Symptoms of ulnar nerve neuritis. Diagnosis and treatment methods

It is responsible for the mobility and sensitivity of the entire brachial plexus.

But when neuralgic diseases the functions of the ulnar nerve are impaired. Various lesions of the ulnar nerve (neuropathy, neuritis, tunnel and cubital syndromes) are quite common and can be associated with a number of different factors.

Anatomical and physiological certificate

It is impossible to understand what exactly caused the dysfunction of the ulnar nerve without the most basic knowledge of the anatomy of the human body, since only in this way can one get a complete picture of the course nerve fibers at the elbow.

The ulnar nerve is a long nerve located in the brachial plexus. It consists of biological fibers CVII-CVIII (7th and 8th cervical), which exit directly from the spinal cord.

On the arm itself, the nerve enters directly from the axillary fossa and moves to the intermuscular septum of the medial region in the middle of the shoulder and lies in the osteo-fibrous canal, which is formed inside the shoulder, tendon and wrist. This canal in the medical literature is called capital or Mouchet's canal.

It is in this place that the ulnar nerve is located almost on the very surface and as close as possible to the bones, and it is here that compression of the nerve fibers most often occurs.

As a rule, everyone who has injured their elbow at least once in their life, be it a fracture or a simple blow to a door handle, has felt quite unpleasant sensations that cause an immediate aggravation of the pain syndrome (also, the nerve can be pulsed in this place independently at any time and well feel it by touch).

After the fiber gradually leaves the limits of this channel, it ends up between the forearm muscles, but still part of its endings are in the muscle area. Moving to the border of the forearm, it is divided into several parts (external and dorsal), as well as into a small palmar branch, passing from the forearm to the palmar ligament and wrist. This department human body is responsible for the perception of the external world - flexion and extension of the limb occurs.

Anatomical knowledge contributes faster diagnostics pathology.

Ulnar nerve, its anatomy, functions and diseases in Elena Malysheva’s program:

Neuropathy is the most common disease of the ulnar nerve

Ulnar nerve neuropathy is a process of numbness and decreased sensitivity in the fingers and hand as a whole. The advanced stage of this disease leads to muscle atrophy, which can lead to complete numbness of the tips of the phalanges.

There are two types of ulnar neuropathy:

1. Primary – development inflammatory reaction does not depend on other pathological processes occurring in the body. This condition is most often observed in people who long time rest the elbow on the working surface of a machine or table, the armrest of a chair, etc.
2. Secondary (or symptomatic) is a complication of a disease that already exists in a person. Most common cause development of degenerative-dystrophic changes is compression (pinching) of the ulnar nerve, which is characteristic of some diseases:

• osteomas – benign new formations of bone tissue;
• synovitis - inflammation of the synovial membrane;
• fractures and dislocations of the shoulder or forearm;
• bruised hand;
• tenosynovitis – inflammation of the inner joint membrane;
• deforming osteoarthrosis – a chronic disease of cartilage and joint tissues;
• bursitis of the elbow joint - inflammation of the joint capsule;
• post-traumatic arthrosis.

In some cases, neuropathy develops as a result of a severe acute infectious disease (rash or typhoid fever, tuberculosis, syphilis).

General clinical picture

In general, damage to the ulnar nerve due to neuropathy is characterized by a violation of its basic functions, which leads to decreased mobility, pain, decreased sensitivity of a particular muscle group and general malaise. The cause of this condition may be damage that was caused to the fiber when a separate part of the elbow was compressed (this leads to pinching and damage to the nerve).

In addition, such damage can be either a separate or related disease.

Areas of numbness in ulnar nerve neuropathy

Symptoms of ulnar nerve neuropathy include the following:

• decreased sensitivity of the limb, which leads to the absence of pain;
• numbness of the limb, which deprives it of mobility.

Establishing diagnosis

In order to establish damage to the ulnar nerve, a standard neurological examination is performed, during which the causes and nature of the disease are determined. The most informative method Damage diagnosis is electroneuromyography. It allows you to determine with maximum accuracy the location and extent of damage to the nerve fibers, as well as determine the level of damage to the nerve roots that form the elbow joint.

With modern patient care, diagnosing ulnar nerve damage is a quick and most accurate procedure.

Treatment of neuropathy consists of the following procedures:

• first of all, the patient is admitted to a hospital, since ulnar nerve neuropathy is a serious disease and without constant medical supervision the patient’s condition can only worsen;
• Painkillers are prescribed to reduce pain;
• An effective method of treating the disease is detoxification therapy, vitamins to maintain the body, non-steroidal anti-inflammatory drugs that reduce the inflammatory process.

Symptoms and treatment of neuralgia

The origin of ulnar neuralgia can be different - somatic and infectious pathologies, trauma, prolonged compression.

The inflammatory process affects the fibers of the peripheral nerves and manifests itself:

• pain syndrome;
• numbness of the upper limb (impaired passage of nerve impulses to the brain);
• disruption of the functional activity of the arm muscles.

Treatment of neuralgia of the elbow joint is complex and consists of the use of medication and physiotherapeutic methods:

• using a plaster splint, the arm is fixed in a half-bent position and suspended in a special bandage - in this way, the cause that caused the neuralgia is most often eliminated;
• in case of an inflammatory reaction, antibacterial agents are prescribed, in case of acute infectious disease– antiviral;
• to relieve swelling, it is necessary to take potassium-sparing diuretics;
• B vitamins are considered an effective means for improving cellular metabolism;
• Papaverine is strongly recommended to improve trophism and blood circulation in tissues;
• to maintain the physiological tension of nerve and muscle tissues, electrophoresis, ampli-pulse and UHF are prescribed;
• The patient can carry out massage sessions independently, starting with rubbing the fingertips, flexion and extension of the joints of the phalanges and hands.

Inflammatory process in the elbow area

Ulnar nerve neuritis is an inflammation accompanied by constant painful sensations V elbow joint, numbness of the limb and weakness of the entire muscle.

Symptoms of ulnar nerve neuritis:

• burning sensation in the elbow area;
• swelling of the limb is pink-violet;
• weakness;
• change in body temperature;
• drooping of a limb when it is overexerted.

Treatment consists of the following set of procedures:

1. First of all, the hand is fixed to prevent it from drooping. This is done using a compression bandage and, as a rule, the arm is completely immobilized.
2. The next step of treatment is daily therapeutic exercises, taking anti-inflammatory and painkillers.

After some time, when hand mobility improves, the exercises will become more complex, gradually increasing the load.

Ulnar nerve entrapment

Pinching of the ulnar nerve (cubital tunnel syndrome or ulnar nerve compression syndrome, ulnar syndrome) can lead to decreased sensitivity and complete loss of arm mobility.

Pinching is expressed by the following symptoms:

• numbness and decreased mobility of the limb;
• change in muscle mass in the arm;
• pain syndrome.

Treatment of cubital tunnel syndrome:

• adherence to a constant regimen (therapeutic exercises, reduction of physical activity, and so on);
• physiotherapy;
• taking painkillers.

Carpal tunnel syndrome

Ulnar nerve tunnel syndrome is a specific deviation that manifests itself in neuralgic diseases. The nerve is pinched in the area of ​​the shoulder and forearm.

Treatment for carpal tunnel syndrome involves:

• restriction of physical activity;
• physiotherapy;
• taking vitamins and non-steroidal anti-inflammatory drugs.

If left untreated, damage to the ulnar nerve can lead to a decrease in sensitivity, and subsequently cause complete numbness of the hand.

• therapeutic exercises and other exercises aimed at developing the ulnar nerve;
• taking vitamins that help strengthen nerve endings.

This section was created to take care of those who need qualified specialist without disturbing the usual rhythm of your own life.

