Ulnar nerve neuropathy treatment. Ulnar nerve neuropathy

Anatomical structure Some zones through which the ulnar nerve passes create many prerequisites for its compression. Such places are the cubital canal (Mouchet canal), formed by several structures in the area elbow joint, and Guyon's canal, formed in the wrist area. 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:

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.
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 inflammatory process, 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 long time leans on a machine, office table or other object;
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;
deformation of bones or connective tissue in 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:

reduced sensitivity of the ring and little fingers on the side of their palmar surface (while the sensitivity on the back side is 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 in bringing and spreading the fingers, the thumb is 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 for visualization structural changes that arise 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 It 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 caused by habits or movements that must be performed because of your professional activity, 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, surgical intervention is recommended. 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.

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 brachial plexus, which performs two functions: motor and sensitive.

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 Injuries, wounds, and infectious diseases can also serve. 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”;
feeling of numbness and tingling between ring finger and the little finger, which extends 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 physical therapy exercises to restore lost functions of the arm. 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 for a long time (1 – 2 months), surgical intervention is performed. This may be suturing the nerve trunk, neurolysis of the ulnar nerve, or other surgical methods.

Among lesions of the brachial plexus nerves, ulnar nerve neuropathy ranks second in frequency of occurrence. General damage to the ulnar nerve usually manifests as the claw toe symptom. The characteristic hand position is caused by atrophy of the muscles of the hand itself and paresis, hyperextension of the metacarpophalangeal joints of the fingers, as well as flexion in the case of the interphalangeal joints. The latter is most pronounced in the little finger and ring finger.

Noticeable is the loss of sensitivity in the area of the little finger, and also the ulnar end of the ring finger, as well as the ulnar end of the palm. The superficial location of the ulnar nerve in the area of the elbow joint makes it vulnerable during compression. A little lower, compression of the ulnar nerve in the elbow canal is possible. Prolonged compression of the base of the palm, for example, when using hand tools or when riding a bicycle, may also be accompanied by disruption of the deep branch of the ulnar nerve. As a result, weakness of one’s own muscles begins to develop, but there is no sensitivity disorder.

Ulnar nerve neuropathy.

In the ulnar nerve, neuropathy provokes compression of the nerve in the area of the elbow joint, which occurs in people who perform work with their elbows resting on a workbench, machine, desk, or even when sitting for prolonged periods with their hands placed on chair armrests. It is also possible that compression of the ulnar nerve may be localized at the level of the elbow joint in the ulnar groove of the median epicondyle or in the place where the nerve exits, where it is compressed by the fibrous arch, which is stretched between the heads of the flexor carpi ulnaris (the so-called ulnar nerve syndrome). An isolated position of the nerve occurs in the case of fractures of the internal humeral condyle and in the case of supracondylar fractures. Nerve compression can also occur at the wrist level. It so happens that nerve damage can be observed in the case of typhoid and typhus and other acute infections.

Let's look at the main symptoms of ulnar nerve neuropathy. Numbness and paresthesia develop in the area of the 5th and 4th fingers, and also along the ulnar end of the hand to the wrist level. As the disease progresses, there is also a significant decrease in strength in the area of the adductor and abductor muscles of the fingers. In this case, the hand becomes like a “clawed paw”. Due to the preservation of the function of the radial nerve, the main phalanges of the fingers are very strongly extended. Due to the preservation of functions median nerve The position of the middle phalanges is bent, the fifth finger is most often abducted. Hypoesthesia or anesthesia is also observed in the area of the ulnar half of the IV, as well as the entire V finger on the side of the palm, and in addition the IV, V and half of the III finger on the back of the hand. There is atrophy of the small muscle tissues of the hand - vermiform, interosseous, as well as the elevations of the little finger, as well as the first finger. In order to accurately make a diagnosis, we are forced to resort to specialized techniques: 1) during the clenching of the hand into a fist, incomplete flexion of the fourth, fifth, and partially third fingers occurs; 2) in the case of a hand that fits tightly to the surface of the table, it is impossible to “scratch” the table with the little finger; 3) in the same position of the hand, adduction and extension of fingers, especially V and IV, are impossible; 4) during the test, the paper cannot be held by the first finger, which is straightened, and the phalanx of the end of the first finger cannot be flexed (a function that is carried out by the long flexor of the first finger, which is innervated by the median nerve).

Let us briefly consider what ulnar nerve neuropathy is, treatment and diagnosis.

