Compressive neuropathy of the ulnar nerve. Treatment of ulnar nerve neuropathy

Ulnar nerve damage with the loss of it functional abilities defined as neuropathy. The disease distorts the sensitivity of the hand and reduces the performance of its individual muscles. Neuropathy includes two main pressure syndromes ulnar nerve– Guyon's canal syndrome and cubital canal syndrome.

Anatomical data

To more clearly understand the essence of the problem, you need to imagine the location of the ulnar nerve. Comes out from the cervical plexus nerve ganglia and, going down through armpit and through the entire hand, reaching the fingers. It innervates not only the skin of the little finger and a small area of the palm up to the ring finger, but also controls some of the muscles responsible for the work of the hand. The nerve wraps around the elbow slightly from the inside and behind - this place is called the cubital canal (or cubital), which is formed by muscle tendons, ligaments and bones. Exiting to the wrist, the nerve crosses Guyon's canal, formed by the two carpal bones and the ligament between them. These two channels are directly related to ulnar neuropathy.

What causes neuropathy?

The ulnar nerve is damaged when:

Dislocations and fractures of the humerus, hand and forearm bones;

Infringement in the area of the cubital canal and Guyon's canal.

Most often, it is the ulnar nerve that is pinched. The causes of nerve entrapment within the cubital canal are:

Frequently repeated intense bending of the elbow joint;

Any activity associated with constant forced reliance on the elbow;

Long-term intravenous infusions when the arm is constantly strongly extended (for example, in seriously ill patients).

The causes of ulnar carpal syndrome (compression of the nerve in Guyon's canal) are:

Occupational diseases associated with hand strain;

Constant walking with a cane;

Long-term motorcycle or bicycle riding at a professional level of intensity;

Aneurysms, tumors, enlarged lymph nodes, arthritis and arthrosis of the elbow or wrist joints.

Symptomatic manifestations of neuropathy.

Symptoms are classified according to the location of the ulnar nerve lesion.

Symptoms of cubital tunnel syndrome:

Pain, tingling, twitching or burning in the cubital fossa, radiating to the forearm and little finger;

Increased pain and discomfort during bending of the arm, transition to pronounced and constant pain;

Impaired sensitivity of the ulnar side of the forearm towards the little finger;

Violation motor functions in the area of the elbow when bent, as well as the ring and little fingers when clenching the palm into a fist (hard, painful or impossible);

In case of long absence normal function muscle atrophy progresses on the nerve, the hand loses weight to the level of the middle finger with the normal appearance of its second half;

Transformation of the hand into a “bird” or “clawed” one.

Symptoms of Guyon's canal syndrome are minor, but similar to cubital canal syndrome. However, there are a number of differences by which they are differentiated:

Pain with paresthesia increases with flexion of the hand and does not change with flexion of the elbow;

Sensory disorders do not extend to the back of the entire hand;

Little finger with ring finger they also lose their sensitivity on the palmar part;

Impaired motor activity: inability to press fingers to the palm, spread them to the side, cannot bring them together thumb with palm;

- the hand does not always become “clawed”;

Muscle atrophy from lack of normal nerve function.

Guyon's canal does not compress the entire nerve, but its individual fibers, so symptoms can appear separately, i.e., for example, only motor or only sensory disorders. If you do not consult a doctor in time, the symptoms become mixed.

If the ulnar nerve is damaged in any other place of passage, the symptoms will be similar to the syndromes described above. For a forearm fracture or humerus disorders of innervation and function will be noted in elbow area forearm, hand, little finger and middle finger. Due to weakness muscle tone bending the hand will be difficult. Fractures and dislocations allow a diagnosis to be made quickly and more accurately in terms of neuropathy, because the cause of the symptoms on the face.

Diagnosis of ulnar neuropathy.

To make a diagnosis, examination and a tapping test are necessary. Using this diagnostic technique, you can determine in which of the canals the nerve is pinched. The idea is to lightly tap the suspected areas of nerve compression with a neurological hammer. As a result, there are clinical symptoms in specific places and specific characteristics, in accordance with the channel.