Symptoms of ulnar nerve neuritis. Diagnosis and treatment methods

Neuritis refers to diseases of an inflammatory nature, involving the peripheral part of the nervous system. The disease can affect either one nerve in isolation or several at the same time. In this case, it is customary to talk about polyneuritis. The extent of the lesion depends on the cause of the pathological process.

Depending on the place of influence of the provoking factor and the localization of the nerve ending, it is customary to distinguish neuritis of the ulnar nerve, facial, intercostal, peroneal nerve, cochlear neuritis and many others.

Regardless of the affected nerve, it is still possible to identify the main symptoms inherent in all neuritis. Among them, the most common is pain in the localization of the nerve ending, a change in the sensitivity threshold, and a decrease in strength in the muscles of certain areas of the body.

Ulnar neuritis affects a fairly large number of people. Among all neuritis, damage to this nerve is in second place.

Predisposing factors to the occurrence of neuritis

Several factors may simultaneously be involved in the development of neuritis, but in some situations it is possible to highlight specific reason. Thus, the following provoking factors are most often observed:

• general or local hypothermia due to exposure to temperatures with low degree over a long period of time on a specific area of ​​the body or the body as a whole;
• infectious agents, such as measles, diphtheria, influenza, typhoid fever, brucellosis or herpes;
• traumatic damage to both the nerve itself and the area of ​​​​the bone where it passes. As a result, it is pinched with further development neuritis. Thus, with neuritis of the elbow joint, a fracture of the internal humeral condyle and epicondyle can be diagnosed.
• vascular pathology, which helps to reduce local blood circulation, as a result of which nerve nutrition is disrupted;
• hypovitaminosis with insufficient levels of vitamins and microelements;
• intoxication with alcohol or salts heavy metals, for example, arsenic, mercury, lead;
• endocrine pathology ( diabetes, thyroid dysfunction);
• anatomical features of the structure of the musculoskeletal canal, in the cavity of which the nerve passes, of congenital origin or as an acquired pathology. The ulnar nerve is localized in the ulnar groove, where it is compressed by a fibrous arch located between the flexors of the hand.
• compression of the nerve trunk with irradiation of characteristic symptoms along the branch nerves. Such conditions can occur during sleep, in an incorrect sitting position, with a sudden change in body position, or during surgery in this area. Ulnar nerve neuritis often develops during prolonged work with elbows resting on a machine, desk or armrests.
• osteochondrosis, herniated discs.

Clinical manifestations of ulnar nerve neuritis

Clinical symptoms and intensity of manifestations of neuritis depend on the degree of functional load of the affected nerve, the severity of the lesion and the area innervated by this nerve. Most of the nerves of the peripheral part of the nervous system consist of sensory, motor and autonomic fibers. As a result, the following symptoms are observed:

1. Changes in sensory sensations, which may manifest as numbness, paresthesia (tingling or goosebumps), increased sensitivity threshold or complete loss of tactile perception;
2. Change in motor activity with the development of paralysis with complete immobilization of a certain part of the body or paresis with a partial decrease in motor ability. At the core this process lies a decrease in strength in the muscles innervated by the affected nerve. In the future, their atrophy, decrease or disappearance of tendon reflexes is possible.
3. Vegetative disorders with trophic changes, manifested by the appearance of swelling, blue discoloration skin, local hair loss, depigmentation, increased sweating, brittle nails and the appearance of trophic ulcers.

These symptoms may occur at the beginning of neuritis or in more advanced stages. However, an integral clinical manifestation is pain of varying intensity, as well as specific symptoms for each specific area of ​​the body.

Neuritis of the elbow joint includes symptoms such as the appearance of paresthesia and decreased sensitivity of the palmar surface of the hand in the area of ​​half of the 4th and full of the 5th fingers. In addition to back surface half of the 3rd and the entire 4th and 5th fingers are affected.

The disease is also characterized by weakness of the adductor and abductor muscles of the 4th and 5th fingers. Further, hypotrophy or atrophy of the muscles that elevate the little finger and thumb, and the interosseous, lumbrical muscles of the hand may develop. As a result of atrophic processes, the palm looks flat.

The hand with ulnar nerve neuritis looks like a “clawed paw”, since the joints on both sides of the middle digital phalanges are bent, and the rest are straightened.

In addition, along the location of the ulnar nerve, it can be pinched in certain anatomical areas (musculoskeletal canals) with the development of tunnel syndrome.

Diagnostic criteria for ulnar nerve neuritis

To diagnose the disease, certain tests specific to ulnar nerve neuritis are used:

• to determine the level of damage, it is necessary to clench the hand into a fist, after which the 4th, 5th and partially the 3rd fingers will not be able to fully bend to form a fist;
• if you press your hand tightly against a flat surface, for example, a table, then it is impossible to make scratching movements on this surface with your little finger;
• in addition, in this position there is no possibility to spread and adduct the fingers, especially the 4th and 5th;
• an attempt to hold the paper straight with the 1st finger ends in failure, since flexion of the distal phalanx is not observed. As a result of defeat median nerve, innervated long flexor of the 1st finger, this function not available.

Therapeutic tactics for ulnar nerve neuritis

The main direction in treating the disease is to identify the cause and eliminate it in the near future. If available infectious process are used antibacterial drugs, to which pathogenic flora is sensitive, and antiviral drugs.

If the cause of neuritis is vascular pathology with impaired local circulation and the development of ischemia, then it is recommended to use vasodilators (papaverine).

With the traumatic genesis of ulnar nerve neuritis, mobilization of the limb is necessary. To reduce the activity of the inflammatory process, non-steroidal anti-inflammatory drugs are used - indomethacin, diclofenac. For severe pain, analgesics are used.

Adjuvant therapy includes B vitamins and decongestants with a diuretic effect. As the severity of the process decreases, anticholinesterase drugs, in particular proserin, and biogenic stimulants (lidase) should be added.

Comprehensive treatment of neuritis involves the inclusion of physiotherapeutic procedures. It is advisable to start using them from the second week. Ultraphonophoresis with hydrocortisone, electrophoresis with novocaine, lidase and proserin, UHF and pulsed currents are widely used. If necessary, electrical stimulation of the affected muscles should be used.

In addition, massage and physical therapy have proven their effect, thanks to which restoration of affected muscle groups is observed. Class physical exercise it is necessary to start from the second day after fixing the limb with a bandage. Before this, it is recommended to do gymnastics in water.

The massage consists of massaging each phalanx of the fingers, starting with the thumb. In addition, flexion and extension of all interphalangeal joints should be performed in order to activate blood circulation and eliminate congestion. Circular movements and finger abductions are also effective.

If ulnar nerve neuritis occurs as a result of its compression in the musculoskeletal canal with the development of tunnel syndrome, then it is advisable to use local administration of drugs directly into this canal. In this case, hormonal and painkillers are necessary to reduce swelling, pain and the activity of the inflammatory process.

Surgical treatment is necessary when the nerve is compressed in order to decompress it. In the case of a long-term inflammatory process, destructive phenomena are observed, as a result of which surgical intervention is recommended. It is based on suturing the affected nerve, and in more advanced forms, its plastic surgery.

Thus, with correct, timely diagnosis and effective treatment, ulnar nerve neuritis has a favorable outcome. Treatment and rehabilitation generally take more than two months. In the future, to prevent recurrent damage or neuritis of another nerve, it is recommended to avoid injuries, hypothermia and monitor the condition of concomitant pathology.

Treatment of ulnar nerve neuropathy

Neuropathy is nerve damage that causes pain and impairment. motor function. Ulnar nerve neuropathy most often occurs as a result of compression.

Ulnar nerve

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

The nerve passes through the Mouchet canal (cubital canal). Its peculiarity lies in its superficial location, which determines high risks 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 damage

Ulnar neuropathy develops due to:

• shoulder injuries;
• dislocations and fractures of the forearm and hand;
• compression in the cubital canal.

