Subluxing Ulnar Nerve

Shock-like sensation upon elbow flexion

What is subluxing ulnar nerve?

The arm is made up of three nerves, the ulnar nerve, medial nerve, and radial nerve. Each nerve is responsible for giving feeling and movement to different parts of the hand. The ulnar nerve allows you to move certain fingers, the hand, and your forearm. 

hand nerves
Each nerve in the arm has different responsibilities. The ulnar nerve is responsible for movement of the hand, forearm, and the last two fingers.

An ulnar nerve subluxation, also known as ulnar nerve instability, is the partial dislocation or abnormal movement of the ulnar nerve. Thus, the subluxation of the ulnar nerve is commonly understood as a misalignment of the ulnar nerve leading to pain and discomfort. 

Subluxation of the ulnar nerve is often misdiagnosed as cubital tunnel syndrome, snapping elbow conditions, or golfer’s elbow making this condition one of the trickier orthopaedic elbow conditions to identify. 

What causes subluxing ulnar nerve?

Subluxation of the ulnar nerve is not a common elbow injury with the condition impacting 16% of the population

There are several root causes which have been identified as potential attributing factors of subluxing ulnar nerve, these are: 

  • Trauma: high impact injury at the elbow or the elbow joint absorbing mechanical stress when extended or flexed. 
  • Congenital laxity of supporting ligaments: occasionally, patients are found with congenital laxity, a condition where supposedly tough and fibrous ligaments are looser and more flexible than they should be. This leads to hypermobility and subsequently increases the likelihood of misalignment occurring. 

What are the symptoms of subluxing ulnar nerve?

Some of the telltale signs of subluxated ulnar nerve include:

  • A shock-like sensation upon elbow flexion 
  • Pain at the elbow joint/ humeral epicondyle 
  • Tenderness at the elbow joint
  • Tingling or burning sensation at the ring and little fingers
  • Elbow snapping and popping during flexion and extension of the elbow
elbow pain
Pain at the elbow is characteristic of a subluxing ulnar nerve.
If you notice any of the symptoms, make an appointment with an orthopaedic specialist to get an accurate diagnosis and treatment.

Dr Puah KL is our Senior Consultant Orthopaedic Surgeon at Artisan Sports & Orthopaedic Surgery. He used to serve the sports service of Singapore General Hospital - the highest volume trauma centre for orthopaedics in Singapore.

Is subluxing ulnar nerve painful?

Yes. Subluxation of the ulnar nerve is often accompanied by pain and the feeling of being inconvenienced.

It is common for patients to report a reduction in quality of life as daily tasks are disrupted due to pain and discomfort.

Who is at risk of subluxing ulnar nerve in Singapore?

Subluxing ulnar nerve could happen to anyone regardless of age, gender, and age. 

The only common pattern that has been identified is:

  • Weightlifters: whether one is a professional weight lifter or a casual gym goer, subluxing ulnar nerve tends to occur among weightlifters who may have practised improper extension of the elbow whilst lifting. 

How is subluxing ulnar nerve diagnosed?

As previously mentioned, the diagnosis of subluxation of the ulnar nerve is particularly tricky. 

To ensure the accuracy of diagnosis, you may be required to undergo the following:

  • Physical examination and medical history: inform your doctor of the potential activities that may have led to an injury such as trauma, exercise, or sports. Additionally, a physical examination such as the elbow flexion test can be used to identify the extent of injury in the impacted area.
  • Nerve conduction test: conducted to investigate the receptivity of nerve signals and to identify if any alteration of sensation has occurred.
  • Electromyography (EMG): an EMG is often prescribed and would be necessary if an incidence of impinged nerves is suspected.
  • Ultrasound or magnetic resonance imaging (MRI): subluxing ulnar nerve is usually detected via MRI or dynamic ultrasonography however, there are cases in which these are not sufficient in capturing the condition thus the need for other tests described here. 
  • X-rays: an x-ray would be ordered to rule out an incidence of fracture or if your orthopaedist suspects presentation of arthritis or osteoarthritis.

What are the treatment options for subluxing ulnar nerve in Singapore?

A subluxation of the ulnar nerve can be treated in the following ways depending on its severity:

  • Elbow brace/splint/sling: to provide the impacted area with an opportunity to heal and rest. 
  • Medication: oral drugs (NSAIDs) and painkillers are commonly prescribed as the first course of treatment and to manage inflammation and pain. 
  • Physiotherapy: upon discontinuation of the use of an elbow brace/splint/sling, an active range of motion exercise would be administered via physiotherapy to regain mobility. 
  • Surgery: in severe cases, surgery such as an anterior transposition of the ulnar nerve or deep intramuscular implantation would be advised. 
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For emergency appointment, please call or Whatsapp us at (65) 8909 8877. We will arrange for a limousine to send you to our clinic.
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