Causes of ulnar nerve neuropathy. Ulnar nerve neuropathy: diagnosis, causes and treatment

Anatomical structure Some zones through which the ulnar nerve passes create many prerequisites for its compression. Such places are the cubital canal (Mouchet's canal), formed by several structures in the elbow joint, and Guyon's canal, formed in the wrist. Compression nerve fibers in these areas leads to neuropathies ulnar nerve. These conditions are accompanied by a number of sensory disturbances and a decrease in the strength of some hand muscles.

Signs of ulnar nerve neuropathies depend on the location of the compression. In this regard, there are two variants of the course of this disease - cubital tunnel syndrome and Guyon's syndrome (ulnar wrist syndrome). Their manifestations are largely similar, but they also have characteristics. In this article we will introduce you to the causes, main manifestations and methods of treatment of such neuropathies.

Causes

There are many reasons for the development of ulnar nerve neuropathies. They are conventionally divided into two groups:

1. Post-traumatic neuropathies. Nerve damage is caused by a stretch, tear, or tear caused by a lateral elbow dislocation, elbow subluxation, or elbow dislocation with fracture. olecranon.
2. Compression neuropathies (cubital tunnel syndrome and Guyon's syndrome). Nerve compression can be caused by certain occupational skills or habits, or various diseases accompanied by inflammation, swelling or bone changes in the areas where the nerve passes.

Compression of the nerve in the cubital canal can be caused by:

• long-term intravenous infusions (droppers);
• the habit of resting your hand on the table surface during a long telephone conversation;
• frequent movements in the elbow joint;
• work in which the elbow rests on a machine, office table or other object for a long time;
• the habit of motorists to lean on the edge of an open window.

Compression of the nerve in Guyon's canal can be caused by:

• prolonged use of a cane;
• frequent driving of a motorcycle or bicycle;
• work associated with frequent use of various tools (pliers, screwdrivers, jackhammers, drills or other vibrating devices).

In addition to these factors, compression neuropathy can be caused by the following diseases and conditions:

• tumors;
• aneurysms of nearby vessels;
• bone deformities or connective tissue in the area of ​​the elbow joint after a fracture;
• , chondromatosis and chondromalacia;
• synovial cysts and thickening of tendon sheaths with tenosynovitis.

Symptoms

Symptoms of cubital tunnel syndrome:

• decreased sensitivity of the ulnar edge of the hand, ring finger and little finger;
• painful sensations in the ulnar fossa, spreading to the forearm, ulnar edge of the hand, ring finger and little finger, intensifying with movement in the elbow;
• paresthesia in the ulnar fossa, ring and little fingers, forearm, ulnar edge of the hand;
• movement disorders expressed in muscle weakness, difficulties in abducting and flexing the hand, flexing the ring finger and little finger;

Symptoms of Guyon's canal syndrome:

• decreased sensitivity of the ring and little fingers on the side of their palmar surface (with back side sensitivity preserved);
• painful sensations of the ring finger and little finger from their palmar surface, the ulnar edge of the hand and the wrist joint;
• paresthesia in the palmar surface of the ring and little fingers, the wrist joint and the ulnar edge of the hand;
• movement disorders, expressed in weak flexion of the ring and little fingers and difficulty bringing the fingers together and apart, thumb not brought to the palm;
• muscle atrophy and changes in its appearance(“clawed” or “bird” hand).

Diagnostics

In most cases, diagnosing neuropathies is not difficult. After interviewing and examining the patient, the doctor performs a tapping test. To do this, he lightly taps with a hammer on areas of possible compression of the nerve. If symptoms of compression are detected - pain, paresthesia - the presence of ulnar nerve neuropathy is confirmed.

Electroneuromyography can be used to determine the area of ​​damage to nerve fibers. The same method allows differential diagnosis between neuropathy and damage to the nerve roots that emerge from the vertebral foramina and form its trunk.

If it is necessary to identify bone defects, the patient is prescribed radiography or MRI. And to visualize the structural changes that occur in the nerve trunk at the entrance to the pinching canal, ultrasound is used.

Treatment

The choice of treatment method for ulnar nerve neuropathies is largely determined by the reasons for their development. When the nerve is torn as a result of fractures, surgery is performed to stitch it together. After this, the patient needs rehabilitation, which can take about six months. If nerve compression is caused by other reasons, then the patient is prescribed conservative therapy, and surgical intervention is recommended only if drug and physiotherapeutic treatment is ineffective.