Massage, physiobalneotherapy, acupuncture, exercise therapy, muscle and nerve stimulation are used (physiotherapy eliminates pain and paresthesia, restores strength in the arm muscles when treating ulnar nerve neuritis). If there are no symptoms of recovery for 1-2 months, surgery is recommended (suturing the nerve trunk, neurolysis, etc.).

If ulnar nerve neuropathy occurs, it is recommended to perform the following actions:

Apply pressure with your healthy hand on the middle phalanges of the fingers until they are completely straightened. The procedure must be repeated 10 times.
Take turns lowering and raising any of the fingers with your healthy hand (starting with the thumb and ending with the little finger). Repeat - 10 times.
Using your healthy hand, take turns moving each finger back, starting with the thumb. Repeat – 10 times.
Make circular movements in both directions with each finger. Repeat – 10 times.
Lower and raise 4 fingers (from the index to the little finger), straighten them in the main phalanges. Repeat – 10 times.
Raise the hand with the healthy hand and lower it, place it on the edge of the palm on the side of the little finger, then make circular movements in the area of the wrist joint counterclockwise and clockwise, the hand is held by the ends of three fingers - the middle, index, and ring. Repeat – 10 times.
The hand is placed vertically in relation to the water on the fingers bent in the main phalanges, the healthy hand bends the fingers in any phalanx and straightens it. Repeat – 10 times.
We place the brush on the bottom with the fingers bent and spread apart, straighten them with springy movements. Repeat – 10 times.
Place a small towel or napkin in the water. We grab and feel the napkin, squeeze it in our hands, move the bent fingers slightly along the napkin, simultaneously moving the base of the palm forward. Repeat – 10 times.
Grabbing rubber objects of different sizes in water and squeezing them. Repeat – 10 times. As movements are restored, they also make gymnastics more active, perform complex movements: modeling from plasticine, grasping small objects - nails, matches, peas, etc. Active movements using the injured hand are the same as in the case of wrist injuries fingers.

Ulnar nerve (n. ulnaris). The ulnar nerve is formed from fibers CVIII - T: spinal nerves, which pass supraclavicularly as part of the primary lower trunk of the brachial plexus and subclavian - as part of its secondary medial bundle. Less commonly, the ulnar nerve additionally includes fibers from the CVII root.

The nerve is located initially medially from the axillary and upper part of the brachial artery. Then, at the level of the middle third of the shoulder, the ulnar nerve departs from the brachial artery. Below the middle of the shoulder, the nerve passes posteriorly through the hole in the medial intermuscular septum of the shoulder and, being located mesdunarial and the medial head of the triceps brachii muscle, moves downward, reaching the space between the medial epicondyle of the shoulder and the olecranon process of the ulna. The section of fascia thrown between these two formations is called the supracondylar ligament, and into the lower osteofibrous canal is called the supracondylar-ulnar groove. The thickness and consistency of the area of fascia at this location ranges from thin and web-like to dense and ligament-like. In this tunnel, the nerve is usually adjacent to the periosteum of the medial epicondyle in the groove of the ulnar nerve and is accompanied by the recurrent ulnar artery. This is the upper level of possible nerve compression in the elbow area. A continuation of the supracondylar-ulnar groove is the flexor carpi ulnaris gap. It exists at the level of the superior insertion of this muscle. This is the second probable place compression of the ulnar nerve is called cubital tunnel. The walls of this canal are limited externally by the olecranon process and the elbow joint, internally by the medial epicondyle and the ulnar collateral ligament, partially adjacent to inner lip block humerus. The roof of the cubital tunnel is formed by a fascial band that extends from the olecranon process to the internal epicondyle, covering the ulnar and brachial bands of the flexor carpi ulnaris and the space between them. This fibrous band, which is triangular in shape, is called the flexor carpi ulnaris aponeurosis, and its particularly thickened proximal base is called the arcuate ligament. The ulnar nerve emerges from the cubital canal and is further located on the forearm between the flexor carpi ulnaris and flexor digitorum profundus. The nerve passes from the forearm to the hand through the osteofibrous Guyon canal. Its length is 1-1.5 cm. This is the third tunnel in which the ulnar nerve can be compressed. The roof and bottom of Guyon's canal are composed of connective tissue formations. The upper one is called the dorsal carpal ligament, which is a continuation of the superficial fascia of the forearm. This ligament is supported by tendon fibers from the flexor carpi ulnaris and palmaris brevis muscles. The bottom of Guyon's canal is formed primarily by a continuation of the flexor retinaculum ligament, which in its radial part covers the carpal tunnel. In the distal part of Guyon's canal, its bottom includes, in addition to the flexor retinaculum, also the pisiform-uncinate and pisiform-metacarpal ligaments.

