Inflammation of the nerve in the elbow joint treatment. Symptoms of damage to the ulnar nerve and its branches

Tingling in the fingers
Spread of pain to other areas
Numbness of fingers
Loss of sensation in the fingers
Pain in the elbow joint
Tingling in the palms
Difficulty bending the wrist
Pain when clenching the hand into a fist
Atrophy of the muscles of the hand
Weakness of the muscles of the hand
Tingling in the forearm
Brush in the form of a clawed paw
Difficulty bending fingers

Etiology
Classification
Symptoms
Diagnostics
Treatment
Prevention and prognosis

In the vast majority of cases, an injury to the arm, forearm or shoulder leads to the onset of the disease. In addition to this, there is a large number of other predisposing factors, both pathological and physiological.

Such a disease has a specific clinical picture, which is why there are no problems with establishing the correct diagnosis. The main symptoms are the inability to clench the hand into a fist, the lack of sensitivity in the fifth and fourth fingers, as well as characteristic appearance brushes.

The diagnosis can be confirmed with the help of instrumental examinations, which in without fail preceded by a physical examination. The tactics of therapy can be medical, physiotherapeutic and surgical, but often the treatment is complex.

The International Classification of Diseases does not allocate a separate cipher for such a disease and classifies it in the category of "Injury to individual nerves", which has a code according to ICD-10 - G 50 - G 59.

The widespread occurrence of such an ailment lies in the fact that, due to its anatomical localization, the ulnar nerve is the most vulnerable place, compared, for example, with the radial or median nerve.

Often there is a traumatic mechanism for the development of the disease. Thus, the most common causes of the development of pathology are presented:

bruises of the upper limbs;
dislocation of the forearm;
supracondylar fracture of the shoulder;
fracture of the medial condyle of the shoulder;
forearm fracture;
fracture of the ulna of the isolated form;
dislocation of the hand;
fracture olecranon.

The above factors lead not only to traumatization of the nerve, but also to its compression in the cubital canal.

and osteodystrophy;
deforming form;
demyelinating pathologies - during their course, the destruction of the myelin sheath of the nerve that covers it occurs. This category of ailments includes multiple and concentric sclerosis, acute optic neuromyelitis and disseminated, as well as diffuse leukoencephalitis. In such situations, they talk about demyelinating neuropathy. ulnar nerve;
radial joint;
aneurysms located near the joints;
swollen lymph nodes;
compression of this nerve by a neoplasm of any nature.

In addition to pathological predisposing factors, pathology often develops against the background of:

habits of constantly leaning on the elbow, in particular while talking on the phone;
regular and monotonous work with tools, for example, a screwdriver and pliers, tongs and hammers, as well as vibrating tools;
riding a bicycle or motorcycle, but only in situations of professional practice in the respective sports;
working conditions associated with the support of the elbows of the right and left hands on the desk, machine, as well as the side of the door on the machine;
prolonged stay under a dropper, in which the upper limb for a long period of time is fixed in an unbent position - while the nerve is amenable to compression.

Disease classification

In the medical field, only one division of the disease is used - according to the etiological factor. From this it follows that neuropathy of the ulnar nerve is:

post-traumatic- the disease often develops against the background of stretching, rupture or other damage to the ulnar nerve, which is due to the above predisposing factors;
compression- this should include cubital canal syndrome and Guyon's syndrome. The main source is nerve compression against the background professional activity and various diseases. In such situations, the formation of inflammation, swelling and bone changes in the areas of passage of this nerve occurs.

Location of the ulnar nerve

Symptoms of the disease

The clinical signs of the disease will differ somewhat depending on the type of neuropathy. For example, with cubital canal syndrome, the symptoms will be as follows:

soreness in the area of the fossa of the elbow, which is located on the inner surface of the elbow. At the beginning of the course of the disease, the pain will be periodic, but as it progresses, it will be constant and intense;
irradiation of pain sensations on the forearm, the fourth and fifth fingers (both in the palm area and with back side), as well as on the ulnar edge of the hand (near the little finger);
tingling and other discomfort in the above areas;
violation of the susceptibility of the skin to external stimuli in the ulnar edge of the hand, the fourth and fifth fingers. It is worth noting that there is one distinguishing feature - first of all, sensitivity disappears in the little finger;
difficulty in the process of bending the hand and fingers;
the brush takes the form of a clawed paw;
an attempt to clench the hand into a fist causes pain, and the affected fingers do not press against the surface of the palm, and it is difficult or impossible to take them aside;
muscle atrophy, which is expressed in a decrease in the size of the hand, retraction of the interdigital spaces and a clearer protrusion of the bone. It is noteworthy that the rest of the affected limb and healthy hand have a normal appearance.