Conservative therapy

If the ulnar nerve is compressed, it is recommended to wear fixing devices to limit compression during movements. For this purpose, special orthoses, bandages or splints can be used. Some of them can only be used at night.

If compression of nerve fibers is provoked by habits or movements that must be performed because of their professional activities, then the patient should completely abandon them. In addition, during treatment it is necessary to avoid movements that cause increased pain or other symptoms.

To eliminate pain and signs of inflammation at the onset of the disease, the following are prescribed:

• Indomethacin;
• Diclofenac;
• Nimesulide;
• Ibuprofen;
• Meloxicam et al.

For local anesthesia Versatis medicinal patch containing Lidocaine can be used.

In case of severe edema, diuretics (Furosemide), agents with anti-edematous and anti-inflammatory effects (L-lysine escinate) and capillary stabilizing agents (Cyclo-3-fort) are used to reduce compression.

To improve nerve nutrition, B vitamins are used:

• Combilipen;
• Neurorubin;
• Milgamma;
• Neurovitan et al.

If there are no signs of elimination inflammatory reaction Instead of non-steroidal anti-inflammatory drugs, a mixture of a solution of Hydrocortisone and local anesthetic(Lidocaine or Novocaine). In most cases, this procedure eliminates the symptoms of neuropathy and has a long-lasting therapeutic effect.

Drug treatment of neuropathies is complemented by physiotherapeutic procedures:

• acupuncture;
• electrophoresis with drugs;
• ultrasound;
• massage;
• physiotherapy;
• electromyostimulation.

Surgery

If conservative therapy is ineffective and there are pronounced scar changes in the area where the nerve passes through the canals, it is recommended to surgical intervention. The purpose of such operations is aimed at eliminating (cutting and removing) the structures that compress the ulnar nerve.

When there is compression in the cubital canal, its plasty is performed, part of the epicondyle is removed and a new canal is created to move the nerve. In cases of Guyon's canal syndrome, a dissection of the palmar carpal ligament above the canal is performed.

Performance surgery allows you to release the nerve from compression, but for full recovery all its lost functions, additional treatment is prescribed:

• medications - analgesics, drugs to improve nerve nutrition and conductivity, vitamins, diuretics;
• physiotherapeutic procedures;
• physiotherapy.

After the operation is completed, the patient’s arm is immobilized using a splint or splint for 7-10 days. After its removal, the patient is allowed to perform passive movements. After 3-4 weeks, active movements are allowed, and only after 2 months can weight-bearing exercises and throws be performed.

The duration of rehabilitation of a patient after such surgical interventions is about 3-6 months. The completeness of restoration of nerve function largely depends on the timeliness of treatment. In advanced cases, even surgical intervention does not allow complete rehabilitation, and some disturbances in sensitivity and movement will accompany the patient throughout his life.

Description:

Neuropathy or neuropathy is nerve damage that also causes impaired motor function. The ulnar nerve most often occurs as a result of compression.

The ulnar nerve is a branched structure of nerve fibers that emerge from spinal cord. It goes through armpit, shoulder, elbow and forearm, up to the flexor carpi ulnaris tendon.

The nerve passes through the Mouchet canal (cubital canal). Its peculiarity is its superficial location, which results in a high risk of compression and damage to the ulnar nerve.

Depending on the location of the nerve damage, symptoms can vary from pain to weakening of the fingers.

Causes of ulnar nerve neuropathy:

All causes of pinched nerves in the elbow joint can be divided into two large groups:

1. Post-traumatic neuropathy develops when the ulnar nerve is stretched, torn or ruptured when:
- subluxation of the elbow joint;
- lateral dislocation of the elbow;
- dislocation of the elbow joint anteriorly with a fracture of the olecranon process.

2. Compressive neuropathy: compression of the nerve trunk in narrow canals - cubital in the elbow joint and Guyon’s canal in the hand as a result of swelling, inflammation or changes in the bone or connective tissue structures of the canal with:

Rheumatoid arthritis;
- deforming arthrosis, chondromatosis;
- deformation of the bones or connective tissue wall of the canal in the area of ​​the healed fracture;
- tumors;
- thickening of tendon sheaths and synovial cysts with tenosynovitis;
- in Guyon's canal, the nerve can be compressed by the abductor digiti minimi muscle.

When a nerve is compressed in the hand area, the following symptoms are noted:

Pain in the area of ​​the first three fingers;
- temporary sensory disturbances;
- increased pain at night;
- impaired flexion of the little finger and ring finger;
- , decreasing the brush size.

Nerve damage in this area is also known as ulnar carpal syndrome. Due to the location of the ulnar nerve, symptoms appear specifically in the wrist area.

