MANUAL MINORS
Nerve compression at the elbow occurs when one of the major nerves passing through the elbow joint (ulnar, median, or radial nerve) is compressed, causing pain, numbness, weakness, or sensory disturbances in the arm, hand, or fingers.
Ulnar nerve compression is the most common, leading to “cubital tunnel syndrome.” Compression of the radial or median nerves is less frequent but can cause “radial tunnel syndrome” (arcade of Frohse) or “pronator teres syndrome,” respectively.
Diagnosis
Diagnosis is based on clinical history, where patients may report pain, tingling, or weakness in areas innervated by the affected nerve. In ulnar nerve compression, symptoms typically affect the fourth and fifth fingers (cubital tunnel syndrome), while radial nerve compression can cause weakness in wrist and finger extension.
Physical examination may include tests such as Tinel’s sign (tapping over the nerve) and the elbow flexion provocation test. Electrophysiological studies, such as electromyography (EMG), can confirm the diagnosis and assess the severity of compression.
Differential Diagnosis
Pathology | Characteristics |
|---|---|
Carpal tunnel syndrome | Median nerve compression at the wrist, with tingling in the first three fingers |
Medial epicondylitis | Pain at the medial epicondyle, without neurological involvement |
Lateral epicondylitis | Pain on the outer elbow, without paresthesias or weakness |
Cervical disc herniation | Nerve compression in the cervical spine, with radiating arm symptoms |
Diabetic neuropathy | Pain and tingling in extremities, unrelated to specific movements |
Emergency Management
Emergency management focuses on relieving pain and inflammation. Non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics can be administered, and in some cases, temporary elbow immobilisation may prevent worsening of symptoms.
If compression is acute and severe, especially with loss of strength or sensation, the patient should be referred for urgent specialist evaluation. Night splints or adjustments in elbow posture can help during the initial phase of treatment.
Definitive Treatment
Definitive treatment depends on the affected nerve and the severity of compression. In early stages, conservative management includes physiotherapy to improve flexibility and strength, along with activity modifications to reduce pressure on the nerve.
In more severe or chronic cases that do not respond to conservative treatment, surgical nerve decompression may be necessary, such as anterior ulnar nerve transposition in cubital tunnel syndrome or radial nerve release in radial tunnel syndrome. Postoperative recovery usually includes rehabilitation to restore neuromuscular function.
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