Symptoms of neuropathy of the ulnar nerve in cases of development of Guyon's canal syndrome practically do not differ from those described above, however, there are several characteristic differences:

pain and tingling are localized in the area wrist joint, on the palm, in the little finger and ring finger. The back region of the hand does not experience such signs;
increased pain only at night or with intense movements;
the disappearance of sensitivity is observed only in the area of \u200b\u200bthe fingers - there is no such sign on the back side;
weakness of flexion of diseased fingers, the inability to fully press them to the palm, difficulty in spreading and mixing them;
the development of atrophy and the formation of a "clawed" form of the hand.

In cases of incomplete neuropathy of the ulnar nerve clinical picture will include:

weakness of the muscles of the hand;
reducing the gap between the little finger and ring finger;
tingling in the palms;
numbness and sensory disturbances of the fifth finger, as well as the part of the fourth finger adjacent to it;
pain syndrome along the entire length of the ulnar nerve.

Diagnostics

If one or more of the above symptoms occur, it is necessary to consult a neurologist who will take measures primary diagnosis and prescribe the necessary instrumental examinations.

The first stage of diagnosis includes:

study of the medical history - to identify pathological predisposing factors;
collection and analysis of the patient's life history - to establish the physiological source of the pathology;
neurological examination - the patient is asked to clench his fingers into a fist, and also check reflexes with a special hammer;
a detailed survey - to determine the nature of the course and the severity of symptoms.

Laboratory studies of blood, urine and stool with neuropathy of the ulnar nerve have no diagnostic value.

The following instrumental procedures help to clarify the diagnosis:

electromyography and electroneurography;
radiography of the elbow joint, forearm and wrist joint;
Ultrasound of the ulnar nerve;
CT of the joints.

Ultrasound of the ulnar nerve

In addition, the clinician must differential diagnosis, during which neuropathy of the elbow joint is distinguished from:

neuropathy of the radial and median nerves;
radicular syndrome;
osteochondrosis and spondylarthrosis;
tunnel neuropathy.

Treatment of the disease

The tactics of how to treat the elbow depends entirely on etiological factor. For example, surgical intervention has the following indications:

malignant or benign formations that compress the nerve;
formation of hematomas and scars;
failure of conservative therapy.

The scheme of operation is selected in individually for each patient, but can be done by:

nerve decompression;
neurolysis;
nerve transposition;
excision of the nerve tumor.

Medical treatment tactics involves taking:

anti-inflammatory drugs;
glucocorticoids;
painkillers;
anticholinesterase;
vasoactive drugs;
vitamin complexes and metabolites.

Therapy with drugs is necessarily supplemented by physiotherapy, namely:

magnetotherapy;
phonophoresis;
electromyostimulation.

After stopping the inflammation, a course is indicated therapeutic massage and LFC. With neuropathy of the ulnar nerve, treatment with gymnastics involves the following exercises:

pressing with a healthy hand on the middle phalanges of the affected fingers until they are fully extended;
alternate abduction of any finger of the diseased hand, with the help of a healthy one - it is recommended to start with the thumb;
alternately lower and raise the fingers of the affected limb;
making circular movements with fingers;
catching rubber objects in water various volumes and their contraction.

A complete list of classes can only be provided by the attending physician.

In total, treatment takes from three months to six months.

Prevention and prognosis

To reduce the likelihood of developing problems with the elbows, or rather, with their nerves, you must:

abandon monotonous movements of the upper limbs, if this is not related to work;
avoid physical overexertion;
regularly perform gymnastics for the upper limbs, especially when specific conditions labor;
constantly take vitamin complexes- to improve the condition nerve fibers;
from time to time undergo a course of therapeutic massage or acupuncture;
prevent fractures and other injuries of the arms, elbows, shoulders and forearms;
complete several times a year medical checkup- to identify diseases that can lead to the occurrence of such an ailment.

The prognosis of the disease directly depends on the timing of the start of treatment and the etiology of damage to the ulnar nerve. If the problem was diagnosed on early dates progression, and the therapy was complex, then neuropathy of the elbow joint is successfully treated and passes without a trace.

What to do?
If you think that you have Ulnar nerve neuropathy and symptoms characteristic of this disease, then a neurologist can help you.