Diagnostics:

When examining a patient with suspected damage to the ulnar nerve, Froman tests are performed:

The patient is asked to put thumbs on the table top next to each other as if he were trying to hold the table top between his thumb and forefinger. Even a small degree of impairment of the motor portion of the ulnar nerve immediately becomes noticeable: the patient cannot hold the greater palm on the painful side straight, straightening it at the interphalangeal joint, placing both phalanges flat on the table surface.
The patient is asked to grab a sheet of paper or cardboard between the side surfaces thumbs so that your fingers remain straight. On the painful side, the finger will be bent at the interphalangeal joint.
Tinnel's sign (increased symptoms when tapping along the area of ​​the cubital canal) allows you to confirm a pinched nerve in the elbow joint.

Loss of sensitivity is detected by touching or lightly pricking the skin of various parts of the hands on both sides. In the affected hand, sensitivity is usually reduced or absent.

X-ray examination and MRI are performed to identify bone defects that may be causing nerve compression in the elbow or hand.

Ultrasound allows you to visualize (see) structural changes nerve trunk at the entrance to the canal that compresses it.

Electromyography can detect impulse conduction disturbances below the area of ​​nerve damage.

Treatment of ulnar nerve neuropathy:

Radial nerve neuropathy is treated comprehensively. Therapy includes:

Drug treatment;
- massage;
- exercises;
- a set of physiotherapeutic procedures.

Surgical treatment is used only in the case of organic pathology, which can be eliminated traditional methods impossible.

Non-steroidal anti-inflammatory drugs based on ibuprofen or diclofenac are used to relieve pain. With the help of these medications, inflammation and swelling of the tissues around the damaged canal are also successfully relieved.

For severe pain that cannot be relieved with pills, local injections of analgesics and medical blockades are used.

To improve the condition of nerve fibers, taking B vitamins is mandatory.

Physiotherapy.

For radial nerve neuropathy, treatment must be comprehensive, so doctors often resort to physical therapy. Most effective methods is ultrasound treatment, electrophoresis with lidocaine and stimulation methods muscle function using current.

If the ulnar nerve is damaged, treatment promotes:

Relieving swelling;
- improvement of local metabolic processes;
- acceleration of regeneration;
- restoration of motor function;
- prevention of muscle atrophy.

Physiotherapeutic methods are indicated only after acute pain and inflammation have been relieved.

A good effect can be achieved with massage or acupuncture. Preference should be given to methods that involve impact on pain points. This allows you to quickly improve your overall well-being and restore the motor function of the affected limb.

Neuropathy can be treated with exercise. This helps prevent muscle atrophy, improves local metabolic processes and helps to quickly restore motor activity.

It is recommended to supplement physiotherapy and massage with independent exercises. You can also ask the doctor to teach the patient the basics of self-massage techniques and additionally massage the sore arm at home.

Surgical treatment is used if the disease is associated with a narrowing of the canal through which the nerve passes. After the operation, there is a long period of rehabilitation, during which massage and physiotherapy are used to restore the motor function of the hand.

Prevention:

Prevention of neuropathy of the elbow and wrist consists in the absence of strong monotonous repetitive loads. Helps improve the condition of nerve fibers regular intake vitamin complexes.

When working with a load on the area in which the ulnar or radial nerve passes, you need to take a break and perform simple exercises. This will avoid channel compression. Professional athletes should periodically change the type of load, this will help prevent compression of the canal.

good preventative measure is massage and acupuncture (acupuncture).

The disease can become a complication after a fracture, dislocation or injury to the elbow. To prevent this from happening, it is necessary to undergo a timely examination and consult a doctor about prevention.

IN Lately All more people are faced with a pathology such as ulnar nerve neuritis. This disease is an inflammatory process that affects peripheral nerve fibers. And the ulnar nerve, which runs very close to the skin, is easily injured during normal activities. As a result, severe pain occurs, the performance of the arm and the sensitivity of the hand may be impaired. Treatment of neuritis should begin as early as possible, when the first symptoms appear.

general characteristics

Ulnar nerve neuritis is statistically the most common among similar diseases. After all, this nerve is the most vulnerable to external influences. Especially with the modern lifestyle, when people spend a lot of time leaning on their elbows. The ulnar nerve runs shallow in this area, so it is easily damaged. After all, even slight pressure on it can lead to inflammation.

