Traditional medicine

Tunnel neuropathy of the ulnar nerve. Ulnar nerve neuropathies: why they occur and how to treat them

Instructions

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

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

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

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

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

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

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

Tingling in fingers
Spread of pain to other areas
Numbness of fingers
Loss of sensitivity in fingers
Elbow pain
Tingling in the palms
Difficulty bending the wrist
Pain when clenching your hand into a fist
Hand muscle atrophy
Weakness of the hand muscles
Tingling in 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, the disease is caused by injury to the arm, forearm or shoulder. In addition to this, there is large number other predisposing factors, both pathological and physiological.

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

The diagnosis can be confirmed using instrumental examinations, which in mandatory preceded by a physical examination. Treatment tactics can be medication, physiotherapy and surgery, but often the treatment is complex.

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

The widespread nature of this disease lies in the fact that, due to its anatomical location, the ulnar nerve is the most vulnerable spot, compared, for example, with the radial or median nerve.

A traumatic mechanism of disease development is often observed. Thus, the most common causes of the development of pathology are presented:

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

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

and osteodystrophy;
deforming shape;
demyelinating pathologies - when they occur, the myelin sheath of the nerve covering it is destroyed. This category of illnesses includes multiple and concentric sclerosis, acute neuromyelitis optica and multiple sclerosis, as well as diffuse leukoencephalitis. In such situations they talk about demyelinating neuropathy of the ulnar nerve;
radial joint;
aneurysms located near 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:

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

Classification of the disease

IN medical field Only one division of the disease is used - according to the etiological factor. It follows from this that ulnar nerve neuropathy occurs:

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

Location of the ulnar nerve

Symptoms of the disease

Clinical signs of the disease will differ slightly depending on the type of neuropathy. For example, with cubital tunnel syndrome, the symptoms will be as follows:

pain in the area of the elbow fossa, which is located with inner surface elbow. At the beginning of the disease, the pain will be periodic, but as it progresses it will be constant and intense;
irradiation pain on the forearm, fourth and fifth fingers (both in the palm and on the back), as well as on the ulnar edge of the hand (near the little finger);
tingling and other unpleasant sensations in the above areas;
disturbance of susceptibility skin to external stimuli in the ulnar edge of the hand, 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 bending the hand and fingers;
the hand takes the form of a clawed paw;
trying to clench your 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 move them to the side;
muscle atrophy, which is expressed in a decrease in the size of the hand, retraction of the interdigital spaces and more distinct protrusion of the bone. It is noteworthy that the rest of the affected limb and the healthy hand have a normal appearance.

Symptoms of ulnar nerve neuropathy in cases of Guyon's canal syndrome are practically no different from those described above, but 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 dorsum 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 the fingers - on the back side there is no such sign;
weakness of flexion of sore fingers, inability to press them completely to the palm, difficulty in spreading and bringing them together;
development of atrophy and formation of a “clawed” shape of the hand.

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

weakness of the hand muscles;
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 adjacent part of the fourth finger;
pain syndrome along the entire length of the ulnar nerve.

Diagnostics

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

The first stage of diagnosis includes:

studying 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 reflexes are checked using a special hammer;
detailed survey - to determine the nature of the course and severity of symptoms.

Laboratory studies of blood, urine and feces for ulnar nerve neuropathy have no diagnostic value.

The following instrumental procedures help clarify the diagnosis:

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

Ultrasound of the ulnar nerve

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

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

Treatment of the disease

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

malignant or benign formations, compressing the nerve;
formation of hematomas and scars;
ineffectiveness of conservative therapy.

The operation scheme is selected individually for each patient, but can be carried out by:

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

Medication therapeutic tactics involves receiving:

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

Drug therapy is necessarily complemented by physiotherapy, namely:

magnetic therapy;
phonophoresis;
electromyostimulation.

After relief of inflammation, a course is indicated therapeutic massage and exercise therapy. For ulnar nerve neuropathy, treatment with gymnastics involves performing the following exercises:

pressing with the healthy hand on the middle phalanges of the affected fingers until they are fully straightened;
alternately abducting any finger of the sore hand, using the healthy one - it is recommended to start with the thumb;
alternately lower and raise the fingers of the affected limb;
making circular movements with your fingers;
capturing rubber objects of various sizes in water and squeezing them.

Only the attending physician can provide a complete list of classes.

