Ulnar Nerve Injury

How Healthcare Providers Diagnose and Treat the "Funny Bone"

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An ulnar nerve injury can cause pain and numbness in your arm. Your arm might also feel weak if you hurt the nerve.

Ulnar nerve injuries can happen from a variety of causes, including accidents and overuse. You can usually treat ulnar nerve injuries by avoiding movements or activities that make your symptoms worse, taking medication for pain, and possibly having surgery.

This article will go over what causes ulnar nerve injuries, how they’re diagnosed, and what your treatment options are.

Man holding his elbow in pain
Shidlovski / Getty Images

What Is The Ulnar Nerve?

The ulnar nerve is one of several major nerves that supply the upper extremities (the arms). The ulnar nerve is formed by the nerve fibers in an area around the shoulder blade called the brachial plexus.

How Nerves Work

Nerves are structures that help information travel between your brain and your body. They carry important signals that let you feel sensations and make movements.

When it leaves the brachial plexus, the ulnar nerve travels down the arm. It sends information to some of the muscles of the forearm and hand and gives sensation to parts of the hand.

Symptoms of Ulnar Nerve Injury

If you injure your ulnar never, you may have symptoms of pain, weakness, and abnormal sensation.

Tingling and Numbness

Numbness and tingling (paresthesia) are signs that the ulnar nerve signals are being interrupted.

This can happen when there is pressure or inflammation around the nerve. The location of the paresthesia is not always the same place where there is a problem that is causing ulnar nerve dysfunction.

For example, in the case of cubital tunnel syndrome (the most common location for paresthesia in the hand), the ring and small finger are affected. However, the location of pressure on the nerve is near the elbow joint.


Pain can be caused by many injuries, but it can be hard to tell if the pain is coming from damage to your ulnar nerve. 

The pain from a nerve condition usually comes with numbness and tingling. It will usually feel like a burning sensation that travels along the path of the nerve. People with nerve pain often described it as shooting or like an electric shock.


When nerve function is affected, the brain has a harder time telling muscles to move. As a result, those muscles can get weak. If you hurt your ulnar nerve, you might have trouble doing certain activities or strength maneuvers. 

For example, you may have difficulty pinching or grasping objects. If you have nerve compression that lasts a long time (chronic), the muscles in your arms can waste away (atrophy).

This is generally an irreversible problem and is seen by noting areas where the body has lost its normal muscle mass. People with ulnar nerve injuries can get wasting of the soft tissues in the hand. Holding both hands side by side can make it easier to see signs of wasting.

Not every person with an ulnar nerve injury or condition affecting nerve function will have all of these symptoms. You may only have one symptom that bothers you, have more than one symptom or have no symptoms. 

Ulnar Nerve Injury Causes

Ulnar nerve injuries can happen along any point of the nerve. Sometimes, the damage is from an acute injury, which is sudden and traumatic. 

Other times, ulnar nerve problems come from a chronic, long-standing condition that causes the nerve to stop working over time. 

Cubital Tunnel Syndrome

The ulnar nerve wraps directly behind the humerus bone along the back of the elbow joint. Cubital tunnel syndrome is the chronic compression of the ulnar nerve behind the elbow.

The condition is categorized as compression neuropathy of the upper extremity. It’s the second most common type of compression neuropathy, after carpal tunnel syndrome.

The actual location of compression of the ulnar nerve in people with cubital tunnel syndrome can vary but can include the ligaments, blood vessels, and tendons.

Guyon's Canal Syndrome (Handlebar Palsy)

Guyon's canal, also called the ulnar tunnel, is a location within the wrist that contains the ulnar nerve. Compression of the ulnar nerve in this spot can be from fractures to the small bones of the wrist or ganglion cysts in the wrist.

One of the most common reasons for nerve compression in Guyon's canal is so-called "handlebar palsy.” 

This condition is common in cyclists and happens if the nerve gets pinched against the bones of the wrist and the handlebar of a bicycle, leading to pain and numbness.

If you cycle, you may want to wear padded gloves when you're gripping the handlebars to avoid compression. If padded gloves don't help, changing your grip or changing to a different style of handlebars can often help with numbness and tingling that tend to occur when compression is applied.

Funny Bone

The funny bone is the name people use to describe contusion injuries to the ulnar nerve behind the elbow. In this location, the ulnar nerve wraps behind the arm bone (humerus) just underneath the skin. 

There is very little soft-tissue protection around the ulnar nerve in this location and, as a result, striking this part of the elbow against an object often causes sharp pain, tingling, and numbness along the ulnar nerve. This is the sensation that people describe when they say they "hit their funny bone."