Office workers, programmers and other people whose professional activities involve the need to rest their elbows on a table or chair armrests are most predisposed to the development of this pathology. In addition, neuritis is common in athletes who expose their hands to increased loads. But besides traumatic injury, the cause of inflammation may be hypothermia. Therefore, builders, loaders and other people who work in damp, cold conditions are susceptible to neuritis.

Causes

To properly treat this disease, it is necessary to determine why the inflammation occurred. Usually the cause of the pathology is immediately clear, especially if the neuritis is post-traumatic or occurs after hypothermia.

But there are other factors that can cause inflammation of the ulnar nerve:

• serious infectious and inflammatory diseases - measles, diphtheria, influenza, herpes;
• endocrine pathologies, especially dysfunction thyroid gland or diabetes mellitus;
• osteochondrosis or hernia intervertebral disc;
• lack of minerals and vitamins in the body;
• cardiovascular pathologies leading to circulatory disorders;
• intoxication as a result of ingestion large quantity certain medications, alcohol or salt poisoning heavy metals;
• arthritis, arthrosis and other diseases of the elbow joint.

The main signs of ulnar nerve neuritis are pain and numbness in the hand

Symptoms

The ulnar nerve is responsible for the innervation of the little and ring fingers, for the work of the muscles that adduct the pollicis, flex the wrist, and adductor and abductor all fingers. Therefore, its defeat immediately affects the functioning of the hand. Manifestations of neuritis depend on the degree and location inflammatory process. But the main symptom is always pain. At first it is aching, then it can become sharp, even burning or shooting.

Other symptoms of ulnar nerve neuritis depend on which nerve fibers are most affected. The disease usually begins with a loss of sensitivity.

Damage to sensory fibers is manifested by numbness, a tingling or crawling sensation. Sometimes the sensitivity of the hand is completely impaired. But most often these sensations are localized in the palm of the hand, as well as the 4th and 5th fingers.

Then signs of damage to the motor fibers of the nerve develop. Convulsions may occur and finger movement functions may be impaired. It is especially difficult to bend your hand or clench your fingers into a fist. Tendon reflexes gradually disappear, and paresis or complete paralysis of the hand appears. Because of this, muscle atrophy develops after some time.

In the absence of treatment, trophic disorders gradually appear. Due to damage to the autonomic nerve fibers, swelling develops, the skin turns blue, hair may begin to fall out, and nails may crumble. In the most advanced cases appear trophic ulcers.

Diagnostics

It is advisable to begin treatment of neuritis as early as possible, when the first signs of inflammation appear. Indeed, as the pathology progresses, atrophy of the hand muscles and complete loss of its functions are possible. Usually, a specialist can immediately determine the presence of neuritis, since the hand has a characteristic shape - like a clawed paw. The little finger is moved to the side, the 3rd and 4th fingers are bent.

To diagnose the disease, there are several tests that will help make a preliminary diagnosis without examination. The patient is asked to place the hand on the table and move the little finger, and also try to spread the fingers to the side. If the ulnar nerve is damaged, this cannot be done. The patient also cannot hold a sheet of paper between his thumb and forefinger, or clench his hand into a fist.

But it is still necessary to conduct an examination to confirm the diagnosis. Most often, MRI, ultrasound and electromyography are prescribed, which help determine the extent of muscle damage.

When making a diagnosis, attention is paid to the characteristic position of the hand in the form of a “clawed paw”

Treatment

Treatment of ulnar nerve neuritis should be comprehensive. First of all, the cause of the inflammatory process is determined, and measures are taken to eliminate it. If this infection, antibacterial or antiviral drugs, in case of circulatory problems, vasodilators are needed, for example, Papaverine. In addition, immediately after diagnosis, the arm is immobilized using a splint. The hand should be in a straight position, fingers bent. And the hand is suspended on a scarf or a special bandage. This immobilization is needed for 2 days. Limiting the load helps to avoid severe pain and prevents muscle atrophy.

After this they appoint complex treatment, which includes the following methods:

• reception medicines;
• physiotherapeutic procedures;
• massage;
• physiotherapy;
• folk recipes.

Drug therapy

On initial stage mandatory method Treatment is to take non-steroidal anti-inflammatory drugs. In addition to reducing inflammation, such medications help relieve pain, often very severe. Ketorol, Nimesulide, Indomethacin, Diclofenac are prescribed. If they do not help relieve pain, analgesics can be used, for example, Baralgin or corticosteroids - Prednisolone, Diprospan, Hydrocortisone. If neuritis is accompanied by tunnel syndrome, hormonal drugs are used as injections directly into the canal.