The method of electroneuromyography has proven itself well, with the help of which the level of damage to nerve fibers is determined and the damage to the nerve roots is differentiated from damage to the trunk. ulnar nerve. With a competent and attentive approach, it will not be difficult for a doctor to diagnose ulnar nerve neuropathy.

Healing procedures.

Complex medical procedures for ulnar nerve neuropathy will directly depend on the cause that caused this pathology.

If the cause is a fracture, as a result of which the nerve was severed, then surgical intervention restoration of the integrity of the nerve cannot be avoided. The nerve will be sutured, but it will take up to six months to restore its functionality. Duration recovery period and the prognosis will depend on how quickly the integrity of the nerve was restored.

With prolonged compression of the nerve in different localizations Treatment begins with conservative methods. If ineffective conservative treatment transition to surgical intervention is possible.

Ulnar nerve neuritis is an inflammatory process of various etiologies, which affects peripheral nerve fibers and is manifested by pain, numbness, loss of function of the innervated muscles; — treatment is complex and includes medication and physiotherapeutic procedures.

Etiology

The ulnar nerve arises from brachial plexus together with the radial one, it descends down the medial side of the shoulder and passes through the posterior surface of the medial epicondyle to the forearm and hand. It carries nerve impulses to deep muscles flexors of the hand and fingers, is responsible for the work of the muscles of the little finger and brings the index, ring and little fingers to the middle. The most common diseases that affect this nerve are neuritis and neuralgia.

Ulnar neuritis is considered a human disease that most time spent in the office. This is due to the fact that such workers are accustomed to leaning on their elbow and can over time injure the ulnar nerve, which runs shallow in this place.

The radial nerve passes next to the ulnar nerve, which can also be affected by long-term compression, for example, during sleep. That's why clinical picture may simultaneously resemble neuralgia of the radial and ulnar nerves.

Other reasons include any infectious agent, hypothermia, damage nerve tissue toxic substances, including chronic consumption of alcoholic beverages. Special place occupies post-traumatic neuritis.

Also some somatic diseases may cause neuritis. For example, diabetes, insufficient output thyroid hormone.

Manifestations

In ICD 10, neuritis and neuropathy are not distinguished separately. Both of these diseases are included in the definition of ulnar nerve damage.

Ulnar nerve neuritis is manifested by numbness of the arm in the part innervated by this nerve. This symptom is short-lived and may be followed by tingling or a burning sensation in the area. Numbness can be complete or partial and sometimes ends with convulsions.

Also noticeably reduced physical activity
in the injured hand, until paralysis occurs. It is difficult for the patient to bend his arm in the hand; it is difficult for him to bring his fingers towards each other. These symptoms are explained not only by a decrease in innervation, but also by a violation of tissue trophism. Subsequently after adequate treatment I can be residual effects in the form of decreased reflexes or muscle weakness.

Malnutrition is also manifested by swelling, bluish skin, local hair loss and increased brittleness of nails. This is due to impaired tissue nutrition and treatment of diseases of the ulnar nerve should include measures aimed at eliminating these symptoms.

A pathognomonic symptom is drooping of the hand, as well as the inability to bend the fingers into a fist. Upon examination, the hand has next view: The fourth and third fingers are bent, the little finger is pointed to the side.

If the patient's main symptom is pain and impaired movement, and there are no autonomic disorders, then we can talk about neuralgia of the ulnar nerve. Pain and numbness in most cases is present in the little finger and ring finger.

Diagnostics

To make a diagnosis of ulnar neuritis
nerve and treat it, in addition to an external examination and history taking, you can ask the patient to perform a few simple steps.

The patient should press his palm with his fingers apart to the surface of the table and try to scratch it with his little finger. A person with inflammation of the ulnar nerve will not be able to do this;
Also, the patient cannot comply with the request to spread his fingers in different directions;
If the ulnar nerve is inflamed, you cannot bend your fist completely and squeeze a piece of paper with two fingers.

These simple tests help to accurately determine nerve damage. Differential diagnosis must be performed with damage to the radial nerve. If it is damaged, the patient's hand hangs down and cannot be straightened independently. Also, with neuralgia of the radial nerve, the thumb is brought to the index finger and there is a sensitivity disorder in the first three fingers of the hand.

