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Ulnar nerve neuropathy of the arm treatment. Treatment of peroneal nerve neuropathy

Neuritis ulnar nerve– this is an inflammatory process of various etiologies that affects peripheral nerve fibers and is manifested by pain, numbness, loss of function of the innervated muscles; — treatment is complex and includes medication and physiotherapeutic procedures.

Etiology

The ulnar nerve arises from brachial plexus together with the radial one, descends down the medial side of the shoulder and through the posterior surface medial epicondyle goes to the forearm and hand. It carries nerve impulses to the deep flexor muscles of the hand and fingers, is responsible for the work of the muscles of the little finger and leads the index, ring and little fingers to the middle. The most common diseases that affect this nerve are neuritis and neuralgia.

Ulnar neuritis is considered a disease of people who spend most of their time in the office. This is due to the fact that such workers are accustomed to leaning on their elbow and can over time injure the ulnar nerve, which runs shallow in this place.

The radial nerve passes next to the ulnar nerve, which can also be affected by long-term compression, for example, during sleep. That's why clinical picture may simultaneously resemble neuralgia of the radial and ulnar nerves.

Other reasons include any infectious agent, hypothermia, damage to nervous tissue toxic substances, including chronic consumption of alcoholic beverages. A special place is occupied by post-traumatic neuritis.

Also some somatic diseases may cause neuritis. For example, diabetes mellitus, insufficient output hormone thyroid gland.

Manifestations

In ICD 10, neuritis and neuropathy are not distinguished separately. Both of these diseases are included in the definition of ulnar nerve damage.

Ulnar nerve neuritis is manifested by numbness of the arm in the part innervated by this nerve. This symptom is short-lived and may be followed by tingling or a burning sensation in the area. Numbness can be complete or partial and sometimes ends with cramps.

There is also a noticeable decrease in motor activity
in the injured hand, until paralysis occurs. It is difficult for the patient to bend his arm in the hand; it is difficult for him to bring his fingers towards each other. These symptoms are explained not only by a decrease in innervation, but also by a violation of tissue trophism. In the future, after adequate treatment, there may be residual effects in the form of decreased reflexes or muscle weakness.

Malnutrition is also manifested by swelling, bluish skin, local hair loss and increased brittleness of nails. This is due to impaired tissue nutrition and treatment of diseases of the ulnar nerve should include measures aimed at eliminating these symptoms.

A pathognomonic symptom is drooping of the hand, as well as the inability to bend the fingers into a fist. Upon examination, the hand has the following appearance: the fourth and third fingers are bent, the little finger is moved to the side.

If the patient's main symptom is pain and impaired movement, and there are no autonomic disorders, then we can talk about neuralgia of the ulnar nerve. Pain and numbness in most cases is present in the little finger and ring finger.

Diagnostics

To make a diagnosis of ulnar neuritis
nerve and treat it, in addition to an external examination and history taking, you can ask the patient to perform a few simple steps.

The patient should press his palm with his fingers apart to the surface of the table and try to scratch it with his little finger. A person with inflammation of the ulnar nerve will not be able to do this;
Also, the patient cannot comply with the request to spread his fingers in different directions;
If the ulnar nerve is inflamed, you cannot bend your fist completely and squeeze a piece of paper with two fingers.

These simple tests can help pinpoint nerve damage. Differential diagnosis must be performed with damage to the radial nerve. If it is damaged, the patient's hand hangs down and cannot be straightened independently. Also, with neuralgia of the radial nerve, the thumb is brought to the index finger and there is a sensitivity disorder in the first three fingers of the hand.

Also, as an additional diagnostic method, electromyography can be performed to determine the degree of muscle damage.

Therapy methods

Treatment of ulnar nerve neuritis can begin with restoring fixation of the hand using a plaster splint, while the arm remains bent and suspended by the neck in a scarf.

Also, treatment should be aimed at eliminating the cause that caused the inflammation of the nerve. It is necessary to prescribe antiviral or antibacterial drugs for infectious diseases. In cases of circulatory and tissue trophism problems, papaverine is used.

As in the treatment of any disease of the nervous tissue, B vitamins and potassium-sparing diuretics are prescribed to relieve swelling.