To improve the conduction of nerve impulses, Proserin or Physostigmine are used. And as an auxiliary therapy, it is necessary to prescribe B vitamins. Diuretics may be required to relieve swelling. Potassium-sparing agents are mainly used, for example, Veroshpiron. In addition, medications are prescribed that improve blood circulation and metabolic processes. Useful biogenic stimulants, for example, "Lidaza".

Physiotherapy helps relieve inflammation and restore muscle function

Physiotherapy

This treatment for ulnar nerve neuritis is the most effective method treatment. But physiotherapy is prescribed no earlier than a week after the first symptoms appear. To relieve pain and inflammation, electrophoresis with Novocaine or Lidase, ultraphonophoresis with Hydrocortisone, magnetic therapy, acupuncture, UHF, impulse currents, mud therapy. In addition, electrical myostimulation of the muscles innervated by the ulnar nerve is prescribed.

Physiotherapy

The use of special exercises begins after the fixator is removed. Both passive and active movements are used. the main objective gymnastics - prevent contractures and muscle atrophy, restore their function.

First, it is recommended to perform gymnastics in water. Most exercises focus on finger movements. The hand goes under the water, and with the healthy hand you need to take the fingers one at a time and bend the phalanges, lifting their top. In addition, circular movements and moving your fingers to the sides are useful. Do the same with the entire brush.

An important exercise aimed at developing a large and index finger. You need to place your elbow on the table. Try to simultaneously lower your thumb down and raise your index finger up. Then the same must be done with the index and middle fingers.

After the hand regains the ability to grasp objects, occupational therapy is carried out. Modeling, drawing, rearranging small objects, such as beads, matches, and catching them from the water are useful.

Passive and active finger exercises help restore finger function

ethnoscience

Such methods are used only as a means of auxiliary treatment. They are considered to be ineffective for neuritis. But they can relieve inflammation and reduce pain. Most often used various compresses, decoctions medicinal herbs:

• tie to a sore spot fresh leaves horseradish, burdock or cabbage;
• instead of ointment, you can use bear fat;
• at night, make a compress of red clay diluted with a small amount of table vinegar;
• drink 3 tablespoons of decoction of raspberry leaves and stems before meals.

If treatment is started on time, the prognosis is usually favorable. But full recovery occurs only after a couple of months. And then you need to monitor your health to prevent relapse of the disease. To do this, you need to avoid hypothermia and prolonged monotonous hand movements. You should try not to keep your arm bent at the elbow for a long time. Regular self-massage and therapeutic exercises will also help prevent nerve damage.

Ulnar nerve neuropathy is a disorder of the peripheral nervous system, arising due to various reasons. Traumatologists most often encounter this pathology, since as a result of mechanical impact on the elbow, a nerve is affected. The nerve trunk located in the elbow joint is compressed, and the function of the entire upper limb.

Anatomy

The ulnar nerve arises from the medial nerve bundle brachial plexus, located in the region of the last cervical and first thoracic vertebrae. Then he goes down inside shoulder and goes around the elbow joint, has no branches.

In the area just below the elbow, the nerve enters the cubital canal, which is formed by the olecranon process and the internal epicondyle, as well as ligaments and tendons. Moving from the elbow to the hand, the nerve branches - one branch goes to the flexor muscles of the fingers, the other to the flexor muscles of the hand. The third, dorsal branch innervates skin parts of the brush and outer surface 3-5 fingers.

When moving to the palm, the nerve of the elbow joint branches again, with one branch running superficially and responsible for the innervation of the skin of the 5th finger, the little finger, and partially the 4th, ring finger. The second branch is located deeper and innervates the muscles, ligaments and bones of the hand. It is this deep branch that passes through Guyon's canal, which is formed above and below by the ligament and bones of the wrist, and side surfaces form the pisiform and hamate bones.

The area of ​​the elbow joint where the nerve passes through the cubital (ulnar) canal is the most vulnerable

When the nerve in this area is damaged, the so-called cubital tunnel syndrome occurs. This pathology is the second most common after carpal tunnel syndrome (neuropathy median nerve).

Causes

It can be caused by injury or diseases of the musculoskeletal system. Post-traumatic neuropathy occurs due to:

• bruised limb;
• forearm dislocation;
• supracondylar fracture of the shoulder;
• fracture ulna;
• dislocation of the hand;
• olecranon fracture;
• deep cut on the hand.

Compressive neuropathy may occur with following states:

• bursitis;
• tenosynovitis;
• deforming osteoarthritis;
• rheumatoid arthritis;
• diabetes;
• neoplasms;
• illnesses bone marrow;
• chondromatosis.