Also as additional method diagnostics, electromyography can be performed to determine the degree of muscle damage.

Therapy methods

Treatment of ulnar nerve neuritis can begin with restoring fixation of the hand using a plaster splint, while the arm remains bent and suspended by the neck in a scarf.

Also, treatment should be aimed at eliminating the cause that caused the inflammation of the nerve. It is necessary to prescribe antiviral or antibacterial drugs for infectious diseases. In cases of circulatory and tissue trophism problems, papaverine is used.

As in the treatment of any disease of the nervous tissue, B vitamins and potassium-sparing diuretics are prescribed to relieve swelling.

A special place in the treatment of neuritis and neuralgia is given to physiotherapeutic restorative procedures. They are aimed at improving the trophism of nervous tissue and maintaining the tone of the muscles of the forearm and wrist.

From the second week of drug treatment, it is worth prescribing electrophoresis with medicinal substances, UHF and pulse currents.

The doctor should also teach the patient the technique of self-massage, which can be done independently at home. You need to start by rubbing the phalanges of the fingers, flexion and extension movements in the joints of the fingers and hand.

For preventive and general strengthening purposes, it is advisable to avoid hypothermia and repeated exposure to a traumatic agent. People who work in an office should try to conduct less sedentary image life and introduce active breaks into your life ( a short walk, office gymnastics).

Lesions of different etiologies n. ulnaris, accompanied by a violation of its sensory and motor functions. It manifests itself as weakness when trying to clench your hand into a fist and hold objects with your hand, lack of sensitivity in the skin of the fifth and partially fourth fingers, atrophy of the hypotenor and small muscles of the hand, appearance brushes, similar to a clawed paw. Diagnosis of ulnar neuropathy relies on the results of neurological examination, electrophysiological testing, and x-rays of bones and joints. Therapeutic tactics are built taking into account the genesis of neuropathy and can include both medication and physiotherapeutic methods, as well as surgical treatment.

General information

Ulnar nerve neuropathy is a fairly common lesion of the peripheral nervous system. It often accompanies injuries to the area elbow joint, and therefore occurs not only in the practice of neurologists, but also in specialists in the field of traumatology.

The anatomical location of the ulnar nerve is such that the most vulnerable place is its section, localized in the area of the elbow joint in the so-called. cubital (ulnar) canal. The symptom complex of compression of the ulnar nerve in this canal is called cubital tunnel syndrome in neurology. Among all neuropathies of compression origin, it ranks second (the first belongs to carpal tunnel syndrome, one of the variants of median nerve neuropathy).

Anatomy of the ulnar nerve

The nerve originates in the medial fascicle (C7-C8, Th1) of the brachial plexus. Without giving up branches, it passes through inside shoulder, then passes to its posteromedial surface. In the area of the elbow joint it runs along the posterior surface of the internal epicondyle of the shoulder, where it is actually subcutaneous. Then it enters the cubital canal formed by the olecranon process, internal epicondyle, ligament and tendons of the forearm muscles.

Elbow to wrist n. ulnaris runs along the medial edge inner surface forearms. Here it gives motor branches to the medial portion of the flexor digitorum muscle and the flexor carpi ulnaris muscle. At the head ulna the nerve gives off a dorsal branch that innervates the skin of the ulnar side of the dorsum of the hand, back surface V, IV and partially III fingers. Moving to the palm, n. ulnaris is divided into superficial and deep branches. The first is responsible for sensory perception of the skin of the little finger and the half of the ring finger facing it. The second is for the innervation of the hypotenor muscles and small muscles of the hand, as well as the joints, ligaments and bones of the hand. After originating from the ulnar nerve, the deep branch passes through Guyon's canal, located between the pisiform bone and the metacarpal palmar ligament.

Causes of ulnar nerve neuropathy

The most common mechanisms for the development of ulnar neuropathy are traumatic injury to the nerve and its compression in the cubital canal. Nerve injury may be accompanied by: arm bruise, forearm dislocation, supracondylar fracture of the shoulder, fracture of the medial condyle of the shoulder, fracture of the forearm, isolated fracture of the ulna or fracture of the olecranon, dislocation of the hand. Cubital tunnel syndrome often occurs in people who are accustomed to resting on their elbow. For example, resting your elbow on a desk, a machine, the side of a car door, etc.