Ulnar nerve (n. ulnaris). The ulnar nerve is formed from fibers CVIII - T: spinal nerves that pass supraclavicularly as part of the primary lower trunk brachial plexus and subclavian - as part of its secondary medial bundle. More rarely, 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 opening in the medial intermuscular septum of the shoulder and, being located in the meso and medial head of the triceps muscle of the shoulder, moves down, reaching the gap between the medial epicondyle of the shoulder and the olecranon ulna. The section of fascia thrown between these two formations is called the supracondylar ligament, and into the lower bone-fibrous canal - the supracondylar-ulnar groove. The thickness and consistency of the area of fascia at this site ranges from thin and cobweb-like to a dense and ligament-like formation. In this tunnel, the nerve usually lies adjacent to the periosteum of the medial epicondyle in the groove of the ulnar nerve and is accompanied by the recurrent ulnar artery. Here is the upper level of possible compression of the nerve in the ulnar region. The continuation of the supracondylar-ulnar groove is the gap of the ulnar flexor of the wrist. It exists at the level of the upper attachment site of this muscle. This is the second probable place compression of the ulnar nerve is called the cubital tunnel. The walls of this canal are bounded from the outside by the olecranon and the elbow joint, from the inside by the medial epicondyle and the ulnar collateral ligament, partially adjacent to the inner lip of the block humerus. The roof of the cubital canal is formed by a fascial band that extends from the olecranon to the medial epicondyle, covering the ulnar and brachial bundles of the flexor carpi ulnaris and the space between them. This fibrous band, which is triangular in shape, is called the flexor carpi 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 ulnar flexor of the wrist and the deep flexor of the fingers. From the forearm to the hand, the nerve passes through Guyon's osteo-fibrous 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 the Guyon canal are made up of connective tissue formations. The top of them is called the dorsal carpal ligament, which is a continuation of the superficial fascia of the forearm. This ligament is reinforced by the tendon fibers of the flexor carpi ulnaris and the short palmar muscle. The bottom of Guyon's canal is formed mainly by the continuation of the flexor ligament retinaculum, which covers the carpal tunnel in its radial part. In the distal part of Guyon's canal, its bottom includes, in addition to the flexor retinaculum, also the pisi-hamate and pisi-metacarpal ligaments.

The next level of possible compression of the deep branch of the ulnar nerve is a 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 pisi-hook-shaped. The roof of the entrance to this canal is formed by a connective tissue spread between the pisiform bone and the hook of the hamate bone. This dense, convex tendon arch is the site of the beginning of the muscle - the short flexor of the little finger. The bottom of the entrance to the specified tunnel is the pisi-cartilaginous ligament. Passing between these two formations, the ulnar nerve then turns outward around the hook of the hamate and passes under the direction of the short flexor of the little finger and the muscle that opposes the little finger. At the level of the pisi-uncinate canal and distal to it, fibers depart from the deep branch to all the own muscles of the hand, supplied by the ulnar nerve, except for the muscle that removes the little finger. A branch to it usually departs from the common trunk of the ulnar nerve.

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

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

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

Deep finger flexor; its ulnar part (innervated by the segment CVIII - TI) flexes 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 his fingernail;
the subject is offered to put his fingers into a fist; with paralysis of this muscle, folding the fingers into a fist occurs without the participation of the IV and V fingers.

Test to determine the strength of this muscle: offer to bend 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 \u200b\u200bthe elevation of the little finger and somewhat 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 ulnaris and ulna on the back of the hand and is divided into five dorsal nerves of the fingers, which terminate in the skin of the dorsal surface of the V, IV and ulnar side III finger. In this case, the nerve of the fifth finger is the longest and reaches the nail phalanx, the rest reach only the middle phalanges.

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

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

Below, ramus superficialis divides into two branches: the digital palmar nerve proper (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 own 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 the dorsal side of the nail phalanx V and the 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 muscle that removes the little finger. This branch arcs to the radial side of the hand and supplies the following muscles.

Adductor thumb muscle (innervated by segment CVIII).

Tests to determine its strength:

the subject is offered to bring the first finger; the examiner resists this movement;
the subject is offered to press an object (strip of thick paper, 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.

The muscle that removes the little finger (innervated by segment CVIII - TI).

Test to determine its strength: the subject is offered to take the V finger; the examiner resists this movement.

The short flexor of the little finger (innervated by segment CVIII) flexes the phalanx of the fifth finger.