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

Prevention and prognosis

To reduce the likelihood of developing problems with your elbows, or more precisely, with their nerves, you need to:

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

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 at early stages progression, and the therapy was comprehensive, then neuropathy of the elbow joint is successfully treated and goes away 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.

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

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

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

Depending on the location of the nerve damage, symptoms can vary from pain to weakening of the fingers.

Causes of damage

Ulnar neuropathy develops due to:

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

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

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

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

stress on the wrist associated with features long work(rotating the instrument in the hands, playing the violin, working with a vibrating instrument);
walking with a cane;
cycling;
riding a motorcycle over rough terrain.

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

Symptoms of the disease

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

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

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

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

When a nerve is compressed in the hand area, the following symptoms are noted:

pain in the area of the first three fingers;
temporary sensory disturbances;
increased pain at night;
impaired flexion of the little finger and ring finger;
muscle atrophy, reduction in hand size.

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

Making a diagnosis

An experienced doctor has no problems making a diagnosis. It can be determined using a simple diagnostic technique, which consists of assessing the pain syndrome by tapping or pressing on the nerve in different places.

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

Radial nerve damage

Neuritis of the upper extremities also includes neuropathy of the radial nerve. This nerve passes through the shoulder and back forearm, and when it is affected, the pain radiates to the wrist.

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

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

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

impaired finger flexion;
weakness of the hand;
local numbness and burning sensation;
impaired reflexes;
muscle atrophy.

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

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

Drug treatment

Radial nerve neuropathy is treated comprehensively. Therapy includes:

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

Surgical treatment is used only in the case of organic pathology, which can be eliminated traditional methods impossible.

Non-steroidal anti-inflammatory drugs based on ibuprofen or diclofenac are used to relieve pain. With the help of these medications, inflammation and swelling of the tissues around the damaged canal are also successfully relieved.

At severe pain, which cannot be removed with tablets, local injections of analgesics are used, as well as medical blockades.

To improve the condition of nerve fibers, taking B vitamins is mandatory.

Physiotherapy

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

If the ulnar nerve is damaged, treatment promotes:

relieving swelling;
improvement of local metabolic processes;
acceleration of regeneration;
restoration of motor function;
prevention of muscle atrophy.

Physiotherapeutic methods are indicated only after acute pain and inflammation have been relieved.

A good effect can be achieved with massage or acupuncture. Preference should be given to methods that involve influencing pain points. This allows you to quickly improve your overall well-being and restore the motor function of the affected limb.

Neuropathy can be treated with exercise. This helps prevent muscle atrophy, improves local metabolic processes and helps to quickly restore motor activity.

It is recommended to supplement physiotherapy and massage with independent exercises. You can also ask the doctor to teach the patient the basics of self-massage techniques and additionally massage the sore arm at home.

Surgical treatment is used if the disease is associated with a narrowing of the canal through which the nerve passes. After the operation you should long period rehabilitation, during which massage and physiotherapy are used to restore motor function of the hand.

Prognosis and prevention

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

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

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

Prevention of neuropathy of the elbow and wrist consists in the absence of strong monotonous repetitive loads. Regular intake of vitamin complexes will help improve the condition of nerve fibers.

When working with a load on the area in which the ulnar or radial nerve passes, you need to take a break and perform simple exercises. This will avoid channel compression. Professional athletes should periodically change the type of load, this will help prevent compression of the canal.

good preventative measure is massage and acupuncture (acupuncture).

The disease can become a complication after a fracture, dislocation or injury to the elbow. To prevent this from happening, it is necessary to undergo a timely examination and consult a doctor about prevention.

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

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

Ulnar nerve neuropathy.

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

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

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

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

If ulnar nerve neuropathy occurs, the following actions are recommended:

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

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

A little anatomy

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

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

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

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

Causes of ulnar nerve neuropathy

Compression of the nerve in the bone canal is facilitated by prolonged support on the elbow associated with professional duties, and sometimes habit.

The ulnar nerve can be damaged by:

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

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

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

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

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

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

Symptoms of ulnar nerve neuropathy

Sensory disorders occur in the area of innervation of the ulnar nerve.

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

Cubital tunnel syndrome

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

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

Guyon's canal syndrome (ulnar carpal syndrome)

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

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

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

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

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

Diagnostics

A neurologist will identify ulnar nerve neuropathy by characteristic symptoms and results objective examination.

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

Treatment of ulnar nerve neuropathy

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

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

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

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

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

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

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

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

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