After injury to the elbow, scars form in the healing area, which cause compression of the nerve trunk.

Nerve compression can occur in the cubital tunnel or Guyon's canal, which is located in the wrist. In this case, they talk about tunnel or carpal syndrome. The cause of neuropathy in Guyon's canal may be professional activity associated with prolonged support of the elbow on a working tool - a machine, workbench, or manual labor using screwdrivers, hammers, pliers, scissors, etc.

The development of compression neuropathy is more common in women, with the right ulnar nerve being affected in most cases. The disease can be triggered by hypothyroidism, complicated pregnancy, and endocrine disorders.

Secondary neuritis can occur as a result of surgical manipulations during the reduction of dislocations and the alignment of bone fragments during fractures. Sometimes the ulnar nerve is stretched and damaged during skeletal traction.

Symptoms

When the nerve in the cubital canal is damaged, hand weakness occurs, which manifests itself in the inability to grasp anything or hold an object. In addition, a person cannot perform actions that require active finger motor skills - typing on a keyboard, playing the piano, turning the pages of a book, etc.

Other symptoms of neuropathy include the following:

• loss of sensation in the 4th and 5th fingers, as well as the outer edge of the palm;
• discomfort and painful sensations in the elbow joint;
• pain syndrome can radiate into the arm below the elbow, mainly from the outside;
• in the morning the pain and discomfort intensify.

It is worth noting that pain and numbness after waking up are caused by bending the elbow during sleep or placing bent arms under the head. When bending the elbow joint, the nerve is compressed even more, the compression increases, and the condition of the limb worsens.

Damage to the ulnar nerve in Guyon's canal is characterized by similar symptoms, but in this case the elbow joint does not hurt and the hand does not lose sensitivity. The pain is localized at the beginning of the hand and in the area of ​​the eminence of the little finger, while numbness inner surface 5th and part of the 4th finger. Guyon's syndrome is also accompanied by impaired motor activity - the fingers bend poorly and are difficult to move apart.

Diagnostics

During the examination, a neurologist uses the Froman test: the patient pinches a piece of paper with his thumb and forefinger. U healthy people the fingers form a ring, but with damage to the ulnar nerve this does not happen, since the upper phalanx of the thumb is too much bent. If you lightly pull the paper with your other hand, it will immediately jump out of the clamp, since the innervation of the corresponding adductor pollicis brevis muscle is disrupted.

When performing the Froman test, excessive flexion of the phalanx of the thumb is detected

To assess the motor ability of the hand, the patient is asked to place his hand on the table, palm down, and, pressing it tightly, try to bend the little finger, spread and close the last two fingers. Difficulty performing these simple activities confirms the presence of neuropathy.

By tapping with a hammer or fingers, the doctor identifies the presence of hypoesthesia of the 4th and 5th fingers. Incomplete flexion of the 5th, 4th and partially the 3rd fingers, which prevents you from clenching your hand into a fist, also indicates pinching of the ulnar nerve. During the examination, trigger points (painful muscle thickening) along the nerve are also determined.

In order to clarify the extent of damage to the ulnar nerve, the doctor may order the following studies:

• magnetic resonance imaging;
• radiography of the elbow and wrist joints;
• Ultrasound of the nerve;
• electromyography;
• electroneurography;
• computed tomography.

Differential diagnosis is carried out with neuropathy of the median and radial nerve, polyneuropathy of various origins, radicular syndrome for pathologies cervical region spine, etc.

Treatment

Treatment of ulnar nerve neuropathy can be either conservative or surgical. Therapy without surgery involves the use of the following groups medicines:

• anti-inflammatory;
• glucocorticosteroid injections (if a nerve is pinched in Guyon’s canal);
• painkillers;
• anticholinesterase;
• vasoactive;
• vitamin complexes.

When the ulnar nerve is pinched, B vitamins are prescribed - they help improve metabolism and normalize blood circulation in the affected area

IN acute phase diseases physical activity limbs should be limited. It is necessary to completely eliminate static and dynamic loads on the hand so as not to provoke strengthening clinical symptoms. To avoid excessive bending of the elbow, patients are advised to tie a towel roll to the elbow at night.

After cupping acute symptoms ulnar nerve neuropathy continues to be treated with physiotherapeutic methods and is referred for following procedures:

• phonophoresis;
• magnetic therapy;
• electromyostimulation;
• limb massage;
• therapeutic exercises.