The majority of cases develop as a result of compression of the nerve in the cubital canal. This occurs as a result of frequent monotonous extension movements in the joint during sports. This kind of defeat is typical for people who train hard in the gym.

Neuropathy can occur in people who have the habit of sticking their bent arm out of a car window or leaning on their elbow while working.

Damage to the fibers in the wrist area can be caused by:

• load on the wrist associated with the characteristics of long-term work (rotating the instrument in the hands, playing the violin, working with a vibrating instrument);
• walking with a cane;
• cycling;
• riding a motorcycle over rough terrain.

There are also a number of organic pathologies that provoke compression of the nerve - these are tumor neoplasms, vascular aneurysm and arthritis of the elbow.

Symptoms of the disease

Symptoms of neuropathy largely depend on the location of the lesion.

If the nerve is compressed in the elbow joint, patients note:

• local pain spreading to the forearm and hand in the little finger area;
• local burning and tingling sensation;
• decreased sensitivity;
• muscle weakness.

If treatment of the lesion is not started in time, muscle atrophy develops over time.

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;
• muscle atrophy, reduction in hand size.

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

Establishing diagnosis

Problems with diagnosis experienced doctor does not arise. Damage to the ulnar nerve can be determined using a simple diagnostic technique, which consists of assessing the pain syndrome by tapping or pressing on the nerve in different places.

To determine the extent of damage, use diagnostic methods, allowing one to estimate the speed of passage of nerve impulses along the fibers.

Radial nerve damage

To neuritis upper limbs also includes radial nerve neuropathy. This nerve runs through the shoulder and back of the forearm, and when it is affected, pain radiates to the wrist.

Radial nerve neuropathy most often occurs due to compression of the canal in the forearm. This may happen as a result incorrect position during sleep or monotonous work with a load on the arm.

Radial neuropathy often accompanies people with injuries that require them to walk on crutches. In this case, compression occurs due to the load on the arm when walking.

Pathology of the radial nerve is characterized by the following symptoms:

• impaired finger flexion;
• weakness of the hand;
• local numbness and burning sensation;
• impaired reflexes;
• amyotrophy.

Due to hand weakness, patients find it difficult to hold anything in their fingers. Accompanied by the inability to turn the hand palm up.

Radial nerve neuropathy without timely treatment leads to the development of atrophy.

Drug treatment

Radial nerve neuropathy is treated comprehensively. Therapy includes:

• drug treatment;
• massage;
• exercises;
• complex of physiotherapeutic procedures.

Surgical treatment is used only in the case of organic pathology, which cannot be eliminated using traditional methods.

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

Treatment must be comprehensive, so doctors often resort to physical therapy. Most effective methods is ultrasound treatment, electrophoresis with lidocaine and methods of stimulating 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.

Prognosis and prevention

Treatment of neuropathy takes from three months to six months, however, noticeable relief of the patient’s condition occurs a few days after starting to take the drugs.

The prognosis largely depends on the timely request for help and the nature of the damage. If the problem is recognized in time and treatment is not delayed, the disease can be successfully treated and goes away without a trace.

With muscle atrophy, it is difficult to restore normal motor activity. Recovery takes a long time, and sometimes it is necessary to resort to surgery.

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.

A 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.

The information on the site is provided solely for popular informational purposes, does not claim to be reference or medical accuracy, and is not a guide to action. Do not self-medicate. Consult your healthcare provider.

Ulnar nerve neuropathies: why they occur and how to treat them

The anatomical structure of some zones through which the ulnar nerve passes creates 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 of nerve fibers in these areas leads to ulnar nerve neuropathies. 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 similar in many ways, but they also have characteristic features. 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, rupture, or tear caused by a lateral elbow dislocation, an elbow subluxation, or an elbow dislocation with an olecranon fracture.
2. Compression neuropathies (cubital tunnel syndrome and Guyon's syndrome). Nerve compression can be caused by certain professional skills or habits, as well as 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:

• rheumatoid arthritis;
• tumors;
• aneurysms of nearby vessels;
• deformation of bones or connective tissue in the elbow joint after a fracture;
• arthrosis deformans, 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;
• motor disorders, expressed in muscle weakness, difficulty abducting and flexing the hand, flexing the ring and little fingers;

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 in bringing and spreading the fingers, the thumb is not brought to the palm;
• muscle atrophy and changes in its appearance (“clawed” or “bird-like” 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 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, non-steroidal anti-inflammatory drugs are prescribed:

For local anesthesia, a 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:

In the absence of signs of elimination of the 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.

Performing surgery allows you to free the nerve from compression, but to 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.

Neuropathies of the ulnar nerve can be provoked for various reasons, which determine further tactics for treating the disease. The main manifestations of these neurological pathologies are the appearance of pain, paresthesia and sensory disturbances. And the effectiveness of their treatment is largely determined by the timeliness of contacting a doctor.

Which doctor should I contact?

If signs of ulnar nerve neuropathies appear, consultation with a neurologist is necessary. After studying the complaints and examining the patient, the doctor may prescribe electroneuromyography, radiography, ultrasound or MRI. In case of injury or advanced disease, a consultation with a surgeon may be recommended for further surgical treatment.

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Ulnar nerve neuropathy is a lesion of the ulnar nerve, as a result of which its function is impaired, which affects sensitivity in the hand area and causes a decrease in the strength of individual muscles of the hand. There are quite a few reasons that cause this condition. There are places along the arm along the ulnar nerve where it is most often subject to compression. Compression in these areas even has separate names: cubital canal syndrome, Guyon's canal syndrome. Each of these syndromes has its own clinical features, but all of them belong to the category of ulnar nerve neuropathy. From this article you will learn about the reasons why clinical features ulnar nerve neuropathy at various levels of damage, methods of its treatment.

It is difficult to understand the uniqueness of lesions of the ulnar nerve at various levels without basic knowledge of its anatomy and topography, so we will dwell on the basic information on the course of the ulnar nerve fibers.

The ulnar nerve is a long nerve of the brachial plexus. It consists of fibers C VII -C VIII (7th and 8th cervical) roots, which exit the spinal cord. The nerve enters the arm from the axillary fossa, then pierces the medial intermuscular septum in the middle of the shoulder, lies in the osteo-fibrous canal formed by the internal epicondyle of the shoulder, olecranon ulna and supracondylar ligament, flexor carpi ulnaris tendon. This canal is called cubital (Mouchet canal). It turns out that in this place the nerve is located quite superficially and at the same time close to the bone formations. This circumstance determines high frequency compression of nerve fibers in this place. Anyone who has hit their elbow at least once has experienced this peculiarity of the superficial location of the ulnar nerve. You can even feel it in this place.

After leaving the canal, the ulnar nerve follows between the muscles of the forearm (at the same time giving part of the branches to the muscles). At the border of the lower and middle third of the forearm, the nerve is divided into the dorsal branch of the hand (which innervates the skin of the dorsal part of the fourth, fifth and ulnar part of the third fingers) and the palmar branch, which passes from the forearm to the hand through Guyon’s canal. Guyon's canal is formed by small bones of the hand and the palmar ligament of the wrist. The ulnar nerve is also often subject to compression at this location. The palmar branch of the ulnar nerve innervates the muscles of the hand and the skin of the palmar surface of the fifth and ulnar half of the fourth finger.

Knowledge of the topographical features of the nerve course helps in diagnosing its lesions. For example, if muscle weakness innervated by the ulnar nerve is detected in the area of ​​the hand and forearm, this means that the level of nerve damage is located above the middle third of the forearm, and if muscle weakness is detected only in the area of ​​the fingers, then the nerve damage is located at the level of Guyon’s canal . The level of involvement is important if surgical treatment becomes necessary.