Test to determine its strength: the subject is asked to bend proximal phalanx V finger, and unbend the remaining fingers; the examiner resists this movement.

The muscle that opposes the little finger (innervated by segment CVII - CVIII) pulls the V finger to middle line brushes and contrasts it.

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

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

The vermiform muscles (innervated by the segment CVIII - TI) flex the main and unbend 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 unbend the middle nail phalanges of the II-V fingers. In addition, the dorsal interosseous muscles abduct II and IV fingers from III; palmar - lead II, IV and V fingers to the III finger.

A test to determine the action of the vermiform and interosseous muscles: they offer to bend the main phalanx of the II-V fingers and simultaneously unbend the middle and nail.

With paralysis of these muscles, a claw-like position of the fingers occurs.

Tests to determine the strength of these mice:

the subject is offered to bend the main phalanx of the II - III fingers, when the middle and nail are unbent; the examiner resists this movement;
the same is suggested to be done for IV - V fingers;
then they offer to unbend the middle phalanx of the II - III fingers, when the main ones are bent; the examiner resists this movement; d) the subject does the same for IV - V fingers.

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

Tests to determine their strength: suggest taking the II finger away from the III; 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 adduct fingers with a horizontal position of the hand.

Tests to determine the strength of the palmar interosseous muscles:

the subject is offered to hold flat object(tape, piece of paper) between II and III fingers; the examiner tries to pull it out;
offer to bring II finger to III; the examiner resists this movement and palpates the contracted muscle.

Symptoms of damage to the ulnar nerve consists of motor, sensory, vasomotor and trophic disorders. Due to paresis 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 I finger is laid outward; holding objects between I and II fingers is difficult. Also somewhat retracted from the IV finger is the V finger. Predominance of extensor function results in core hyperextension and a flexed position nail phalanges fingers - a "claw-like brush" typical for damage to the ulnar nerve develops. Claw-likeness is more pronounced in the IV and V fingers. Violated adduction and breeding of the fingers, the patient can not grasp and hold objects between the fingers. Atrophy of the muscles of the first dorsal gap, hypothenar and interosseous muscles develops.

Sensitive disorders extend to the ulnar part of the hand from the palmar side, the region of the V and ulnar side of the IV fingers, on the back side - to the region of the V, IV and half of the III fingers. Deep sensitivity is disturbed in the joints of the fifth finger.

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

With damage to the ulnar nerve 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 bones that form the elbow joint. This increases the angle of movement of the ulnar nerve and lengthens its path on the shoulder and forearm, which is noticeable when the forearm is flexed. There is a microtraumatization of the ulnar nerve, and it is affected by the compression-ischemic mechanism (tunnel syndrome).

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

Subjective sensory symptoms usually appear before motor symptoms. Paresthesia and numbness are localized in the supply area of the ulnar nerve. After a few months or years, weakness and hypotrophy of the corresponding muscles of the hand join. In acute cubital syndrome caused by nerve compression during surgery, numbness appears immediately after recovery from anesthesia. Paresis of the long muscles (eg, flexor carpi ulnaris) is less common than paresis of the muscles of the hand. Hypesthesia is localized on the palmar and dorsal surfaces of the hand, the fifth finger and the ulnar side of the fourth finger.

The defeat of the ulnar nerve on the hand occurs in the form of the following options:

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

Three types of syndromes are distinguished, combining isolated lesions of the deep motor branch into one group. The first type of syndrome includes paresis of all the muscles of the hand supplied by the ulnar nerve, as well as loss of sensitivity along the palmar surface of the hypothenar, IV and V 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. Surface sensitivity in the hand is not disturbed. The nerve may be compressed in the area of the hook of the hamate between the insertion of the abductor and flexor little fingers, when the ulnar nerve passes through the opposing little finger, and, less commonly, when the nerve crosses the palm posterior to the flexor tendons of the fingers and in front of the metacarpals. The number of affected muscles depends on the place of compression along the deep branch of the ulnar nerve. Fractures of the bones of the forearm can simultaneously occur tunnel syndromes, compression of the median and ulnar nerve in the wrist - the third type of syndrome.

Instruction

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

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

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

The skin of the hand under the little finger may acquire a bluish tint, become thinner, small abscesses or sores often form, in men the hairline may disappear. There are also several simple ways check the function of the ulnar nerve. If you press your palm against the table and try to move your little finger, this will cause difficulty, and it is also difficult to spread your fingers in this position. Another way is to hold a sheet of paper between two fingers, this will not work with neuritis.