Conservative therapy is effective for initial stages neuropathy, when muscle dystrophy and persistent deformation of the fingers are not observed. Otherwise, surgical intervention is performed, during which scars, hematomas and tumors that compress the musculoskeletal canal or the nerve trunk itself are removed. If there is a high risk of re-injury to the elbow joint, the nerve is transferred from outside hands to the inside (transposition).

Excision of pathological structures is performed in case of ineffectiveness of conservative therapy. For patients who are unable to interrupt professional activity on long-term treatment, surgery is also recommended. For example, athletes cannot take a break from training for a long time if they plan to participate in important competitions and Olympics.

Immobilization of the elbow joint is necessary to avoid additional compression of the nerve during flexion of the arm.

IN rehabilitation period after surgical intervention are appointed medications, compresses with paraffin, thermal procedures and electrical myostimulation. In addition, the limbs are kept at rest for a week and a splint or splint is applied. After removing the fixator, passive movements of the joint are first introduced, and after about a month active movements of the arm are allowed. After another month, you can do weight-bearing exercises.

Treatment at home

There are several proven recipes that help relieve pain and inflammation using home remedies:

• Mix ½ cup of chopped horseradish or black radish and the same amount of potatoes and add 2 tbsp. l. honey Spread the resulting mixture thin layer on gauze and wrap. Apply to the sore arm for one hour;
• spicy tincture of bay leaf used for grinding and prepared as follows: 20 leaves are poured into a glass of vodka and left in a dark place for three days;
• 50 gr. propolis pour ½ cup of alcohol or vodka, leave for 7 days and shake periodically. After this, strain and add corn oil in a ratio of 1:5. Compresses with propolis are one of the most effective remedies; you can wear them without removing them all day long. The course of treatment is 10 days;
• pour rosemary leaves with vodka and leave in a dark place for 3 weeks, shaking from time to time. Then strain the infusion and rub it on your injured hand before going to bed;
• An infusion of cloves is best made in a thermos; to do this, you need to put a tablespoon of the dried plant in it and pour ½ liter hot water. After 2 hours you can take it. For two weeks, drink the infusion 3 times a day, one glass, then take a break for 10 days. The total duration of treatment is 6 months;
• Burdock root in the amount of one tablespoon is poured into a glass of red wine and left for two hours. You need to take the product 2 times a day, 1/3 cup;
• cocktail of alcohol, camphor and sea ​​salt for compresses prepare as follows: 150 gr. ammonia, 50 gr. camphor, 1 glass of medical alcohol is diluted with a liter of water and a glass of sea salt is poured into the solution. Before each use, the jar of cocktail should be shaken, and a compress of gauze or bandage soaked in the solution should be applied to the sore arm 3 times a day.

Propolis is very effective remedy to combat many ailments, compresses with propolis help relieve inflammation and accelerate tissue regeneration

Hydromassage

To restore impaired limb functions, it is recommended to massage in water:

• the sore hand is lowered into the water, and with the healthy hand they press on the phalanges of the fingers, trying to straighten them;
• with the help of a healthy hand, each finger is lifted in turn;
• make rotational movements with your fingers alternately to the left and right sides;
• circular movements with the hand (you can help with your healthy hand if it doesn’t work yet);
• raising and lowering the hand;
• the hand is placed perpendicular to the bottom on the tips of the fingers, in this position the healthy hand bends and straightens the fingers;
• You need to put an object at the bottom of a container of water and try to pick it up with your sore hand. First, the item must be large enough - a towel or large sponge will do. As recovery progresses, smaller and different shaped objects are placed.

All exercises are performed 10 times, there are no restrictions on the number of approaches.

To speed up recovery process A regular massage will also be very useful, with the help of which blood circulation is normalized and congestion.

You can massage your arm yourself or ask someone to do it; no special skills are required in this case.

Therapeutic exercises

Will help restore volume and tone to muscles special exercises:

• sit at the table so that your shoulder lies completely on the table, and bend your arm at the elbow. Place your thumb down while raising your index finger. Then vice versa - forefinger goes down, and the big one goes up;
• sitting in the same position, raise middle finger, lowering the index finger down. And in the reverse order: middle - down, index - up;
• Grab the main phalanges of all fingers, except the thumb, with your healthy hand. Bend the captured fingers at the main, lower joints 10 times. Then repeat the same with the middle phalanges, bending and unbending them with your healthy hand;
• With your healthy hand, clench and unclench the hand of your injured hand into a fist.

The number of repetitions of each exercise is 10 times.

To prevent ulnar nerve neuropathy, it is necessary to avoid injury to the limb as much as possible, avoid hypothermia, and maintain immunity. To increase protective functions body, it is recommended to eat a healthy and balanced diet, exercise regularly and not neglect hardening procedures.