Causes of ulnar nerve neuropathy

The ulnar nerve can be damaged by:

• fractures, dislocations of the bones of the shoulder, forearm and hand;
• compression in the area of ​​fibro-osseous canals (cubital and Guyon).

Most often, the ulnar nerve is damaged by compression. Nerve compression does not have to be acute or sudden. On the contrary, more often it develops slowly, as a result of prolonged exposure to a traumatic factor. What causes compression of the ulnar nerve? In the area of ​​the cubital canal, compression is provoked by:

• frequently repeated flexion movements in the elbow joint;
• work related to resting your elbows on a machine, desk, workbench;
• drivers’ habit of putting their bent arm out the window, resting their elbow on its edge;
• the habit of talking on the phone for a long time, resting your hand on the table with your elbow (this problem applies more to women, since they like to chat for a very long time with their friends);
• long-term intravenous infusions when the arm is fixed in an extended position for a significant period of time (and the nerve is subjected to compression). This is only possible in severely ill patients who receive almost continuous infusion therapy.

Compression of the ulnar nerve in the area of ​​Guyon's canal is called ulnar carpal syndrome. This condition is provoked by:

• regular work with tools (screwdrivers, pliers, forceps, vibrating tools, including jackhammers, etc.), that is, professional issues. Of course, using pliers or a screwdriver just a few times will not cause damage to the ulnar nerve. There may be compression of the nerve in this area in violinists;
• constant use of a cane;
• Frequent riding of a bicycle or motorcycle (during professional sports using these vehicles).

In addition to these reasons, ulnar nerve neuropathy can occur when the nerve is compressed by a tumor, an aneurysm of a nearby vessel, enlarged lymph nodes, or arthrosis (or arthritis) of the elbow or wrist joints.

Symptoms of ulnar nerve neuropathy

When a nerve is damaged, its functions are first disrupted, that is, sensory (including pain) and motor (related to muscle strength) problems appear. Sensory disturbances usually occur first, and decreased muscle strength develops as nerve compression continues. With fractures, dislocations and other “acute” causes of ulnar nerve neuropathy, sensory and motor disturbances occur simultaneously.

Cubital tunnel syndrome

Symptoms indicating damage to the ulnar nerve in this area are:

• pain in the area of ​​the ulnar fossa (inner surface of the elbow joint), which spreads to the forearm, IV and V fingers (both palm and back), to the ulnar edge of the hand (adjacent to the little finger). In these same areas, paresthesia may occur: tingling sensations, crawling, burning, twitching, and so on. At first, the pain is periodic, intensifies at night, and is provoked by movements in the elbow joint (flexion is more to blame). Gradually, the pain begins to bother you constantly and increases in intensity from unpleasant sensations to very pronounced pain;
• decreased sensitivity along the ulnar edge of the hand, in the area of ​​the little finger and ring finger. Moreover, there is one peculiarity - the very first sensitivity changes in the area of ​​the little finger;
• somewhat later (compared to sensory disorders) motor disorders occur. Muscle weakness manifests itself as difficulty in flexing and abducting the hand to the ulnar side, impaired flexion of the little and ring fingers, and when trying to clench the hand into a fist, the fourth and fifth fingers are not pressed against the palm. If you place your palm on the table and try to scratch the table with your little finger, then in case of ulnar nerve neuropathy this will not be possible. The fingers cannot be brought together and spread apart;
• with long-term compression of the ulnar nerve, atrophy of the hand muscles develops. The hand becomes thinner, the bones protrude more clearly, and the spaces between the fingers sink. However, the rest of the arm and the opposite hand look completely normal;
• the hand takes on the appearance of a “clawed” or “bird” (due to the predominance of the function of other nerves of the hand that are not affected).

Guyon's canal syndrome (ulnar carpal syndrome)

Symptoms of this pathological condition are in many ways similar to those with cubital tunnel syndrome. However, there are a number of differences that make it possible to distinguish the levels of damage. So, ulnar carpal syndrome manifests itself:

• sensitive disorders: pain and paresthesia of the wrist joint, the palmar surface of the ulnar edge of the hand and the palmar surface of the little finger and ring finger. The back of the hand does not experience such sensations (which distinguishes this syndrome from cubital tunnel syndrome). Both pain and paresthesia intensify at night and with hand movements;
• decreased sensitivity in the area of ​​the palmar surface of the little finger and ring finger. On the back surface of these fingers, sensitivity is not lost (which is also a difference);
• motor disorders: weakness of flexion of the fourth and fifth fingers, they cannot be completely pressed to the palm, difficulty in spreading and bringing the fingers together, it is not possible to bring the thumb to the palm;
• the brush can take on a “clawed” (“bird-like”) shape;
• with the long-term existence of the process they develop muscle atrophy, the hand is losing weight.

Individual fibers of the ulnar nerve may be subject to compression in Guyon's canal. And then the symptoms can occur in isolation: either only sensory disturbances, or only motor ones. In the absence of an application for medical care and the treatment inevitably begins to subject the entire nerve to compression, and then the symptoms will be mixed.

There is a diagnostic technique that works regardless of the location of the ulnar nerve compression. This technique consists of effleurage (with a neurological hammer), lightly tapping with something the place where, presumably, the nerve is being compressed. And as a result, the above sensitive symptoms arise. That is, if you lightly tap on inner surface elbow joint, it can cause pain and paresthesia in the area of ​​its innervation. This technique confirms the presence of ulnar nerve neuropathy.

If the ulnar nerve is damaged in any part of its course, in addition to the above two syndromes, then the symptoms of this condition will also be similar sensory and movement disorders. A fracture of the humerus, forearm bones with compression of the ulnar nerve by bone fragments will manifest itself as pain in the area of ​​the ulnar part of the forearm, hand and IV, V fingers, weakness in flexion of the hand, ring finger, little finger, abduction and extension of all fingers of the hand. In case of fractures or dislocations, it is somewhat easier to identify damage to the ulnar nerve, since the face obvious reason such symptoms.

Diagnostics

To establish the diagnosis of ulnar nerve neuropathy, it is necessary to conduct a neurological examination with a tapping test. A very informative method is electroneuromyography, which allows you to determine the level of damage to nerve fibers and even differentiate, if necessary, damage to the ulnar nerve from damage to the nerve roots that form its trunk (damage to the roots occurs in the area where they exit the spinal cord and vertebral foramina, although clinical symptoms may resemble neuropathy ulnar nerve). Diagnosis of ulnar nerve neuropathy is not particularly difficult if the doctor is attentive to the existing symptoms.

Treatment of ulnar nerve neuropathy

The approach to the treatment of ulnar nerve neuropathy is determined, first of all, by the cause of its occurrence. If the disease occurs as a result of a fracture of the arm bones with traumatic damage to the nerve fibers, then surgical intervention may be immediately required to restore the integrity of the nerve. If the cause lies in long-term and gradual compression of the ulnar nerve, then first they resort to conservative methods of treatment and only if they are ineffective, surgical treatment is performed.

Restoring the integrity of the ulnar nerve in case of arm fractures with fiber rupture is carried out by suturing the nerve. In this case, it may take about 6 months to restore function. The sooner the integrity of the nerve is restored, the more favorable the prognosis.

When a nerve is compressed in the area of ​​the cubital canal or Guyon's canal, the first measure should be to reduce the compression of its fibers during movements. This is achieved with the help of various fixing devices (orthoses, splints, bandages). Some of these products can be used only at night to reduce everyday difficulties that arise due to hand fixation. It is necessary to change the motor pattern, that is, if there is a habit of resting your elbows on the table during office work or telephone conversations, or placing your hand on the window in the car when driving, then you need to get rid of it. You should also avoid movements that increase nerve compression.