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

From medications vascular preparations are prescribed to improve blood circulation and vasodilation, B vitamins, painkillers. A plaster cast is applied to the forearm and area of the hand, while the fingers should be half-bent, and the hand should be fixed in the wrist joint. The forearm and hand are supported by a scarf.

Physiotherapy procedures are also widely used, physiotherapy, treatment with mud baths, acupuncture and massage, all patients are recommended sanatorium treatment. In some cases, surgical intervention is performed (for example, suturing a nerve after an injury).

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

Anatomy

The ulnar nerve departs from the medial bundle of the brachial plexus, located in the region of the last cervical and first thoracic vertebrae. He then descends down inside shoulder and bypasses the elbow joint, has no branches.

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

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

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

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

Causes

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

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

Compressive neuropathy can be seen with following states:

bursitis;
tendovaginitis;
deforming osteoarthritis;
rheumatoid arthritis;
diabetes;
neoplasms;
disease bone marrow;
chondromatosis.

After injury to the elbow, scarring occurs in the healing area, which causes compression of the nerve trunk.

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

The development of compression neuropathy is more often observed in women, and the right ulnar nerve is affected in most cases. Hypothyroidism, complicated pregnancy, endocrine disorders can provoke the disease.

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

Symptoms

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

Other symptoms of neuropathy are as follows:

loss of sensation in the 4th and 5th fingers, as well as the outer edge of the palm;
discomfort and pain in the elbow joint;
pain syndrome can be given to the arm below the elbow, mainly from the outside;
in the morning the pain and discomfort increase.

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

Damage to the ulnar nerve in Guyon's canal is characterized by similar symptoms, but in this case, the elbow joint does not hurt, and the hand does not lose sensitivity. The pain is localized at the beginning of the hand and in the area of the elevation of the little finger, while becoming numb inner surface 5th and part of the 4th finger. Guyon's syndrome is also accompanied by a violation of motor activity - the fingers do not bend well, and it is difficult to spread them apart.

Diagnostics

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

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

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

By tapping with a hammer or fingers, the doctor detects the presence of hypesthesia of the 4th and 5th fingers. Incomplete flexion of the 5th, 4th and partially 3rd fingers, which makes it difficult to clench the hand into a fist, also indicates a pinched ulnar nerve. During the examination, trigger points (painful muscle seals) along the nerve are also determined.

In order to clarify the degree of damage to the ulnar nerve, the doctor may refer to such studies:

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

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

Treatment

Treatment of neuropathy of the ulnar nerve can be both conservative and surgical. Therapy without surgery involves the use of the following groups of drugs:

anti-inflammatory;
glucocorticosteroid injections (with a pinched nerve in Guyon's canal);
painkillers;
anticholinesterase;
vasoactive;
vitamin complexes.

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

AT acute phase diseases physical activity limbs must be limited. It is necessary to completely exclude static and dynamic loads on the arm so as not to provoke amplification clinical symptoms. To avoid excessive bending of the elbow, patients are advised to tie a roll of towel to the elbow bend at night.

After cupping acute symptoms neuropathy of the ulnar nerve continues to be treated with physiotherapeutic methods, and is directed to following procedures:

phonophoresis;
magnetotherapy;
electromyostimulation;
limb massage;
therapeutic exercises.

Conservative therapy is effective in the initial stages of neuropathy, when there is no muscle dystrophy and persistent deformity of the fingers. Otherwise, surgical intervention is performed, during which scars, hematomas and tumors that compress the musculoskeletal canal or the nerve trunk itself are removed. At high risk repeated injury to the elbow joint, the nerve is transferred from outside hands on the inside (transposition).

Excision of pathological structures is performed in case of ineffectiveness of conservative therapy. Patients who do not have the opportunity to interrupt their professional activities for long-term treatment operation is also recommended. For example, athletes cannot take a break from training for a long time if they plan to participate in important competitions and olympiads.

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

AT rehabilitation period after surgical intervention appointed medications, compresses with paraffin, thermal procedures and electromyostimulation. In addition, during the week, the limbs provide rest, and a splint or splint is applied. After removing the fixator, passive movements of the joint are first introduced, and after about a month, active movements of the hand are allowed. After another month, you can do exercises with a load.

Treatment at home

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

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

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

Hydromassage

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

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

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

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

Hand massage can be done on your own or you can ask someone, special skills are not required in this case.