The next level of possible compression of the deep branch of the ulnar nerve is the short tunnel through which this branch and the ulnar artery pass from Guyon's canal into the deep space of the palm. This tunnel is called the pisiform-uncinate tunnel. The roof of the entrance to this channel is formed connective tissue, located between the pisiform bone and the hook of the hamate bone. This dense, convex tendinous arch is the origin of the flexor little finger brevis muscle. The bottom of the entrance to this tunnel is the pisiform-crticular ligament. Passing between these two formations, the ulnar nerve then turns outward around the hook of the hamate and passes under the origin of the flexor little finger brevis and the opponens little finger muscles. At the level of the pisiform-uncinate canal and distal to it, fibers extend from the deep branch to all the intrinsic muscles of the hand supplied by the ulnar nerve, except for the abductor little finger muscle. The branch to it usually arises from the common trunk of the ulnar nerve.

In the upper third of the forearm, branches extend from the ulnar nerve to the following muscles.

The flexor carpi ulnaris (innervated by segment CIII - TX) flexes and adducts the hand.

A test to determine its strength: the subject is asked to bend and bring the hand; the examiner resists this movement and palpates the contracted muscle.

Flexor digitorum profundus; its ulnar part (innervated by the CVIII - TI segment) bends the nail phalanx of the IV - V fingers.

Tests to determine the action of the ulnar portion of this muscle:

The subject’s hand is placed palm down and pressed tightly against a hard surface (table, book), after which he is asked to make scratching movements with a fingernail;
the subject is asked to form a fist with his fingers; with paralysis of this muscle, folding the fingers into a fist occurs without the participation of the fourth and fifth fingers.

A test to determine the strength of this muscle: they suggest bending the distal phalanx of the IV - V fingers; the examiner fixes the proximal and middle phalanges in an extended state and resists flexion of the distal phalanges.

At the level of the middle third of the forearm, a sensitive palmar branch departs from the ulnar nerve, which innervates the skin of the area of the eminence of the little finger and slightly higher. Below (along the border with the lower third of the forearm, 3-10 cm above the wrist) another sensitive dorsal branch of the hand departs. This branch does not suffer from pathology in Guyon's canal. It passes between the tendon of the flexor carpi ulnaris and ulna on the back of the hand and is divided into five dorsal nerves of the fingers, which end in the skin of the dorsum of the V, IV and ulnar side III finger In this case, the nerve of the fifth finger is the longest and reaches the nail phalanx, the rest reach only the middle phalanges.

The continuation of the main trunk of the ulnar nerve is called its palmar branch. It enters Guyon's canal and is 4 - 20 mm below the styloid process. radius is divided into two branches: superficial (mainly sensitive) and deep (mainly motor).

The superficial branch passes under the transverse carpal ligament and innervates the palmaris brevis muscle. This muscle pulls the skin to the palmar aponeurosis (innervated by the CVIII - TI segment).

Below the ramus superficialis is divided into two branches: the digital palmar nerve itself (supplies the palmar surface of the ulnar side of the fifth finger) and the common digital palmar nerve. The latter goes towards the IV interdigital space and is divided into two more proper digital nerves, which continue along the palmar surface of the radial and ulnar sides of the IV finger. In addition, these digital nerves send branches to back side nail phalanx of the V and ulnar half of the middle and nail phalanx of the IV fingers.

The deep branch penetrates deep into the palm through the gap between the flexor of the fifth finger and the abductor of the little finger muscle. This branch arcs towards the radial side of the hand and supplies the following muscles.

The adductor pollicis muscle (innervated by segment CVIII).

Tests to determine its strength:

the examinee is asked to bring the first finger; the examiner resists this movement;
the examinee is asked to press an object (a strip of thick paper, a tape) with the main phalanx of the first finger to the metacarpal bone of the index; the examiner pulls out this object.

With paresis of this muscle, the patient reflexively presses the object with the nail phalanx of the first finger, i.e., uses the long flexor of the first finger, innervated by the median nerve.

Abductor digiti minimi muscle (innervated by segment CVIII - TI).