A special place in the treatment of neuritis and neuralgia is given to physiotherapeutic restorative procedures. They are aimed at improving the trophism of nervous tissue and maintaining the tone of the muscles of the forearm and wrist.

From the second week of drug treatment, it is worth prescribing electrophoresis with medicinal substances, UHF and impulse currents.

The doctor should also teach the patient the technique of self-massage, which can be done independently at home. You need to start by rubbing the phalanges of the fingers, flexion and extension movements in the joints of the fingers and hand.

For preventive and general strengthening purposes, it is advisable to avoid hypothermia and repeated exposure to a traumatic agent. People who work in an office should try to lead a less sedentary lifestyle and introduce active breaks into their lives (a short walk, office gymnastics).

Ulnar nerve neuropathy is a disease accompanied by damage to the ulnar nerve, which results in impairment of its function. As a result, the problem area becomes very sensitive, and the strength of individual hand muscles weakens. There are quite a few reasons for this condition.

To better understand the nature of ulnar nerve neuropathy, it will be useful to analyze anatomical features this area.

So, the ulnar nerve is a long nerve process of the brachial plexus. This nerve is located quite close to the subcutaneous tissue, but at the same time it is in close contact with the bone formation. Because of this, compression of the nerve fibers in the area often occurs. Probably everyone who has hit an elbow in their life realized this when faced with unpleasant sensations after the blow.

Ulnar nerve neuropathies can occur due to:

fractures, dislocations of the shoulder bones, forearm bones or carpal bones;
compression in the area of fibro-osseous canals.

Most often, the ulnar nerve suffers precisely from strong sudden compression. In this case, nerve damage occurs gradually, as a result of prolonged exposure to an irritating factor. And the compression itself may be due to:

frequently performed flexion movements;
due to work that involves contact between the elbows and the machine/desk/workbench;
due to the habit of drivers to place a bent hand on the edge of the window, leaning on its sharp edge;
due to the habit of talking on the phone for a long time, leaning his elbows on the table.

The ulnar nerve may also be compressed in the area of Guyon's canal. In this case, doctors make a diagnosis of ulnar carpal syndrome. This syndrome can be provoked by:

regular work with certain instrument;
constant use of an auxiliary cane;
Frequent riding of a motorcycle or bicycle.

Another cause of ulnar nerve neuropathy may be a tumor compressing the area of the nerve endings.

Symptoms of emerging ulnar nerve neuropathy

When the nerve described above is damaged, its functions are first disrupted, that is, problems associated with the motor activity of the hand arise. Usually, excessive sensitivity first occurs, and only after that a decrease in muscle strength is noted, which becomes a consequence of compression of the nerve. If there is a fracture or dislocation, ulnar nerve neuropathy and excessive sensitivity during movement occur simultaneously.

Features of cubital tunnel syndrome

Symptoms indicating damage to the ulnar nerve in this area appear as:

Pain in the area of the cubital fossa, which radiates to the forearm, fourth and fifth fingers. Tingling, burning sensations and signs of twitching may also be noted. At first, the pain is rare, but it can intensify at night. During the day they are observed during physical activity.
Decreased sensitivity over the entire area of the ulnar edge of the hand, in the area of the little finger and in the area ring finger.
Later, movement disorders are detected. It is difficult for the patient to move the hand left side, it is difficult to bend the little finger and ring finger.
If the problem of compression of the ulnar nerve is observed for a long time, muscle atrophy occurs. The hand becomes noticeably thinner, the bones protrude more clearly, and the spaces between the fingers sink.

Guyon's canal syndrome

This syndrome is similar to cubital tunnel syndrome. But, unlike it, with ulnar wrist syndrome the following may be observed:

Sensory disorders that worsen at night and during active wrist movement;
Deterioration of sensitivity in the area of the little finger from the palm, as well as the ring finger;
Movement disorders;
The brush takes on a “clawed” shape;
On last stage- the hand becomes thinner, signs of muscle atrophy are observed.

Often doctors, in order to clearly make a diagnosis, carry out the following diagnostics: they lightly knock on the inner surface of the inflamed elbow joint. If the patient feels pain and paresthesia in the area of his innervation, then Guyon’s canal syndrome can be safely confirmed.

