Ulnar neuritis refers to inflammation and irritation of the ulnar nerve. This is a common injury in overhead-throwing athletes, including quarterbacks. This nerve runs along the inside of the elbow, through a narrow passage called the cubital tunnel, and controls sensation in the ring and pinky fingers, as well as important forearm and hand muscles.
In this blog, I’ll break down what quarterbacks need to know about ulnar neuritis: what causes it, how to recognize it, how to treat it, and most importantly, how to prevent it.
Anatomy of the Ulnar Nerve
The ulnar nerve originates in the neck (C8-T1 nerve roots) and travels down the arm, passing through the cubital tunnel at the elbow. This is a vulnerable spot, especially when the elbow is repeatedly bent and straightened, as happens with every throw a quarterback makes.
Key Anatomy Points:
Path: Neck → Arm → Cubital Tunnel (Elbow) → Hand
Function:
Motor innervation to part of the forearm and majority of the hand.
Sensory innervation to the medial forearm, medial wrist, pinky, and ½ of the ring finger.
Why Quarterbacks Are at Risk
Repetitive throwing, especially with incorrect fundamentals, can place stress on the medial elbow — which in turn can irritate and inflame the ulnar nerve.
Common contributing factors:
Repetitive Elbow Flexion: Each time you throw, the elbow flexes and extends, causing the ulnar nerve to stretch and rub within the cubital tunnel.
Valgus Stress: The throwing motion itself applies a significant valgus (outward) force to the elbow, placing tension on the ulnar nerve.
Direct Pressure: Hitting the elbow during play can place direct pressure on the ulnar nerve.
Instability: Prior elbow injuries, particularly to the ulnar collateral ligament (UCL), can increase nerve movement within the tunnel — further increasing irritation risk.
Signs & Symptoms
Tingling or numbness in the ring and pinky fingers, especially after throwing.
Inner elbow pain, particularly after high-volume throwing sessions.
Decreased grip strength.
Loss of fine motor control.
Symptoms worsen with prolonged elbow flexion, like holding a phone.
Diagnostics
Physical Exam with a healthcare provider: Often includes testing for sensation, grip strength, and provoking nerve irritation.
Tinel’s Sign: Tapping over the cubital tunnel to reproduce symptoms.
Elbow Flexion Test: Holding the elbow in flexion to provoke symptoms.
Nerve Conduction Studies: In persistent cases, these tests assess nerve speed and function.
Imaging (if needed): Ultrasound or MRI can evaluate nerve position and detect underlying structural problems (such as UCL injury).
Treatment
Activity Modification
Rest from throwing if symptoms are acute. Rest can help reduce local inflammation in the area. If you are able to take several weeks off then it might speed up long term recovery.
Modify throwing programs to reduce volume, especially during the recovery phase.
Night Splinting
Elbow extension splints worn at night prevent prolonged flexion (a common aggravator).
Physical Therapy Program
A structured rehab program helps restore mobility, improve flexibility, and rebuild strength while protecting the nerve.
Common rehab exercises:
Ulnar Nerve Glides
Wrist Flexor Stretch
Reverse Forearm Rockers
Side Rockers
Eccentric Wrist Curls
Banded Pronation and Supination
Triceps Stretch
PVC Pronation and Supination
Anti-inflammatory Medications
Oral NSAIDs (like ibuprofen) can help reduce acute inflammation and aid in pain relief. Consult healthcare provider before taking.
Injections (Case-by-Case)
If other conservative measures fail, in some cases, a corticosteroid injection around the nerve can reduce swelling. However, this is used sparingly in throwing athletes due to risk of tissue weakening.
Surgery (if Needed)
If symptoms persist despite 3-6 months of conservative care and all other options have failed then surgical options may be considered:
Ulnar Nerve Decompression: Removing tight tissue compressing the nerve.
Ulnar Nerve Transposition: Moving the nerve out of the cubital tunnel to a safer position.
Biomechanics & Strength Training to Prevent Ulnar Neuritis
A well-refined throwing motion helps minimize medial elbow stress and protect the ulnar nerve. Key points for quarterbacks to reduce arm pain when throwing:
Efficient Arm Slot: Maintaining a natural ¾ arm slot (neither too high nor too low) helps distribute stress evenly across the elbow.
Lead with the Lower Half: Proper sequencing — generating power from the hips and trunk — reduces over-reliance and stress on the arm/elbow.
Avoid Forcing Excessive Layback: Over-stressing the elbow into extreme external rotation (late cocking phase) increases valgus stress. This is often seen when trying to force a QB into layback they cannot comfortably get into.
Steady Off-side: opening the off-side wide and flying the chest open will often result in less force generation through hip and torso rotation and more stress on the arm/elbow.
Short and efficient stride step: a long stride step results in less rotation in the hips which will often place more strain on the arm to generate force during the throw.
Deceleration and Follow-Through: A controlled follow-through reduces deceleration stress at the elbow. Weakness in internal rotation in the shoulder will often result in the elbow having to take a large % of “shock absorption” during deceleration. Strength through shoulder internal rotation helps to properly decelerate the arm and prevent excessive stress at the elbow
Targeted Strength Training
A quarterback’s elbow health starts at the shoulder and core. Here are some areas to focus on:
Scapular Stability
Ys, Ts, Ws
Serratus Punches
Bear Hold + Scapular Ts
Rotator Cuff Strengthening
Banded Arm Care Series (Available on drill library)
Club Swings (Available on drill library)
Essential Arm Care (Available on drill library)
Core Power & Stability
Pallof Press
Pallof Hold
Cable Trunk Rotations
Med Ball Lateral Oblique Throws (Available on drill library)
PVC ISO Holds (Available on drill library)
Dead Bugs (Available on drill library)
Feet Elevated SB Plank SAW (Available on drill library)
Forearm/Wrist Strengthening
Eccentric Wrist Curls
Banded Pronation and Supination
PVC Pronation and Supination
Farmer Carries (Available on drill library)
Flexibility & Recovery
Post-Throw Stretching: Focus on triceps, forearms, and pecs.
Nerve Glides as Maintenance: Even after symptoms resolve, periodic nerve gliding maintains healthy nerve mobility.
Final Takeaways
Ulnar neuritis doesn’t have to derail your season — but ignoring the warning signs can turn a minor nerve irritation into a chronic performance-limiting injury. For quarterbacks, protecting your elbow is about:
Perfecting your mechanics.
Optimizing full-body strength and mobility.
Listening to your body and managing throwing volume appropriately.
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