Test to determine its strength: the subject is asked to retract the fifth finger; the examiner resists this movement.

The flexor pollicis brevis (innervated by segment CVIII) flexes the phalanx of the fifth finger.

A test to determine its strength: the subject is asked to bend the proximal phalanx of the fifth finger and straighten the remaining fingers; the examiner resists this movement.

The muscle opposing the little finger (innervated by the CVII - CVIII segment) pulls the fifth finger towards midline brushes and contrasts it.

A test to determine the action of this muscle: it is suggested to bring the extended V finger to the I finger. With muscle paresis, there is no movement of the fifth metacarpal bone.

Flexor brevis thumb; its deep head (innervated by the CVII - TI segment) is supplied jointly with the median nerve.

The vermiform muscles (innervated by the CVIII - TI segment) flex the main and extend the middle and nail phalanges of the II - V fingers (I and II mm. lumbricales are supplied by the median nerve).

The interosseous muscles (dorsal and palmar) flex the main phalanges and simultaneously extend the middle nail phalanges of the II - V fingers. In addition, the dorsal interosseous muscles abduct fingers II and IV from III; palmar - bring the II, IV and V fingers to the III finger.

A test to determine the action of the lumbrical and interosseous muscles: it is suggested to bend the main phalanx of the II - V fingers and simultaneously extend the middle and nail ones.

When these muscles are paralyzed, a claw-like position of the fingers occurs.

Tests to determine the strength of these mice:

the examinee is asked to bend the main phalanx of the II - III fingers when the middle and nail ones are straightened; the examiner resists this movement;
They suggest doing the same for the IV - V fingers;
then they offer to straighten middle phalanx II - III fingers, when the main ones are bent; the examiner resists this movement; d) the subject does the same for the IV - V fingers.

Test to determine the action of the dorsal interosseous muscles: the examinee is asked to spread his fingers while horizontal position brushes

Tests to determine their strength: suggest moving the second finger away from the third; the examiner resists this movement and palpates the contracted muscle; the same is done for the fourth finger.

Test to determine the action of the palmar interosseous muscles: the subject is asked to bring his fingers with the hand in a horizontal position.

Tests to determine the strength of the palmar interosseous muscles:

the examinee is asked to squeeze flat object(tape, piece of paper) between fingers II and III; the examiner tries to pull her out;
suggest bringing the second finger to the third; the examiner resists this movement and palpates the contracted muscle.

Symptoms of damage to the ulnar nerve consist of motor, sensory, vasomotor and trophic disorders. Due to paresis of m. flexoris carpi ulnaris and the predominance of the action of antagonist muscles, the hand deviates to the radial side. Due to paresis mm. adductoris pollicis and antagonistic action of m. abductoris pollicis longus et brevis The first finger is retracted outward; holding objects between fingers I and II is difficult. The fifth finger is also slightly removed from the fourth finger. The predominance of the extensor function leads to hyperextension of the main ones and a bent position nail phalanges fingers - a “claw-shaped hand” typical for lesions of the ulnar nerve develops. The claw shape is more pronounced in the 4th and 5th fingers. The adduction and extension of the fingers are impaired, the patient cannot grasp and hold objects between the fingers. Atrophy of the muscles of the first dorsal space, hypothenar and interosseous muscles develops.

Sensory disorders spread to the ulnar part of the hand from the palmar side, the area of the V and ulnar side of the IV fingers, and from the back side - to the area of the V, IV and half of the III fingers. Deep sensitivity is impaired in the joints of the fifth finger.

Cyanosis, coldness of the inner edge of the hand and especially the little finger, thinning and dry skin are often observed.

When the ulnar nerve is damaged at different levels, the following syndromes occur.

Cubital ulnar nerve syndrome develops when rheumatoid arthritis, with osteophytes of the distal end of the humerus, with fractures of the epicondyle of the humerus and the bones forming the elbow joint. At the same time, the angle of movement of the ulnar nerve increases and its path on the shoulder and forearm lengthens, which is noticeable when the forearm is flexed. Microtraumatization of the ulnar nerve occurs, and it is affected by a compression-ischemic mechanism (tunnel syndrome).