To establish the diagnosis of actual ulnar nerve neuropathy, a neuropathological examination with medical tapping tests should be performed. The method of electroneuromyography is also considered informative. Diagnosing ulnar nerve neuropathy is not difficult if the doctor pays close attention to the patient's symptoms.

Treating signs of ulnar nerve neuropathy

The doctor must initially understand what exactly caused the problem. If the cause was a fracture or injury, then immediate surgical intervention may be needed to restore the integrity of the nerve. When the cause was compression of the nerve, conservative treatment methods are first used, and only after their low effectiveness they resort to surgical intervention. If there is a need to restore the integrity of the ulnar nerve after previous fractures, the nerve is sutured. Recovery usually occurs within six months. The sooner the integrity of the nerve is restored, the better the prognosis.

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

Anatomy

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

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

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

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

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

Reasons

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

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

Compressive neuropathy can occur in the following conditions:

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

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

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

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

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

Symptoms

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

Other symptoms of neuropathy include the following:

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

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

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

Diagnostics

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

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

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

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

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

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

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

Treatment

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

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

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

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

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

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

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

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

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

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

Treatment at home

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

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

Propolis is a very effective remedy for combating many ailments; compresses with propolis help relieve inflammation and accelerate tissue regeneration

Hydromassage

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

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

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

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

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

Therapeutic exercises

Special exercises will help restore muscle volume and tone:

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

The number of repetitions of each exercise is 10 times.

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

Lately everything 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 when modern look life when people spend a lot of time leaning on their elbows. The ulnar nerve runs shallow in this area, so it is easily damaged. After all, even slight pressure on it can lead to inflammation.

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

Reasons

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 of the thyroid gland or diabetes mellitus;
osteochondrosis or hernia intervertebral disc;
lack of minerals and vitamins in the body;
cardiovascular pathologies leading to poor circulation;
intoxication as a result of taking large amounts of certain drugs, poisoning with alcohol or salts of 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 adduct and abductor all fingers. Therefore, its defeat immediately affects the functioning of the hand. Manifestations of neuritis depend on the degree and location inflammatory process. But the main symptom is always pain. At first it is aching, then it can become sharp, even burning or shooting.

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

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

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

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

Diagnostics

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

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

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

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

Treatment

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

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

reception medicines;
physiotherapeutic procedures;
massage;
physical therapy;
folk recipes.

Drug therapy

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

To improve the nerve impulses"Proserin" or "Physostigmine" are used. And as a adjuvant 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.

Therapeutic exercise

Application begins special exercises after removing the lock. Both passive and active movements are used. The main goal of gymnastics is to prevent contractures and muscle atrophy and 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 the thumb and index fingers. 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 should 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

Traditional medicine

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

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

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

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

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

The next level of possible compression of the deep branch of the ulnar nerve is the short tunnel through which this branch and the ulnar artery pass from Guyon's canal into the deep space of the palm. This tunnel is called the pisiform-uncinate tunnel. The roof of the entrance to this channel is formed connective tissue, located between the pisiform bone and the hook of the hamate bone. This dense, convex tendinous arch is the origin of the flexor little finger brevis muscle. The bottom of the entrance to this tunnel is the pisiform-crticular ligament. Passing between these two formations, the ulnar nerve then turns outward around the hook of the hamate and passes under the origin of the flexor little finger brevis and the opponus little finger muscle. 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 flexor carpi ulnaris tendon and the ulna on the dorsum of the hand and is divided into five dorsal nerves of the fingers, which end in the skin of the dorsal surface of the fifth, fourth and ulnar side of the third 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 the back of the nail phalanx of the 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 abductor of the little finger muscle. This branch arcs towards the radial side of the hand and supplies the following muscles.

The adductor pollicis muscle (innervated by segment CVIII).

Tests to determine its strength:

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

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

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

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

The short flexor of the little finger (innervated by the CVIII segment) bends 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 to the midline of the hand and opposes 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 subject is asked to spread his fingers with the hand in a horizontal position.

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

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

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

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

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

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

Rarely, habitual displacement of the ulnar nerve (dislocation) occurs, which is facilitated by congenital factors(posterior position of the medial epicondyle, narrow and shallow supracondylar-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. Hypesthesia 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:

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

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