ulnar nerve) are known as paresthesia. Approximately 40% of Americans will suffer ulnar neuropathy at some point in their lives. The onset is often gradual, and risk factors include being elderly, diabetic, alcoholic, or having a job or hobby that requires excessive time be spent with the arms bent. Cyclists seem especially disposed to the condition; in fact, ulnar neuropathy is sometimes also called “bicyclers’ neuropathy.”

Because ulnar neuropathy is due to nerve damage, recovery time will depend on the extent of that damage, so it is important to treat the problem in its early stages. If the condition progresses too long, the nerve may begin to waste away. Persons with severe cases of ulnar neuropathy develop curled or claw-like hands – evidence of muscles no longer able to function.

Your physical therapist will be able to instruct you in how best to address your ulnar nerve symptoms. Minor cases may be managed by gentle stretching, strengthening exercises, ice to reduce inflammation, using supportive devices such as pads or splints to protect the elbow, and activity modification. For more severe cases, your doctor may recommend surgery to alleviate pressure on the nerve or relocate it altogether.

Seeing your physical therapist or doctor early can help prevent complications and possible surgery in the future. With a few simple tweaks, nearly everyone with ulnar neuropathy will be able to make a full recovery. And that’s good news because a fully-functioning ulnar nerve is something to be thankful for. So next time you hit your “funny bone,” take a moment to thank your unprotected ulnar nerve for continuing to do its hazardous job.

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