Compression of the nerve in the cubital canal and Guyon's canal is possible with inflammatory or anatomical changes structures that form these channels. Thus, compression neuropathy of the ulnar nerve can be observed with osteoma, sprain, synovitis, tendovaginitis, deforming osteoarthritis, rheumatoid arthritis, osteodystrophy, bursitis of the elbow joint, post-traumatic arthrosis of the wrist joint and other diseases. Work associated with prolonged pressure of instruments (screwdriver, hammer, scissors, forceps, etc.) on this area can provoke ulnar neuropathy at the level of Guyon’s canal.

Symptoms of ulnar nerve neuropathy

Defeat n. ulnaris at the level of the cubital canal is characterized by weakness in the hand, which manifests itself when trying to pick up something in the hand (for example, lift a kettle from the stove), play the piano, type on the keyboard, etc. Sensory disturbances are manifested by a feeling of numbness in the little finger, partially in the ring finger and the ulnar edge of the palm. Typically there is a feeling of discomfort in the area of the elbow joint, often pain in it, radiating into the hand along the ulnar edge of the forearm. Often, an increase in the listed symptoms is observed in the morning, which is associated with the habit of many patients to sleep with their hands under the pillow or under the head, which means bending them at the elbow joints.

On examination, attention is drawn to the hypotrophy of the hypotenor and small muscles of the palm, the position of the fingers in the form of a clawed paw (the main phalanges are in extension, and the middle ones are bent).

Ulnar neuropathy in Guyon's canal has similar manifestations. The difference is localization pain syndrome only in the area of the base of the hand and hypotenor, the presence of sensory disorders exclusively on the palmar surface of the little finger and half of the ring finger with complete preservation of the sensitivity of the dorsum of the hand.

Diagnosis of ulnar nerve neuropathy

IN acute period ulnar nerve neuropathy important point is the exclusion/limitation of static and dynamic loads that enhance pathological manifestations diseases. For patients suffering from cubital tunnel syndrome, to limit flexion of the arm at the elbow during night sleep, it is recommended to bandage a rolled towel to the flexor surface of the elbow. Subsequently, when it subsides inflammatory process and to reduce pain, a special exercise therapy complex is prescribed.

Ulnar nerve neuropathy - lesions of various etiologies n. ulnaris, accompanied by a violation of its sensory and motor functions. It is manifested by weakness when trying to clench the hand into a fist and hold objects with the hand, lack of sensitivity of the skin of the fifth and partially fourth fingers, atrophy of the hypotenor and small muscles of the hand, and the appearance of the hand, similar to a clawed paw.
In the diagnosis of ulnar neuropathy, they rely on the results of a neurological examination, electrophysiological testing, and radiography of bones and joints.
Treatment tactics are built taking into account the genesis of neuropathy and can include both medication and physiotherapeutic methods, as well as surgical treatment.

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Ulnar nerve neuropathy is a fairly common lesion of the peripheral nervous system. It often accompanies injuries to the elbow joint, and therefore occurs not only in the practice of neurologists, but also in specialists in the field of traumatology.

The anatomical location of the ulnar nerve is such that the most vulnerable place is its area, localized in the area of the elbow joint in the so-called. cubital (ulnar) canal. The symptom complex of compression of the ulnar nerve in this canal is called cubital tunnel syndrome in neurology. Among all neuropathies of compression origin, it ranks second (the first belongs to carpal tunnel syndrome, one of the variants of median nerve neuropathy).

Anatomy of the ulnar nerve

The nerve originates in the medial bundle (C7-C8, Th1) of the brachial plexus. Without giving off branches, it passes along the inside of the shoulder, then passes to its posteromedial surface. In the area of the elbow joint it runs along the posterior surface of the internal epicondyle of the shoulder, where it is actually subcutaneous. Then it enters the cubital canal formed by the olecranon process, internal epicondyle, ligament and tendons of the forearm muscles.