From medications first resort to non-steroidal anti-inflammatory drugs (Diclofenac, Ibuprofen, Nimesulide, Meloxicam and others). These drugs can reduce pain, swelling in the area of ​​the nerve and adjacent formations, and remove inflammation. For pain relief, you can use a lidocaine patch (Versatis) topically. For decongestant purposes, diuretics (Lasix), L-lysine escinate, Cyclo-3-fort can be used. B vitamins (Neurorubin, Neurovitan, Combilipen, Milgamma) have some analgesic and trophic effect. To improve nerve conduction, Neuromidin is prescribed.

If immobilization and non-steroidal anti-inflammatory drugs do not have an effect, then an injection of hydrocortisone with an anesthetic is resorted to in the area where the nerve is compressed (Guyon's canal or cubital canal). Usually this procedure has a good healing effect.

Physiotherapy is widely used in the treatment of ulnar nerve neuropathy. Ultrasound, electrophoresis with various drugs, electrical muscle stimulation is the most commonly used procedure. Massage and acupuncture are effective. Physical therapy plays an important role in helping to restore muscle strength.

However, sometimes if you seek medical help late, you can restore normal work it is not possible to treat the ulnar nerve using only conservative methods.
In such cases, surgical intervention is resorted to. The essence of surgical treatment is to release the ulnar nerve from compression. In case of cubital tunnel syndrome, this can be plastic surgery of the canal, creating a new canal and moving the ulnar nerve there, removing part of the epicondyle; in Guyon's canal syndrome, this can be a dissection of the palmar carpal ligament above the canal. Using these methods, the nerve is released, but this alone is not enough to fully restore function. After a successful operation, it is necessary to use medications (vitamins, agents that improve nerve trophism and conductivity, decongestants, painkillers), physiotherapeutic methods and exercise therapy. It may take 3 to 6 months to fully restore ulnar nerve function. In advanced cases, when medical help was sought very late and there is severe muscle atrophy, complete recovery is impossible. Some motor and sensory disorders may remain with the patient forever. Therefore, you should not hesitate to consult a doctor if you experience symptoms that indicate possible ulnar nerve neuropathy.

Thus, ulnar nerve neuropathy is a pathological condition that occurs as a result of a number of reasons. The main clinical symptoms of the disease are pain, sensory disturbances and muscle weakness in the area of ​​the ulnar edge of the hand and IV, V fingers of the hand. Ulnar nerve neuropathy is treated conservatively and surgically. The choice of treatment depends on the cause of the neuropathy and individual characteristics course of the disease. Success in treatment is largely determined by the timeliness of seeking medical help.

Educational film “Neuropathy of peripheral nerves. Clinic, basics of diagnosis and treatment” (from 5:45):

Various health disorders, functioning of elements motor system, skeleton and connecting parts - cartilage, joints - pose a considerable problem. Treatment of diseases, for example, can take many years and require numerous investments of time and money. It is also impossible not to treat - the pathology will affect everyday life, limiting the ability to move, and therefore work.

general information

Treatment and prevention of diseases of the elbow joint is a broad topic, since there is a wide variety of pathologies affecting this element of the human body. Diseases differ from each other in their manifestations, the nuances of getting rid of them, as well as the mechanisms of development and progress. It is customary to distinguish four large categories: inflammation, degeneration, injury and pathology of nearby tissues.

Inflammatory processes are bursitis, arthritis. Epicondylitis, known to many, belongs to this class. Arthrosis is associated with degenerative changes in organic tissues. Injuries can be very different - you can break an element of the elbow, sprain a ligament or dislocate an area. Of the surrounding tissues, muscle, nerve, and also may be damaged due to the disease. vascular system, providing nutrition to the elbow joint.

For everyone's illnesses specified groups each has its own unique features and nuances of clinical manifestations. After analyzing the patient’s complaints, the doctor will certainly determine what he had to deal with and select the appropriate therapeutic course.

Relevance of the problem

If you notice any symptoms of underlying diseases of the elbow joint, you should not delay visiting a doctor. Nowadays, anyone can access the services of a qualified medical personnel with specialized equipment. Doctors will quickly understand the cause of pain and poor mobility in the area. Diagnostics will help to correctly and accurately identify the pathology, the doctor will select suitable treatment. Only an early and fully completed course will help achieve either complete restoration of the site, or the maximum possible under current conditions. If you delay going to the clinic, you risk depriving yourself of joint mobility for life.

Of course, the causes, symptoms, and treatment of pain in the elbow joint are the area of ​​specialization of professional doctors, but ordinary people should also understand what can cause such problems. Knowing the common, widespread pathologies, having an idea of ​​their manifestations, you can adequately assess the problem that has arisen, and therefore consciously consult a doctor as soon as possible.

Arthritis

Among those indicating the need urgent treatment symptoms of elbow joint diseases, in reality, an impressive percentage of cases are manifestations of rheumatoid type arthritis. The pathology is an autoimmune one, affecting the spinal column and joints in different parts body, and the elbow will be no exception. Complex mechanism progress, risk factors have not yet been fully studied, due to which arthritis, like other diseases of the autoimmune spectrum, is an urgent and serious medical problem. Inflammatory processes often accompany systemic lupus erythematosus, scleroderma and spondyloarthritis, but in most cases rheumatoid arthritis is diagnosed.

A feature of the pathological condition is the generation of antibodies by tissues to the connective fibers included in the joint. The body's own antibodies harm the joints at the cellular level, as a result of which a person suffers from typical manifestations of arthritis. Symptoms of the disease include bilateral damage to parts of the body. The pain is especially severe in morning hours, and after a slight load it decreases. In the first half hour after waking up (sometimes longer), a person is bothered by stiffness of the joint area. The elbow has limited movement, and the surrounding tissues swell. Deformation of areas and erosion are possible.

Nuances of the development of the disease

Most often, symptoms indicating the need for treatment for elbow disease appear in small areas of the body. Traditionally, rheumatoid arthritis is localized in small joint areas, most often in the feet and bones, but the elbows are affected somewhat less frequently.

The main percentage of patients are elderly people. When arthritis develops in minors, the juvenile form of the disease is diagnosed. Another variant of pathology is Still's disease.

Reactive arthritis

This disease is also an inflammatory disease. The prognosis is somewhat better than in the case of the rheumatoid form; although severe deformation of the affected area is observed, it is observed in a rather small percentage of patients. The pathology most often develops when the body is infected, and the source of penetration is localized outside the joint area. From medical statistics it is known that the root cause for the majority is urogenital infections and intestinal diseases. The human immune system reacts to the pathogen, generates antibodies that affect the viability of pathological microflora and elements of the body.

There are a number of common symptoms that indicate the need for treatment for inflammation of the elbow joint. The disease is indicated by pain, especially pronounced near large joint areas, as well as short-term stiffness of movement in the morning. Both symmetrical and unilateral lesions are possible. To alleviate the condition, the patient is prescribed non-hormonal anti-inflammatory drugs - this category of drugs has proven to be the most effective. After the root cause is cured, the symptoms of arthritis continue to bother you for about a month. A successfully chosen therapeutic course helps to completely get rid of adverse effects over time.

Bursitis

This type of elbow joint disease is also an inflammatory disease, and is considered severe because it is difficult to treat. A feature of the condition is microbial infection of the joint cavity. Bursitis often accompanies arthritis of an infectious nature. The first to suffer is the bursa near the joint. Infection may occur due to injury or an incorrect injection. Pathological microflora can enter the joint through the bloodstream from the source of infection inside the body. The joint becomes an area of ​​localization of the inflammatory focus, which is accompanied by severe pain, which is activated when trying to move. The tissues turn red and swell, and touching causes severe discomfort. Often, bursitis is accompanied by manifestations of poisoning of the body - fever, weakness. Some people have headaches, others feel tired all the time.

