Tunnel neuropathy of the ulnar nerve treatment. Neuropathy - damage to the nerve of the elbow joint

Ulnar nerve (n. ulnaris). The ulnar nerve is formed from fibers CVIII - T: spinal nerves which pass supraclavicularly as part of the primary inferior trunk 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 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 canal is formed by a fascial band that extends from olecranon to the internal epicondyle, covering the ulnar and humeral 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 divides into five dorsal nerves of the fingers, which end in the skin back surface 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.

adductor muscle thumb arms (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 pollicis brevis; 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 and bent position of the nail phalanges of the 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 syndrome of the ulnar nerve develops with rheumatoid arthritis, with osteophytes of the distal end of the humerus, with fractures of the epicondyle of the humerus and the bones that form 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 dorsal surfaces of the hand, the fifth finger and the ulnar side of the fourth finger.

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

1. with sensitive loss and weakness of the hand muscles;
2. without sensory loss, but with paresis of all hand muscles supplied by the ulnar nerve;
3. without loss of sensitivity, but with weakness of the muscles innervated by the ulnar nerve, excluding the hypothenar muscles;
4. 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, tunnel syndromes and compression of the median and ulnar nerve in the wrist area can simultaneously occur - the third type of syndrome.

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

General information

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

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

Anatomy of the ulnar nerve

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

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

Causes of ulnar nerve neuropathy

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

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

Symptoms of ulnar nerve neuropathy

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

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

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

Diagnosis of ulnar nerve neuropathy

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

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, 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:

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 vegetative type. 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 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, integral clinical manifestation is a pain syndrome varying intensity, and 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, half of the 3rd and the entire 4th and 5th fingers are affected on the dorsal surface.

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 you are sensitive pathogenic flora, 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 should be added, in particular proserin, and biogenic stimulants(Lidase).

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 impulse currents. 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 stagnation. 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 it is recommended to carry out surgical intervention. 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.

Why do elbow joints hurt?

Damage to the ulnar nerve (ulnar nerve neuropathy) (G56.2) is pathological condition, in which the ulnar nerve is affected, manifested by disruption of the muscles of the hand responsible for the movements of the ring and little fingers, and numbness in this area.

Etiology of damage to the ulnar nerve: compression of the nerve in the area of ​​the elbow joint (long-term work with support on the elbows); fracture of the internal condyle of the humerus or supracondylar fracture; compression in the wrist area; past infections.

Symptoms of ulnar nerve damage

Patients complain of pain in the little finger, tingling sensation, burning sensation in the hand. Gradually, numbness and weakness of the little finger appear, the impossibility of palmar flexion of the hand, and difficulty in adducting and abducting the fingers.

An objective examination of the patient reveals paresthesia, hypoesthesia in the little finger, along the medial surface of the hand (70%). Weakness of the interosseous muscles, adductor pollicis, and hypothenar muscles (70%). Atrophy of the interosseous and hypothenar muscles (50%). Hyperextension in the metacarpophalangeal joints and flexion in the interphalangeal joints (55%). When clenching the hand into a fist, the little and ring fingers do not bend completely (Fig. 3). Pitre's test (inability to bring the fourth and fifth fingers of the hand when the palm rests on a hard surface) - 60%. Flexion of the terminal phalanx of the fifth finger is impossible. In the area of ​​innervation of the ulnar nerve there may be autonomic disorders- cyanosis, impaired sweating, local increase in temperature.

Diagnostics

• Electroneuromyography.
• X-ray or CT scan elbow and/or wrist joint.

Differential diagnosis:

• Damage to the lower part of the brachial plexus.

Treatment of ulnar nerve damage

Treatment is prescribed only after confirmation of the diagnosis by a medical specialist. Nonsteroidal anti-inflammatory drugs and vitamins are indicated. Physiotherapy, massage, exercise therapy, novocaine and hydrocortisone blockades, and acupuncture are provided. Surgery prescribed for compression of the ulnar nerve.

Essential drugs

There are contraindications. Specialist consultation is required.

• (non-steroidal anti-inflammatory drug). Dosage regimen: IM - 100 mg 1-2 times a day; after pain relief, it is prescribed orally in daily dose 300 mg in 2-3 doses, maintenance dose 150-200 mg/day.
• (non-steroidal anti-inflammatory drug). Dosage regimen: IM at a dose of 75 mg (contents of 1 ampoule) 1 time/day.
• (vitamin B complex). Dosage regimen: therapy begins with 2 ml intramuscularly 1 time per day for 5-10 days. Maintenance therapy - 2 ml IM two or three times a week.

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

general characteristics

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

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

Causes

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

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

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

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

Symptoms

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

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

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

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

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

Diagnostics

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

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

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

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

Treatment

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

After this, complex treatment is prescribed, which includes the following methods:

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

Drug therapy

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

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

Physiotherapy helps relieve inflammation and restore muscle function

Physiotherapy

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

Physiotherapy

Application begins special exercises after removing the lock. Both passive and active movements are used. the main objective gymnastics - prevent contractures and muscle atrophy, restore their function.

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

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

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

Passive and active finger exercises help restore finger function

ethnoscience

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

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

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