From elbow to wrist n. ulnaris runs along the medial edge of the inner surface of the forearm. Here it gives motor branches to the medial portion of the flexor digitorum muscle and the flexor carpi ulnaris muscle. At the head of the ulna, the nerve gives off a dorsal branch that innervates the skin of the ulnar side of the dorsum of the hand, the dorsal surface of the fifth, fourth and partially third fingers. Moving to the palm, n. ulnaris is divided into superficial and deep branches.
The first is responsible for sensory perception of the skin of the little finger and the half of the ring finger facing it.
The second is for the innervation of the hypotenor muscles and small muscles of the hand, as well as joints, ligaments and bones of the hand. After originating from the ulnar nerve, the deep branch passes through Guyon's canal, located between the pisiform bone and the metacarpal palmar ligament.

Causes of ulnar nerve neuropathy

The most common mechanisms for the development of ulnar neuropathy are traumatic injury nerve and its compression in the cubital canal. Nerve injury may be accompanied by: arm contusion, forearm dislocation, supracondylar fracture of the humerus, fracture of the medial condyle of the humerus, fracture of the forearm, isolated fracture of the ulna or fracture olecranon, dislocation of the hand. Cubital tunnel syndrome often occurs in people who are accustomed to resting on their elbow. For example, resting your elbow on a desk, a machine, the side of a car door, etc.

Compression of the nerve in the ulnar canal and Guyon’s canal is possible due to inflammatory or anatomical changes in the structures that form these canals. Thus, compression neuropathy of the ulnar nerve can be observed with osteoma, sprain, synovitis, tendovaginitis, deforming osteoarthritis, rheumatoid arthritis, osteodystrophy, bursitis of the elbow joint, post-traumatic arthrosis of the wrist joint and other diseases. Work associated with prolonged pressure of instruments (screwdriver, hammer, scissors, forceps, etc.) on this area can provoke ulnar neuropathy at the level of Guyon’s canal.

Symptoms of ulnar nerve neuropathy

During inspection, pays attention hypotrophy of the hypotenor and small muscles of the palm, the position of the fingers in the form of a clawed paw (the main phalanges are in the extension position, and the middle ones are bent).

Ulnar neuropathy in Guyon's canal has similar manifestations. The difference is the localization of the pain syndrome only in the area of the base of the hand and hypotenor, the presence of sensory disorders exclusively on the palmar surface of the little finger and half of the ring finger, with complete preservation of the sensitivity of the dorsum of the hand.

Diagnosis of ulnar nerve neuropathy

During the study, the neurologist reveals hypoesthesia of the fifth and adjacent half of the fourth fingers; incomplete flexion of fingers V, IV and partly III when trying to form a fist; the presence of trigger points in the area of the medial epicondyle of the shoulder, along the radial nerve or in the area of the pisiform bone. To assess the range of movements in the hand, the patient is asked to place the hand with the palm of the hand on the table and, trying to keep it pressed to the table, try to “scratch” the table with the little finger, spread and close the fingers. Difficulty performing these movements, like the previous symptoms, indicates ulnar neuropathy.

Electromyography and electroneurography help to clarify the topic of damage to the radial nerve. Ultrasound nerve allows us to establish the etiology pathological changes underlying neuropathy, and the degree of compression of the nerve in the canals. Analysis of joint condition and bone structures carried out based on the results of radiography of the elbow joint, radiography of the forearm and wrist joint, if necessary.

Differentiate neuropathy n. ulnaris follows from neuropathies of the median and radial nerve, from polyneuropathy of various origins, from radicular syndrome, caused by damage to the lower cervical spine due to osteochondrosis, myelopathy, spondyloarthrosis and other pathologies.

Treatment of ulnar nerve neuropathy

Therapeutic tactics for ulnar neuropathy largely depend on the etiology of nerve damage. Surgical treatment required to remove tumors, hematomas, scars that compress the nerve trunk or cause compression of the musculoskeletal canal in which it passes. Surgical tactics are also used in the absence of the desired effect from conservative treatment. According to indications, nerve decompression, neurolysis, release of adhesions, nerve transposition, nerve tumor removal, and other operations are performed.