Therapeutic exercises

Return the volume and tone of the muscles will help special exercises:

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

The number of repetitions of each exercise is 10 times.

To prevent neuropathy of the ulnar nerve, it is necessary, as far as possible, to avoid injury to the limb, not to overcool, and to maintain immunity. To boost protective functions body, it is recommended to eat properly and balanced, exercise regularly and not neglect hardening procedures.

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

Signs of neuropathy of the ulnar nerve depend on the place of compression. In this regard, two variants of the course of this disease are distinguished - cubital canal syndrome and Guyon's syndrome (ulnar wrist syndrome). Their manifestations are in many respects similar, but they also have characteristics. In this article, we will acquaint you with the causes, main manifestations and methods of treatment of such neuropathies.

Causes

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

Post-traumatic neuropathies. Nerve damage is caused by a sprain, tear, or tear caused by a lateral dislocation of the elbow, subluxation of the elbow, or dislocation of the elbow with a fracture of the olecranon.
Compression neuropathies (cubital canal syndrome and Guyon's syndrome). Nerve compression can be caused both by some professional skills or habits, and various diseases, accompanied by an inflammatory process, swelling or bone changes in the areas of the passage of the nerve.

Nerve compression in the cubital canal can be provoked by:

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

Nerve compression in Guyon's canal can be provoked by:

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

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

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

Symptoms

Symptoms of cubital tunnel syndrome:

reduced sensitivity of the ulnar edge of the hand, ring finger and little finger;
pain in the cubital fossa, spreading to the forearm, ulnar edge of the hand, ring finger and little finger, aggravated by movement in the elbow;
paresthesia in the cubital fossa, ring finger and little finger, forearm, ulnar edge of the hand;
motor disorders, expressed in muscle weakness, difficulty in abduction and flexion of the hand, flexion of the ring finger and little finger;

Symptoms of Guyon's canal syndrome:

reduced sensitivity of the ring finger and little finger from the side of their palmar surface (at the same time, sensitivity is preserved from the back side);
painful sensations of the ring finger and little finger from the side of their palmar surface, the ulnar edge of the hand and the wrist joint;
paresthesia in the palmar surface of the ring finger and little finger, wrist joint and ulnar edge of the hand;
movement disorders, expressed in weak flexion of the ring finger and little finger and difficulty in bringing and spreading the fingers, the thumb is not brought to the palm;
muscle atrophy and changes appearance("clawed" or "bird" brush).

Diagnostics

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

Electroneuromyography can be used to determine the area of damage to nerve fibers. The same method allows for 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 X-ray or MRI. And for visualization structural changes arising in the nerve trunk at the entrance to the pinching canal, ultrasound is used.

Treatment

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

Conservative therapy

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

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

To eliminate pain and signs of inflammation at the beginning of the disease are prescribed:

Indomethacin;
Diclofenac;
Nimesulide;
ibuprofen;
Meloxicam etc.

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

With severe edema, diuretic drugs (Furosemide), anti-edematous and anti-inflammatory agents (L-lysine aescinate) and capillary-stabilizing agents (Cyclo-3-fort) are used to reduce compression.

To improve the nutrition of the nerve, B vitamins are used:

Combilipen;
Neurorubin;
Milgamma;
Neurovitan etc.

In the absence of signs of elimination inflammatory response instead of non-steroidal anti-inflammatory drugs, administration is prescribed by injection into the cubital canal or Guyon's canal of a mixture of a solution of Hydrocortisone and a local anesthetic (Lidocaine or Novocaine). In most cases, this procedure eliminates the symptoms of neuropathy and has a lasting therapeutic effect.

Medical treatment of neuropathies is supplemented by physiotherapy procedures:

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

Surgery

With the ineffectiveness of conservative therapy and severe cicatricial changes in the area where the nerve passes through the canals, surgical intervention is recommended. The purpose of such operations is to eliminate (cut and remove) structures that compress the ulnar nerve.

During compression in the cubital canal, its plasticity 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 transection of the palmar carpal ligament is performed above the canal.

Performance surgical operation allows you to release the nerve from compression, but for the complete restoration of all its lost functions, additional treatment is prescribed:

drugs - analgesics, drugs to improve the nutrition of the nerve and its conductivity, vitamins, diuretics;
physiotherapy procedures;
physiotherapy.

After the operation is completed, the patient's hand is immobilized with 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, exercises with a load and throws can be performed.

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