Only a doctor will tell you why the disease requires an antibacterial therapeutic course, which means you first need to take tests to determine the sensitivity of the microflora. At the same time, the doctor will prescribe non-hormonal anti-inflammatory drugs and local anesthesia in order to reduce the manifestations of the disease. Self-treatment of bursitis at home, without the supervision of a doctor, is not possible - the likelihood of severe complications is high.

Gout

This disease is most often localized in the legs, but occasionally the elbow suffers. Disease of the elbow joint is associated with the accumulation of transformation products uric acid. Salt crystals accumulate in the joint. This is especially typical for people who consume purine bases in their food. Gout worries people who are obese and diabetic and who drink a lot of alcohol. There may be genetic factors in the development of the disease.

Gouty arthritis is a disease of the elbow joint in which the pain has a pronounced rhythm. The pathology is prone to relapse, the acute form alternates with remission. Examination of the fiber in the layers of tissue under the skin reveals small nodules formed by uric acid in the form of crystalline deposits. Acute stages often follow after drinking alcohol or refusing to diet. A patient's blood test shows elevated levels of uric acid. General analysis urine gives an idea of ​​deviations from the norm. To confirm the disease, you can check the joint fluid for the presence of uric acid transformation products.

The therapeutic course involves specialized nutrition and the use of medications aimed at reducing the concentration of urates in organic tissues. In the acute phase, the patient is advised to take non-hormonal anti-inflammatory drugs. Preparations containing colchicine have proven themselves well.

Epicondylitis

This pathology is one of the most common, quite specific, and has long attracted the attention of doctors around the world. Epicondylitis is a disease of the elbow joint, accompanied by the formation of inflammatory foci in the area where muscle tissue is attached to the humerus and epicondyles. The unofficial name for this pathological condition is condylitis, which is what many patients know it by. In fact, the term that gives the disease its name is “epicondyle,” which in Latin is epicondylus.

The need for treatment of epicondylitis (disease of the elbow joint) may arise against the background of prolonged muscle stress affecting the forearm area. In this case, the epicondyles become the site of localization of numerous microscopic injuries. It is customary to talk about two types of the disease: lateral and medial forms. The first is also known as external. This often worries professional athletes. The main risk group is those who play tennis. The medial type is not uncommon among golfers. For many, it develops as a consequence of joint injury.

Nuances of pathology

Doctors have been studying the symptoms and treatment of epicondylitis of the elbow joint for decades. It has been established that the disease is indicated by soreness of the internal and external joint parts, weakening of muscle strength in the forearm area. During normal work, a person feels severe pain, and the tissues surrounding the joint swell. Epicondylitis develops chronically and requires a comprehensive therapeutic course. This pathology is an indication for a change in workplace and nature of activity.

If signs of the acute phase of the disease indicate the need for treatment of epicondylitis of the elbow joint, the patient is advised to take analgesics. The joint area needs cooling. When acute stage is completed, the doctor refers the patient to a physical therapy program. To restore the zone's functionality, it is necessary to practice physical therapy exercises.

Arthrosis

This disease is degenerative in nature, more often diagnosed in older people and accompanies osteoarthritis. The peculiarity of the pathological condition is its connection with constant loads on the diseased area. Arthrosis is usually observed in areas where the joints are damaged. Impaired health can provoke synovitis, which is prone to relapse, in which osteophytes formed by bone tissue increase. Under their influence, the joints are deformed.

Arthrosis indicates pain that is weakened at rest and becomes more active during exercise. Pain often appears when a person begins to move, but soon passes. In comparison with many of the diseases described above, arthrosis does not lead to stiffness of the area in morning time. The progress of the pathology is associated with a decrease in joint mobility and irreversible deformations. Synovitis recurs, and the symptoms are similar to those of other types of inflammation in the joint.

Arthrosis is one of the chronically developing pathologies that cannot be completely cured. The therapeutic course is aimed at alleviating symptoms and maintaining the patient’s quality of life for as long as possible. A well-chosen program can slow down the progression of the disease. Usually the doctor prescribes chondroprotectors, recommends a physiotherapy program and a course of therapeutic exercises.

Dislocation

Often you have to think carefully and look for why your elbow joints hurt. The causes, treatment methods, and diagnostic nuances are determined by the characteristics of the case. Often the pain is caused by an injury - the elbow is especially susceptible to these injuries. high degree. The area of ​​the human body is formed by three bones, includes a vulnerable joint capsule, is protected by a weak muscle frame, which means that any strong load leads to injury. To avoid dislocation, you need to be extremely careful and prevent aggressive external influences.

A dislocation is possible if the elbow has suffered a direct blow or the person has put too much force into moving the area. In this case, the area loses the ability to actively move, its shape is disrupted, tissue swelling and spasm of nearby muscles are observed. Receiving an injury and the period shortly after this are bothered by severe soreness of the area.

As a rule, a visual examination is sufficient to make a diagnosis. In the absence of complications, conservative treatment is practiced - the dislocation is reduced, a plaster bandage or bandage is applied to the shoulder or forearm. As a complication, habitual dislocation is possible when the fibrin of the joint ceases to protect the area, as it should normally. Even weak application of force provokes dislocation. Treatment may include surgery on the patient.

Stretching

This injury also falls into the category of diseases of the elbow joint and is very common. The pathological condition is associated with muscle strain and provokes pain similar to that characteristic of inflammatory processes in the joints. An adequate therapeutic course allows you to quickly cure a sprain without leaving a trace.

The nuances of the pathological condition include the intermittent nature of the pain, which is disturbing when applying force to the affected area. In this case, the muscles of the forearm (one, several) suffer; occasionally the pathology extends to the articular shoulder. Symptoms appear after you have suffered an injury or applied too much stress to the areas. Due to stretching, the tissue around the joint swells and range of motion is limited. The condition is not considered dangerous, but requires responsible treatment. After receiving an injury, you need to ensure complete rest of the area for the first few hours and apply a cooling compress. When the acute inflammatory process has exhausted itself, local analgesics and warming compounds are applied. In some cases, physical therapy is indicated.

Sprains caused by active sports physical work, can be repeated regularly. This condition requires special attention, since it can provoke the appearance of a serious disease of the elbow joint - epicondylitis.

Fracture

Bone tissue injury is perhaps the most severe type of damage to the integrity of the articular area. You can break and damage the humerus and radius. If the process goes particularly wrong, the fracture line affects the articular plane and damages several bones at the same time. A fracture usually occurs when a particularly powerful direct force is applied. Such consequences are not uncommon in the event of an unsuccessful fall or accident. The risk of fracture is higher with osteoporosis, when bone tissue becomes less dense. This is typical for women during menopause, the elderly and patients forced to use non-hormonal anti-inflammatory drugs with a systemic effect for a long time.

A fracture can be suspected if the injury is accompanied by sharp and severe pain, as well as a characteristic crunching sound. Soon after this event, the tissues near the elbow joint swell, the area loses mobility, and the joint becomes deformed. If the fracture is open, bone fragments can be seen in the wound. X-ray will show accumulation bloody discharge near the joint. If the fracture affects the joint space, it is classified as complicated. Treatment is urgent surgery, after which the limb is immobilized. Treatment control is realized through x-rays.

When the bone has completely healed, the patient will be referred to rehabilitation program recovery normal mobility and hand functionality.

The ulnar nerve is most often affected at the level of the elbow.

The cause is frequently repeated stretching and compression of the nerve. Sometimes compression develops after a fracture.

External compression occurs when the ulnar groove is shallow (with tetraplegia, anesthesia, coma).