Traumatic Injuries

Traumatic injuries occur as the result of sudden, often violent damage to the nerve. 

Some of the more common mechanisms include nerve contusion (bruising), lacerations, and concussive injuries:

  • Nerve contusions typically occur after a fall or motor vehicle collision.
  • Lacerations can be caused by injury from broken glass, knife wounds, and other sharp objects.
  • Concussive injuries to the nerve can be caused by injuries where the nerve may not be directly damaged by a bullet fragment but get hurt as a result of the concussive force of the gunshot.

Since the ulnar nerve is located close to the skin, direct trauma to the overlying skin and soft tissues can cause a contusion injury to the nerve.

How Ulnar Nerve Injuries Are Diagnosed

Nerve injuries can be tough to diagnose, depending on the cause. Finding the location of a nerve injury can be straightforward or more challenging.

The evaluation and treatment of nerve-related conditions is not always a simple one-step visit to a healthcare provider's office.

Sometimes, multiple providers work together to find the source of a nerve injury and determine the best treatment for the cause. 

People with nerve injuries can be seen by their primary care provider, orthopedic surgeons, neurosurgeons, neurologists, physiatrists, or other specialists to help determine the most appropriate treatment for a specific condition.

Your provider will ask you about your symptoms and do a physical exam to diagnose an ulnar nerve injury.

One of the amazing things about the nerves in our bodies is that—except in very rare circumstances—they provide the same patterns of sensation and muscle involvement in just about everyone.

The ulnar nerve very predictably provides sensation in the exact same area for almost everyone: the small finger and half of the ring finger. Knowing these patterns of nerve function can help a skilled provider find the source of the problem.

Tinel's Sign

Many examination techniques are used to isolate and test nerve function. One specific test used to examine people with suspected nerve abnormalities is called Tinel's sign.

A Tinel sign is considered positive when the provider taps directly over the location of nerve abnormality and it re-creates symptoms of paresthesia and discomfort along the path of the nerve rather than at the specific location where the tapping takes place.

For example, a positive Tinel's sign in a patient with cubital tunnel syndrome would, by tapping behind the elbow joint directly over the ulnar nerve, re-create symptoms of paresthesia and pain in the ring and small fingers.

Other Tests

Other tests can be done to assess the ulnar nerve and the surrounding anatomy which could be causing compression or injury to the ulnar nerve. 

  • A regular X-ray can check for deformities of the bone, bone spurs, or other abnormal structures that could be causing irritation to the ulnar nerve.
  • Other imaging tests, including MRIs and CT scans, are less commonly used but can be helpful if there is a concern for a possible cause such as a ganglion cyst, tumor, or other soft tissue mass that could be causing compression on the nerve.
  • High-resolution ultrasound is being used more frequently because it is noninvasive and relatively quick and easy to do. However, ultrasound examinations are highly dependent on technician experience, and not every facility has the capability to look at a patient’s ulnar nerve with ultrasound. 
  • Electrical studies of the nerve include the measurement of nerve conduction and electromyography (EMG).

While these studies can be helpful in finding the source of a nerve condition, they can be uncomfortable for the patient since they involve placing needles into the skin and measuring an electrical current along the path of the nerve.

Treatment for Ulnar Nerve Injuries

The only way to treat an ulnar nerve injury successfully is to figure out exactly where the problem is. This may sound straightforward, but the symptoms of the nerve injury are often not felt at the location of the damage to the nerve.

Trying to determine the location of the problem often takes some time and testing, but these steps need to happen before a treatment can be decided on.

In almost all nerve damage situations, the most important first step is to find ways to relieve pressure and tension on the nerve that is injured.

Treatment for an ulnar nerve injury might include:

  • Avoiding specific activities that put pressure on the nerve
  • Immobilization to limit movement of the nerve
  • Padding for protection to keep pressure off of the nerve

If a component of the compression on the nerve is the result of inflammation, treatments that reduce inflammation can be helpful.

These treatments commonly include:

Surgical treatments for ulnar nerve problems depend on the type of injury. When there is a direct injury to the nerves, such as a laceration, these injuries are often fixed soon after the injury. 

If there is a broad area of damage to the nerve, nerve grafting may have to be done to reconnect healthy portions of the nerve. When there is compression on the nerve, surgical solutions are aimed at relieving the pressure and removing tension from the nerve.

In some cases, this just requires removing pressure on the nerve in a minimally invasive surgical procedure. In other cases, it involves relocating the position of the nerve so that there is less tension on it.

A common treatment for people with cubital tunnel syndrome is to move the nerve from the back of the elbow to the front (ulnar nerve transposition). In the new position, the nerve is no longer under a lot of tension when the elbow is bent.


