Sulcus Ulnaris Syndrome: Symptoms, Osseous Spurring, and Cubital Tunnel Syndrome

Sulcus Ulnaris Syndrome:

• What is Sulcus Ulnaris Syndrome?
• Symptoms
• Osseous Spurring
• Cubital Tunnel Syndrome

What is Sulcus Ulnaris Syndrome?

Sulcus Ulnaris Syndrome refers to irritation or compression of the ulnar nerve as it passes through the sulcus ulnaris—a groove located on the inner side of the elbow, behind the medial epicondyle. This is the same area commonly called the “funny bone,” where tapping causes tingling due to nerve exposure. When the nerve is repeatedly compressed, stretched, or irritated in this groove, symptoms similar to cubital tunnel syndrome can develop.

The condition is often triggered by prolonged elbow flexion, leaning on the elbows, repetitive motions, trauma, or anatomical variations that narrow the sulcus. Since the ulnar nerve controls sensation to the ring and little fingers and motor function to many hand muscles, compression in this region can lead to sensory disturbances, hand weakness, and functional decline. Sulcus ulnaris syndrome is therefore considered part of the spectrum of ulnar neuropathies at the elbow and is closely related to cubital tunnel syndrome.

Symptoms

Typical symptoms of sulcus ulnaris syndrome involve both sensory and motor changes along the ulnar nerve distribution. Early symptoms include tingling, numbness, and burning sensations in the ring and little fingers. These symptoms often worsen at night, especially when the elbow is bent for long periods. Many patients also report discomfort or aching along the inner elbow.

As the condition progresses, motor symptoms become more noticeable. These may include weakness in grip strength, difficulty spreading the fingers, loss of dexterity, and clumsiness with fine motor tasks. In severe cases, muscle wasting (atrophy) in the hypothenar region and interosseous muscles of the hand may occur. Persistent symptoms should prompt evaluation, as chronic compression can lead to irreversible nerve damage if not treated appropriately.

Osseous Spurring

Osseous spurring refers to the formation of bone spurs—small, abnormal bone growths—near the sulcus ulnaris. These spurs can further narrow the space through which the ulnar nerve passes, increasing the likelihood of nerve compression. Bone spur formation may result from arthritis, previous elbow fractures, repetitive strain, or chronic mechanical irritation in the area.

When osseous spurs are present, symptoms may be more severe and persistent because the physical narrowing limits nerve mobility. Imaging such as X-rays or MRI is often used to identify spurs, and treatment may require both conservative measures and, in more advanced cases, surgical decompression or removal of the spur. Addressing osseous spurring is important because nerve irritation caused by bony obstruction does not typically resolve without targeted management.

Cubital Tunnel Syndrome

Cubital Tunnel Syndrome is the broader condition involving compression of the ulnar nerve at the elbow, which may occur at multiple points, including the sulcus ulnaris and the cubital tunnel. While sulcus ulnaris syndrome specifically highlights compression within the bony groove, cubital tunnel syndrome includes compression under the Osborne ligament, the flexor carpi ulnaris aponeurosis, and surrounding soft tissues. Both conditions share similar symptoms, but cubital tunnel syndrome may present with more pronounced discomfort during elbow flexion.

Management for both conditions often overlaps and includes activity modification, nighttime elbow extension splints, nerve gliding exercises, anti-inflammatory measures, and ergonomic adjustments. When conservative management fails, surgical options such as ulnar nerve decompression or anterior transposition may be considered. Understanding the relationship between sulcus ulnaris syndrome and cubital tunnel syndrome helps clinicians determine the specific site of compression and choose the most effective treatment approach.