Damage to the ulnar nerve usually manifests itself as numbness in the little finger and medial surface of the hand, and weakness of the hand muscles. Percussion in the elbow area reveals positive symptom Tinnel.

Conservative treatment follows the same principles as for carpal tunnel syndrome. For cubital tunnel syndrome, it is recommended to avoid prolonged flexion of the forearm; immobilization of the elbow joint with a splint at night is indicated. When atrophy of the hand muscles occurs, surgical intervention is indicated.

Symptoms of ulnar nerve neuropathy

The ulnar nerve innervates the following muscles: the ulnar flexor of the hand (m. flexor carpi ulnaris), the deep flexor of the fingers, the ulnar part (m. flexor digitorum profundus); adductor pollicis muscle, abductor pollicis muscle (m. abductor digiti quinti); short flexor of the fifth finger (m. flexor digiti quinti brevis), muscle opposing the fifth finger (m. opponens digiti quinti), short flexor thumb(m. flexor pollicis brevis), lumbrical muscles III and IV (mm. lumbricales); interosseous muscles (mm. interossei).

The motor function of the ulnar nerve is to flex the hand and deflect it to the ulnar side; flexion of the proximal and extension of the middle and distal phalanges of the V, IV and partially III fingers; adduction and abduction of fingers; adduction of the first finger.

The territory of sensitive innervation is the ulnar part of the palmar and dorsum of the hand (11/2 fingers on the palm and 21/2 fingers on the dorsum). Deep sensitivity is most impaired in the fifth finger.

Symptoms of damage to the ulnar nerve at different levels. With high damage to the ulnar nerve (on the shoulder, compression in the ulnar canal), flexion of the hand is difficult, the hand deviates to the radial side; the adduction of the first finger is weakened and it is retracted outward; difficulty holding objects with fingers I and II; flexion of the proximal and extension of the distal phalanges of the V–IV (III) fingers, adduction and extension of the V, IV fingers are impaired. The predominance of antagonist muscles leads to the formation of a “clawed, bird’s foot” (hyperextension of the proximal phalanges and flexion of the distal phalanges). Atrophy of the interosseous muscles, hypothenar muscles, and muscles in the first dorsal space develops.

Sensory disturbances are recorded on the ulnar side of the palm and the dorsum of the hand and fingers. In these areas, cyanosis, hyperemia, thinning and dry skin, and changes in nails are often detected.

The causes of damage to the ulnar nerve at this level can be bone fractures, joint deformation, dislocation of the nerve, trauma (compression) of the nerve during prolonged work in one position at a desk or desk, prolonged bed rest (especially in unconscious), when the nerve is pressed against the bone by the hard plane of the table or the edge of the bed.

The clinical picture of nerve damage in the middle and lower thirds of the forearm is distinguished by the preservation of palmar flexion of the hand.

Compression of the ulnar nerve at the level of the wrist joint is manifested by various syndromes. Ulnar wrist syndrome is characterized by pain and paresthesia in the ulnar part of the hand, hypoesthesia of the fifth finger, weakness of flexion of the fifth (IV) and adduction of the first fingers. Pain can be provoked by palpation, tapping, or applying a cuff.

Neuropathy of the deep branch of the ulnar nerve (pisiform-uncinate tunnel) is manifested only by movement disorders, flexion, abduction and abduction of the fingers, adduction of the first finger, and atrophy of the muscles of the hand are impaired.

Neuropathy of the dorsal branch (trauma to the styloid process of the ulna, pressure from bracelets, handcuffs) is manifested by pain, paresthesia and impaired sensitivity on the dorsal surface of the V, IV, III fingers.

Study of ulnar nerve function

1. Active movements are assessed - flexion of the hand and fingers.

2. The patient is asked to clench his fingers into a fist - fingers V, IV (III) are not clenched enough. If this movement is prevented, then weakness of the flexors of these fingers is felt.

3. The patient is asked to “scratch” the table with his little finger with the hand tightly fitting - the movement fails.

4. The patient is asked to hold a sheet of paper with straightened fingers I and II. When the doctor tries to pull out the sheet, the distal phalanx of the first finger bends (function of the median nerve).

5. The patient is asked to bend and adduct the hand. The physician resists movement and feels weakness in the wrist flexors.

6. The patient is asked to, overcoming the doctor’s resistance, adduct the first finger - the adduction force is reduced.

7. The patient is asked to spread and adduct his fingers on a horizontal surface, overcoming the doctor’s resistance.

8. Evaluate appearance brushes (“clawed brush”).

9. Sensitivity is examined: hypoesthesia is recorded along the ulnar edge of the palmar and dorsal surface (5 fingers on the palmar surface and 4 fingers on the dorsal surface).

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Bruises, sprains. Conservative treatment uses techniques to increase the range of motion, relieve inflammation and swelling of the periarticular tissues. For this purpose they are used pharmacological preparations and physiotherapeutic procedures - diathermic currents, massage, electrophoresis. Therapeutic gymnastics and physical exercises help restore range of motion in the joint, strengthen muscles, ligaments and tendons. When a complicated pathology or serious injury is diagnosed, patients are indicated for surgical intervention. The list of popular treatment methods for the elbow joint includes interpositional, padless, wedge-shaped arthroplasty surgery and joint replacement.

Etiology and symptoms

Treatment depends on why the elbow joints hurt. The cause of pathologies can be a disease that affects all joints in the body. This occurs when gout, chondrocalcinosis, malignant and benign neoplasms, tendinitis , . Swelling disappears after the underlying disease is eliminated. Some pathologies are not yet amenable to any conservative or operative method therapy, such as rheumatoid arthritis. Therefore, treatment uses drugs to prevent relapses and reduce the severity of symptoms. There are also specific causes of pain and stiffness in the elbow joint:

• . As the disease progresses, compression of large blood vessels by bone growths occurs in the vertebrae. Cubital tunnel syndrome is diagnosed, caused by compression of the ulnar nerve;
• bursitis. The disease can be isolated and often occurs due to injury or excessive physical exertion. It is often provoked by a general pathology, for example, gout. Bursitis occurs due to aseptic or infectious inflammation synovial bursa. One of the symptoms is a visible and easily palpable lump in the elbow area;
• or . Pain in the elbow joint is the result of destructive and degenerative changes in the tissues. The causes of arthritis or arthrosis are increased physical activity, aging of the body, endocrine disorders, autoimmune pathologies, bad habits;
• diffuse fasciitis. The disease is accompanied by pain and limited mobility of the elbow joint. Visible external damage is deformation of the skin in the form of an orange peel. With a complicated course of fasciitis, a small compaction forms;
• intervertebral hernia in the thoracic or cervical spine spine. Its formation can cause pinching of nerve endings. Elbow pain is considered referred pain. In the absence of medical intervention, functions are impaired, skin sensitivity of the forearm decreases, and atrophy of the biceps muscle develops;
• epicondylitis. A characteristic symptom of the pathology is severe pain when trying to bend or straighten the hand. Treatment methods for epicondylitis, or “”, in the elbow joint depend on its type. Lateral pathology is characterized by inflammation of the tendons attached to the bone base and preservation of the functional activity of the elbow. With internal epicondylitis, the range of motion in the joint may be somewhat limited. The disease accompanies those responsible for flexion. The pain radiates to the elbow joint and forearm.

Injury to the joint usually occurs when a fall rests on the hand. manifested by severe pain, rapidly developing inflammatory edema, and inability to bend or straighten the elbow. Posterior dislocation is characterized by joint deformation, shortening of the forearm, and limited movement. With an anterior dislocation, elongation of the forearm on the injured side and a depression above the joint are diagnosed. Loss of sensitivity in the hand is possible with lateral dislocation due to compression or disruption of the integrity of the nerve fibers.