If you injury your ulnar nerve, you may have pain, numbness, tingling, and weakness in your arm. It can be tricky to find out the cause of the injury because the symptoms you have may not be exactly where the problem is. Your provider can use different tests to figure out the source of the problem and recommend the appropriate treatment. 

23 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Lee EY, Sebastin SJ, Cheah A, Kumar VP, Lim AYT. Upper extremity innervation patterns and clinical implications for nerve and tendon transfer. Plast Reconstr Surg. 2017;140(6):1209-1219. doi:10.1097/PRS.0000000000003873

  2. Orthobullets. Ulnar nerve.

  3. Menorca RM, Fussell TS, Elfar JC. Nerve physiology: mechanisms of injury and recoveryHand Clin. 2013;29(3):317–330. doi:10.1016/j.hcl.2013.04.002

  4. Johns Hopkins. Cubital tunnel syndrome

  5. Colloca L, Ludman T, Bouhassira D, et al. Neuropathic painNat Rev Dis Primers. 2017;3:17002. doi:10.1038/nrdp.2017.2

  6. Taylor JL, Amann M, Duchateau J, Meeusen R, Rice CL. Neural contributions to muscle fatigue: from the brain to the muscle and back againMed Sci Sports Exerc. 2016;48(11):2294–2306. doi:10.1249/MSS.0000000000000923

  7. Dy CJ, Mackinnon SE. Ulnar neuropathy: evaluation and managementCurr Rev Musculoskelet Med. 2016;9(2):178–184. doi:10.1007/s12178-016-9327-x

  8. Mount Sinai. Muscle atrophy.

  9. MedlinePlus. Ulnar nerve dysfunction.

  10. American Academy of Orthopedic Surgeons. Ulnar nerve entrapment at the elbow (cubital tunnel syndrome).

  11. Assmus H, Antoniadis G, Bischoff C. Carpal and cubital tunnel and other, rarer nerve compression syndromesDtsch Arztebl Int. 2015;112(1-2):14–26. doi:10.3238/arztebl.2015.0014

  12. Depukat P, Henry BM, Popieluszko P, et al. Anatomical variability and histological structure of the ulnar nerve in the Guyon's canalArch Orthop Trauma Surg. 2017;137(2):277–283. doi:10.1007/s00402-016-2616-4

  13. University of Michigan. Nerve injuries of the hand, wrist, and elbow.

  14. Mankowitz SL. Laceration management. J Emerg Med. 2017;53(3):369-382. doi:10.1016/j.jemermed.2017.05.026

  15. Institute of Medicine (US) Committee on Pain, Disability, and Chronic Illness Behavior; Osterweis M, Kleinman A, Mechanic D, editors. Pain and Disability: Clinical, Behavioral, and Public Policy Perspectives. Washington (DC): National Academies Press (US); 1987. 7, The Anatomy and Physiology of Pain. 

  16. National Institute of Neurological Disorders and Stroke. Carpal tunnel syndrome fact sheet.

  17. Das Neves Borges P, Vincent TL, Marenzana M. Automated assessment of bone changes in cross-sectional micro-CT studies of murine experimental osteoarthritisPLoS One. 2017;12(3):e0174294. doi:10.1371/journal.pone.0174294

  18. National Institute of Biomedical Imaging and Bioengineering. Ultrasound.

  19. Domkundwar S, Autkar G, Khadilkar SV, Virarkar M. Ultrasound and EMG-NCV study (electromyography and nerve conduction velocity) correlation in diagnosis of nerve pathologiesJ Ultrasound. 2017;20(2):111–122. doi:10.1007/s40477-016-0232-3

  20. Woo A, Bakri K, Moran SL. Management of ulnar nerve injuries. J Hand Surg Am. 2015 Jan;40(1):173-81. doi:10.1016/j.jhsa.2014.04.038

  21. Vardeh D, Mannion RJ, Woolf CJ. Toward a Mechanism-Based Approach to Pain DiagnosisJ Pain. 2016;17(9 Suppl):T50–T69. doi:10.1016/j.jpain.2016.03.001

  22. Grinsell D, Keating CP. Peripheral nerve reconstruction after injury: a review of clinical and experimental therapiesBiomed Res Int. 2014;2014:698256. doi:10.1155/2014/698256

  23. Kamat AS, Jay SM, Benoiton LA, Correia JA, Woon K. Comparative outcomes of ulnar nerve transposition versus neurolysis in patients with entrapment neuropathy at the cubital tunnel: a 20-year analysis. Acta Neurochir (Wien). 2014;156(1):153-7. doi:10.1007/s00701-013-1962-z

By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.