Orthotropic steel decks (OSDs) are commonly used in the construction of bridges due to their load-bearing capabilities. However, they are prone to fatigue damage over time due to the cyclic loads from vehicles. Therefore, the early structural health monitoring of fatigue damage in OSDs is crucial for ensuring bridge safety. Moreover, Lamb waves, as elastic waves propagating in OSD plate-like structures, are characterized by their long propagation distances and minimal attenuation. This paper introduces a method of emitting high-energy ultrasonic waves onto the OSD surface to capture the nonlinear Lamb waves formed, thereby calculating the nonlinear parameters. These parameters are then correlated with the fatigue damage endured, forming a damage index (DI) for monitoring the fatigue life of OSDs. Experimental results indicate that as fatigue damage increases, the nonlinear parameters exhibit a significant initial increase followed by a decrease. The behavior is distinct from the characteristic parameters of linear ultrasound (velocity and energy), which also exhibit changes but to a relatively smaller extent. The proposed DI and fatigue life based on nonlinear parameters can be fitted with a Gaussian curve, with the R-squared value of the fitting curve being close to 1. Additionally, this paper discusses the influence of rib welds within the OSDs on the DI, whereby as fatigue damage increases, it enlarges the value of the nonlinear parameters without altering their trend. The proposed method provides a more effective approach for monitoring early fatigue damage in OSDs.