For sprained or torn ligaments and tendons functional activity the elbow joint is reduced, the symmetry of the muscle relief is disturbed, swelling and severe pain occur. A characteristic symptom of a bruise is a hematoma caused by damage to small blood vessels.

Patients who underwent conservative treatment of damaged elbow ligaments were examined at the Research Institute of Traumatology and Orthopedics. In 50% of people, joint function has not been fully restored. Therefore, many traumatologists immediately prescribe surgery to patients.

Drug therapy

Symptoms and treatment of the elbow joint are closely interrelated. To reduce the severity of severe pain, it is necessary to use injection solutions. When weak, aching pain It is enough to use tablets, capsules or dragees. Treatment carried out in the initial stages of the pathology is most effective. It allows you to completely eliminate the symptoms of injuries or diseases and return the joint to its previous mobility.

Nonsteroidal anti-inflammatory drugs

NSAIDs are the first choice drugs in the treatment of pathologies of the musculoskeletal system, including the elbow joint. They have anti-inflammatory, analgesic, antipyretic effects. Taking NSAIDs helps eliminate pain, tissue swelling and bruises. And if symptoms of general intoxication of the body occur, drugs effectively cope with fever, chills, fever, etc. What the doctor can prescribe:

• Nimesulide (80 rubles);
• Ketorolac (45 rubles);
• Celecoxib (210 rubles);
• Diclofenac (40 rubles);
• Meloxicam (65 rubles);
• Ibuprofen (40 rubles);
• (65 rubles).

For severe pain, take a tablet 3 times a day for a week. Ointments and gels are applied slightly above the area of ​​pain and inflammation 2-4 times a day. NSAIDs are combined with proton pump inhibitors, active ingredients which are esomeprazole, pantoprazole, omeprazole, rabeprazole. These drugs prevent the development of severe adverse reaction non-steroidal drugs- damage to the gastric mucosa. NSAIDs are not prescribed to patients with severe pathologies of the digestive organs, kidneys, liver, pregnant or breastfeeding women.

Regular use of NSAIDs increases the risk of decompensation of chronic heart failure in patients with diseases of the cardiovascular system. This is due to the toxic effects of drugs on the kidneys. The body begins to retain water and sodium, the tone of peripheral vessels increases, and afterload increases.

Chondroprotectors

Chondroprotectors are drugs used to prevent the progression of destructive and degenerative changes in the elbow joint. Their use is recommended for patients during the rehabilitation stage after surgery. Chondroprotectors are used as prophylactic from damage to joints by people actively involved in sports or experiencing physical stress in the service. Structure-modifying agents usually include collagen, hyaluronic acid, vitamins A, E, B2, B6, B1, B12. Some of them contain extracts of marine fish and invertebrates, connective tissues of cattle, and extracts from medicinal plants. The following chondroprotectors have proven themselves in the treatment of diseases of the elbow joint:

• Teraflex and Teraflex Advance (from 500 rubles);
• Structum (1430 rubles);
• Alflutop (1500 rubles);
• Rumalon (2100 rubles);
• Piaskledin (1250 rubles);
• Don (1300 rubles);
• Mukosat (645 rubles);
• Chondroxide (650 rubles).

The duration of taking chondroprotectors depends on the stage of the disease or the degree of injury to the elbow joint. In severe cases or osteoarthritis, treatment is required for 1-2 years. Chondroprotectors gradually accumulate in other joint structures. After 3-4 weeks they begin to exhibit pronounced anti-inflammatory and analgesic activity, which persists for several months after discontinuation of the drugs. To increase therapeutic effectiveness, rheumatologists recommend simultaneous use systemic and local chondroprotectors - cream, Teraflex, Arthro-Active.

B.A. Michel conducted a study of the therapeutic effect of chondroitin on the joint, the main evaluation criterion of which was the width of the joint space on x-ray images. It was found that taking 0.8 g of chondroprotector daily caused a statistically significant stabilizing effect on the width of the joint space in arthrosis.

Intra-articular administration of drugs

Intra-articular injection - injection of the drug into the cavity of the elbow joint. This is a required part conservative treatment any inflammatory pathology (arthritis) and degenerative disease (arthrosis). The introduction of a medicinal solution into a joint does not cause more pain to the patient than intravenous or intramuscular injection. This method of therapy is used to quickly stop a severe inflammatory process and eliminate symptoms.

Regular administration of chondroprotectors promotes the gradual restoration of cartilage tissue during lung diseases And medium degree gravity. Intra-articular injections avoid surgery on the elbow joint. What drugs are used during the procedure:

• glucocorticosteroids - Celeston, Diprospan, Hydrocortisone, Flosteron, Kenalog;
• chondroprotectors - Tsel-T, Chondrolone, Alflutop, Chondroitin, Glucosamine;
• hyaluronic acid or its derivatives - Crespin-gel, Sinokrom, Ostenil.

Preparations with hyaluronic acid are used to restore the required volume of synovial fluid. Its deficiency provokes rapid wear of articular tissues, characteristic.

In rheumatology, the use of gas injections is practiced. Injected into the joint cavity carbon dioxide, which has gone through several stages of cleaning. Carbon dioxide stimulates the acceleration of metabolism, improves blood circulation and microcirculation in damaged tissues. After several sessions of treatment procedures, the range of motion in the joint is restored, its morning swelling and pain disappear.

Physiotherapeutic procedures

Physiotherapy is prescribed to patients regardless of the cause of pain in the elbow joint. They slow down the progression of degenerative pathologies and stimulate the restoration of bone and cartilage tissue after injury. The combination of physiotherapeutic manipulations with a course of medications significantly accelerates the recovery of patients. Contraindications to their implementation are an acute inflammatory process in the joint cavity and (or) its infection with pathogenic bacteria. The greatest therapeutic effectiveness is typical for the following physiotherapy procedures:

• diathermic currents. The principle of operation of this method of electrotherapy is the deep heating of damaged tissues with high-frequency currents (usually 1.65 MHz). Under the influence of heat, metabolic processes are accelerated, and the blood supply to tissues with nutritional and bioactive compounds is normalized. Enhanced tissue regeneration and restoration of the original mobility of the elbow joint are launched;
• cryotherapy. Physiotherapy is usually used to treat injuries, the clinical manifestations of which are extensive swelling and hematomas. During cryotherapy, liquid nitrogen is applied to the damaged joint. Microcirculation is restored, blood circulation improves, swelling and bruising resolve;
• laser therapy. The procedure is carried out using low-energy laser technology to activate metabolic processes. Laser therapy helps relieve chronic inflammation and eliminate molecular oxygen deficiency. After 5-10 sessions of physical therapy, the need for painkillers decreases or completely disappears;
• sodium chloride baths. These procedures have analgesic, anti-inflammatory and immunomodulatory effects. A peculiar spraying of salt crystals onto damaged tissue occurs, creating a warming effect. Cells begin to consume more oxygen, metabolism and healing of joint structures accelerate.

The most commonly prescribed physiotherapeutic procedure is electrophoresis. A tampon soaked in medicinal solution. On top of it there are electrodes through which a weak light is passed. electricity. Under the influence of impulses, drug molecules penetrate into the hyaline cartilage, synovial fluid, bone tissue. During electrophoresis, maximum absorption of active ingredients into the joint cavity occurs.

In rheumatology and traumatology, the use of a modern physiotherapeutic method - shock wave therapy - is practiced. It consists of extracorporeal short-term exposure to bone and connective tissue with low-frequency acoustic impulses. SWT is used in the treatment of pathologies of the elbow joint, including epicondylitis.

Do not suppress pain in the elbow joint. Careful diagnosis and a competent therapeutic regimen will help prevent the progression of pathology. Treatment started immediately after the first symptoms appear significantly speeds up recovery.