Rarely, habitual displacement of the ulnar nerve (dislocation) occurs, which is facilitated by congenital factors (posterior position of the medial epicondyle, narrow and shallow epicondyle-ulnar groove, weakness of the deep fascia and ligamentous formations above this groove) and acquired (weakness after injury). When the forearm is flexed, the ulnar nerve moves to the anterior surface of the medial epicondyle and returns back to the posterior surface of the epicondyle during extension. External compression of the nerve occurs in people who remain in one position for a long time (at a desk, desk).

Subjective sensory symptoms usually appear before motor symptoms. Paresthesia and numbness are localized in the supply zone of the ulnar nerve. After a few months or years, weakness and wasting of the corresponding hand muscles occur. In acute cubital syndrome, caused by compression of the nerve during surgery, sensations of numbness appear immediately after recovery from anesthesia. Paresis of long muscles (for example, flexor carpi ulnaris) is less common than paresis of the hand muscles. Hypoesthesia is localized on the palmar and back surfaces hand, V finger and ulnar side of the IV finger.

Damage to the ulnar nerve on the hand occurs in the following variants:

with sensitive loss and weakness of the hand muscles;
without sensory loss, but with paresis of all hand muscles supplied by the ulnar nerve;
without loss of sensitivity, but with weakness of the muscles innervated by the ulnar nerve, excluding the hypothenar muscles;
only with sensory loss, in the absence of motor ones.

There are three types of syndromes, combining isolated lesions of the deep motor branch into one group. The first type of syndrome includes paresis of all hand muscles supplied by the ulnar nerve, as well as loss of sensitivity along the palmar surface of the hypothenar, fourth and fifth fingers. These symptoms may be caused by compression of the nerve just above Guyon's canal or in the canal itself. In the second type of syndrome, weakness of the muscles innervated by the deep branch of the ulnar nerve appears. Superficial sensitivity in the hand is not impaired. The nerve may be compressed at the hamate hook between the insertion of the abductor and flexor digiti flexor muscles, when the ulnar nerve passes through the opponensis muscle of the little finger, and, less commonly, when the nerve crosses the palm posterior to the digital flexor tendons and anterior to the metacarpals. The number of muscles affected depends on the location of the compression along the deep branch of the ulnar nerve. With fractures of the bones of the forearm, there may simultaneously occur tunnel syndromes, compression of the median and ulnar nerve in the wrist area is the third type of syndrome.

Instructions

The ulnar nerve is most vulnerable in the area of the elbow joint. Often this disease occurs in those who have the habit of resting their elbows on a hard surface, as well as when the elbow joints are in a bent position for a long time (for example, office workers). The risk of getting sick increases if the room is damp or cold.

Predisposing factors for the development of neuritis are chronic endocrine diseases (diabetes, diseases thyroid gland), chronic intoxication(alcoholism), mercury, lead poisoning, etc. Also, neuritis can develop after infections (herpes, diphtheria, malaria, etc.), in the presence of fractures and bruises in the elbow joint and forearm.

The main signs of ulnar nerve neuritis are weakness of the hand - the patient cannot make a fist, the 3rd, 4th fingers and little finger remain straightened, and cannot hold objects with his fingers. Also disturbing is numbness and pain between the little finger and ring finger of the hand, as well as in the area of the ulnar edge of the hand to the wrist. The small muscles of the hand gradually atrophy, and it takes on the appearance of a “clawed paw.”

The skin of the hand under the little finger may acquire a bluish tint, become thinner, small abscesses or ulcers often form, and in men may disappear hairline. There are also several simple ways check the functioning of the ulnar nerve. If you press your palm to the table and try to move your little finger, this will cause difficulty, and in this position it is also difficult to spread your fingers. Another way is to hold a piece of paper between two fingers; this cannot be done if you have neuritis.

Treatment of ulnar nerve neuritis should begin as early as possible, as it can lead to complete atrophy hand muscles. First, the cause of the inflammation is determined, with infectious diseases antibiotics are prescribed for viral origin neuritis is treated with antiviral therapy. It is also necessary to remove predisposing factors (for example, the habit of leaning on the table with your elbows and hypothermia).

From medications are appointed vascular drugs to improve blood circulation and dilate blood vessels, B vitamins, painkillers. A plaster cast is applied to the forearm and hand area, the fingers should be bent and the hand should be fixed in the wrist joint. The forearm and hand are supported by a scarf.

Physiotherapeutic procedures, physical therapy, treatment with mud baths, acupuncture and massage are also widely used; it is recommended for all patients Spa treatment. In some cases, surgery is performed (for example, suturing a nerve after injury).