Conservative therapy involves the prescription of anti-inflammatory drugs (glucocorticoids, diclofenac, ketorolac), painkillers (metamizole sodium, injections local anesthetics), anticholinesterase drugs (ipidacrine, neostigmine, etc.), vasoactive agents ( a nicotinic acid, pentoxifylline), metabolites (vitamins B, alpha-lipoic acid).
Effectively complements drug treatment carrying out physiotherapy: UHF, phonophoresis, magnetic therapy. Fight with muscle atrophy carried out using massage and electrical myostimulation.

In the acute period of ulnar nerve neuropathy, an important point is the exclusion/limitation of static and dynamic loads, which enhance the pathological manifestations of the disease.
For patients suffering from cubital tunnel syndrome, to limit flexion of the arm at the elbow during night sleep, it is recommended to bandage a rolled towel to the flexor surface of the elbow.
Subsequently, when the inflammatory process subsides and the pain syndrome decreases, a special exercise therapy complex is prescribed.

Attention! the information on the site is not medical diagnosis, or a guide to action and is intended for informational purposes only.

Ulnar nerve neuritis– a fairly common phenomenon, ranking second in frequency of the disease among other types of neuritis. The ulnar nerve is one of the main nerves of the brachial plexus, which performs two functions: motor and sensory.

When it is damaged, both functions are impaired to one degree or another. The ulnar nerve is most vulnerable in the area of the elbow joint, and even simple compression (with prolonged support of the elbows on a table, armrests of chairs, etc.) can lead to its damage and inflammation. Reason ulnar neuritis may also cause injuries, wounds, infectious diseases. How to identify and treat ulnar nerve neuritis, we will consider further.

Symptoms of ulnar nerve neuritis

Ulnar nerve damage can be diagnosed by the following signs:

with the arm extended forward, the hand hangs down, resembling a “clawed paw”;
a feeling of numbness and tingling between the ring finger and little finger, which spreads along the ulnar edge of the hand to the wrist;
weakness of the hand muscles (impossible to grasp and hold an object);
when clenching your fingers into a fist, the third, fourth and fifth fingers do not bend completely;
when the hand fits tightly to the table, the little finger is removed from the surface, and it is also impossible to spread and bring the fingers in this position;
cyanosis, impaired sweating, local decrease in skin temperature in the area of the affected nerve.

In advanced stages of the disease, the hand on the injured arm begins to lose weight, become deformed, and the muscles atrophy.

Treatment of ulnar nerve neuritis

If you notice the first signs of ulnar nerve neuritis, you should immediately contact a neurologist, because in this case, only timely treatment will be the key to success.

First of all, if the ulnar nerve is damaged, a special splint is applied to the hand and forearm. The hand is fixed in the position of extreme straightening in wrist joint(the fingers are half bent), and the forearm and hand are suspended on a scarf.

As a rule, on the second day after applying the fixing bandage, they begin training. physical therapy to restore lost hand functions. Exercise therapy for ulnar nerve neuritis includes the following exercises:

Place your arm bent at the elbow on the table so that the forearm is perpendicular to the table. Alternately lower your thumb down and raise your index finger up, and vice versa.
The hand is in the same position. Forefinger lower down, and raise the middle one up, and then vice versa.
With your healthy hand, grab the main phalanges of the four fingers - from the index to the little finger. Bend and straighten the main and then middle phalanges.

Each exercise is performed 10 times.

You can also perform gymnastics in water by immersing your hand in a basin of warm water.

Along with this, a massage is performed to relieve pain and accelerate nerve conduction and sensitivity. Massage begin with cervicothoracic region spine, and then the entire limb is massaged using kneading, rubbing and vibration techniques.

Physiotherapeutic methods (electrophoresis, ultrasound, etc.) are used to eliminate pain and restore muscles. Also complex therapeutic measures includes taking vitamins B, C and. Good results are achieved at .

In cases where the condition does not improve long time(1 – 2 months), carried out surgical intervention. This may be suturing the nerve trunk, neurolysis of the ulnar nerve, or other surgical methods.