A tumor such as a neuroma of the ulnar nerve causes the development of neuropathy with pain and loss of motor and sensory function of the 4th and 5th fingers. The problem can be eliminated through surgery. After it is carried out, it is recommended to take non-steroidal anti-inflammatory drugs that reduce unpleasant symptoms and contribute to the speedy recovery of hand function.

With neuropathy, sensitivity and motor activity of several fingers are lost.

Compressive neuropathy also causes ulnar nerve palsy.

Causes of the disease

The immediate cause of the development of neuropathy is trauma, which occurs as a result lateral dislocation or fracture of the olecranon, as well as other types of damage. More often this phenomenon is observed when a person falls on bent arms and legs. This injury is combined with a lesion knee joint. This pathology can also be provoked prolonged compression nerve roots, which is caused by compression of the nerve in Guyon's canal. The development of these diseases is influenced by the type labor activity and the patient's lifestyle.

In addition, the following predisposing factors for the occurrence of neuropathy can be identified:

• arthritis;
• autoimmune disorders;
• tumors;
• pathologies of vessels that are located nearby;
• dystrophy cartilage tissue joints;
• history of elbow or hand fractures;
• long-term intravenous infusions;
• inflammation of the synovium.

Trauma or prolonged hypoxia of nerve fibers has a demyelinating effect and also causes hemorrhage in the nerve tissue. As a result, impulses are transmitted through neurons very slowly, and sometimes this process is completely disrupted. Compression-ischemic neuropathy of the ulnar nerve is associated with damage to these formations due to anatomical features structure of the upper limb, since in these places bone tissue are located as close as possible to the nerve fibers.

Symptoms of ulnar nerve neuropathy

For damage to the canal in the hand area it is typical:

• the appearance of symptoms observed after a hand injury;
• increased pain when bending the palm;
• muscle atrophy of the arm below the wrist.

Damage to the ulnar nerve, which manifests itself as cubital tunnel syndrome, has the following distinctive features:

• pain in the elbow area;
• decrease muscle mass arms below the elbow;
• increased pain when bending or damaging the elbow joint.

Damage to the right ulnar nerve is more common.

How is it diagnosed?

Neurolysis of the ulnar nerve can be suspected based on the presence of characteristic complaints in the patient and medical history. To confirm the diagnosis, an X-ray examination is used, with the help of which the displacement of the bone elements of the hand is clearly visualized, which has a traumatic effect. Soft tissue abnormalities can be identified by using ultrasound diagnostics, and in case of insufficient visualization, magnetic resonance imaging is used. Electromyography is used to determine the speed at which nerve impulses travel through fibers. In addition, the patient passes the mandatory minimum laboratory research - general analysis blood and urine.

Treatment of the problem

Since post-traumatic neuropathy of the radial nerve, ulnar plexus and median nerve are often combined, the therapy of the pathology consists of a complex impact on the problem that served as the impetus for the development of the process. Initially, it is necessary to eliminate the cause of permanent injury or compression of the fibers. Pain relief is performed through therapeutic effects or surgery. At the end of treatment, the patient needs a long course of rehabilitation using physiotherapy and therapeutic exercises.

Drugs

Compression of the nerve causes severe pain and symptoms of inflammation, which are eliminated through the use of non-steroidal anti-inflammatory drugs in the form of ointments or intramuscular injections. The patient is also shown multivitamins, neuroprotectors and substances that improve regional blood flow. For severe swelling, diuretics are used. Such procedures will help with minor manifestations of the pathology, but the cause of the neuropathy will remain, which is the risk of damage to the ulnar nerve again.

Carrying out the operation

Effective treatment for neuropathy involves surgery and enlargement of the ulnar nerve canal. The procedure is performed using an endoscope, which is inserted into a small incision in the skin along with all the necessary instruments. This minimizes the volume of the incision and the degree of tissue damage. The course of the operation consists of removing anatomical formations that cause a demyelinating effect on nerve fibers.

Ulnar nerve neuropathy according to ICD-10 is assigned code G56.2.

Prevention methods and prognosis

Pathology can be prevented by avoiding injury to the hand or its nerve plexuses. If inflammatory diseases or neoplasms are detected near the passage of nerves, they must be promptly eliminated. It is also important for the health of the nervous system proper nutrition with sufficient vitamin content. Tunnel neuropathy of the ulnar nerve with a long and progressive course causes paresis or paralysis of the limb with complete loss of its functions.