Traditional medicine

Inflammation of the ulnar nerve treatment. Essential drugs

Depending on the nature of the lesion ulnar nerve There are two types of neuropathy:

Post-traumatic.
Compression.

Post-traumatic pathology develops against the background of damage to the ulnar nerve (sprains, ruptures, tears). The causes of such injuries are the following factors:

joint subluxation;
lateral dislocation;
anterior dislocation accompanied by a fracture of the olecranon.

Compressive neuropathy, as a rule, is a consequence of compression (compression) of the trunk of nerve fibers. The defeat occurs in narrow channel Guyon, located in the hand area, and in the cubital canal, which is part elbow joint. Compression occurs as a result of tissue swelling, inflammatory processes in the joint, pathological changes bone and connective structures surrounding the nerve trunk. The reasons for the appearance of factors predisposing to the development of neuropathy are:

rheumatoid arthritis;
deforming arthrosis;
chondromatosis and chondromalacia;
tumor formation;
progression of tenosynovitis, leading to tendon hardening and the formation of synovial cysts;
deformation changes in bones and connective tissues in the walls of the canals as a result of a fracture.

In Guyon's canal, the nerve may be compressed by the muscle responsible for abducting the little finger. If the lesion occurs in the cubital canal, then such neuropathy is called "cubital syndrome"

Often, patients are diagnosed with a secondary pathology, the causes of which are manipulations in the elbow joint in the process of reducing a dislocation or when combining parts of the bone after a fracture. Skeletal traction can also cause neuropathy, since such a procedure often leads to stretching of the nerve.

Symptoms of patholo G II

Ulnar nerve neuropathy can be complete or partial. With complete damage, pronounced signs are observed in the form of loss of sensitivity in the area of the little finger and ring finger. There is also paralysis of the muscles responsible for flexion and extension of the thumb. In addition, the activity of the interosseous muscles is disrupted, against the background of which the fingers acquire a semi-bent position and become like claws. That is, neuropathy leads to the fact that patients have impaired grasping functions of one hand, the ulnar nerve of which is damaged as a result of injury or compression.

Partial nerve damage to the elbow joint causes the following symptoms:

paresis (decreased sensitivity) or complete numbness in the area of the little finger and partial surface of the ring finger;
weakening of the hand muscles;
tingling and discomfort on inside palms;
pain syndrome that occurs along the affected ulnar nerve.

Diagnosis of the disease

When patients complain of symptoms characteristic of ulnar nerve neuropathy, the specialist prescribes comprehensive examination. It should be aimed at clarifying true reasons disorders and identification of probable factors leading to nerve damage.

Froman tests are considered an effective diagnostic technique for neuropathy.

Patients are asked to perform simple tasks: press firmly thumbs to the table surface or grab a sheet of paper with them. When committing similar actions it can be observed that on the patient’s sore arm thumb constantly bent at the phalanx and cannot be controlled when trying to straighten it.

To make sure that the nerve of the elbow joint is pinched, the doctor applies light blows to the area of the cubital canal with the edge of his palm. If the painful signs intensify and become more pronounced (Tinnel's symptom), then this indicates the development of cubital syndrome - the most common type of ulnar nerve neuropathy.

By gently tingling or feeling the skin around the hand, you can determine the degree of sensitivity impairment. As a rule, during the course of the pathology, patients are diagnosed with a partial decrease in sensitivity or its complete absence.

Patients diagnosed with ulnar nerve neuropathy in mandatory sent for instrumental diagnostics:

magnetic resonance imaging;
X-ray;
ultrasound examination;
electromyography.

MRI and radiography are necessary to detect bone structures possible defects, which often cause compression of the nerve in the area of the hand or elbow.

Ultrasound is used to visualize changes in structures nerve trunk at the point where it enters Guyon's canal or cubital canal.

Electromyography is a diagnostic technique that determines impulse conduction disturbances that occur below the area of compression or nerve damage.

Treatment of neuropathy

Treatment of the disease can be either conservative or surgical. The choice of treatment method directly depends on the causes of damage to the nerve of the elbow joint.

Medications and physiotherapeutic procedures are used to early stages development of pathology, when the muscles have not yet atrophied and persistent deformation of the finger joints is not observed. For cubital neuropathy, drugs from the NSAID group are used. They relieve well painful sensations, reduce tissue swelling, thereby reducing the degree of nerve compression. Patients are also prescribed B vitamins, which are necessary to improve metabolic processes and normalize peripheral circulation in the affected area.

When a nerve is pinched in Guyon's canal drug therapy supplemented with glucocorticoid drugs ( injections for local administration).

If conservative therapy didn't give positive result, and the patient’s condition has not improved, then in such cases it is required surgical treatment. The main goal of surgery is to excise (remove) the structures that compress the ulnar nerve.

Ulnar nerve neuritis – neurological disease peripheral nervous system, and the nerve on one arm or both can be affected. Symptoms will depend on what causes became the main ones for this pathology.

Why does it appear

The peculiarity of the disease is that several factors can take part in its development, although sometimes it is still possible to isolate separate reason. Most often, the inflammatory process in this area occurs due to:

Hypothermia, both local and general. Moreover low temperatures must act on the body for a long time.
Infections, and most often these are measles, influenza, diphtheria, herpes, or brucellosis.
Injuries - post-traumatic neuritis of the ulnar nerve occurs, which is considered the most common diagnosis. In this case, not only inflammation, but also a fracture can be diagnosed.
Blood supply disorders.
Lack of vitamins.
Intoxication, not only with alcohol, but also with salts of heavy metals.
Diabetes mellitus.
Work disturbances thyroid gland.
Anatomical features of the part of the bone in which the nerve itself passes.
External compression of the nerve during incorrect posture when sitting.
Operations.
Osteochondrosis.
Disc herniation.

As for the symptoms of neuritis of this kind, they will primarily depend on the causes, although there are also manifestations that are characteristic of all variants.

How it manifests itself

Before starting treatment, you should establish the cause of the pathology, and also find out from the patient all existing complaints.

The first thing you should pay attention to is complaints of impaired skin sensitivity. This may include numbness, tingling, goosebumps, or complete loss of tactile sensations.

The second important sign is a change in motor activity of the hand. This can be complete paralysis, that is, the limb stops moving altogether, or paresis, in which there is a partial decrease in motor activity. This is due to the fact that muscle strength is significantly reduced, and atrophy may even occur. Tendon reflexes may also disappear completely.

As the condition worsens, they begin to develop trophic disorders hand tissues. This is expressed in swelling, bluish skin, hair loss, and this happens only in one area or another, excessive sweating, brittle nails. In the most severe cases with complete absence treatment, real ulcers appear.

But still the most main symptom- This is pain that can be of varying intensity. In this case, paresthesia and decreased sensitivity appear in the palm area and in the area of the 4th and 5th fingers.

Then the wasting of the muscles begins, which are responsible for the movements of the 5th finger, as well as those that help flex and extend the hand. Due to these processes, the palm becomes flat. With a long course of the disease, such a dangerous and unpleasant condition as carpal tunnel syndrome develops.

Diagnostics

Symptoms of ulnar nerve neuritis are determined by the duration of the disease, so before starting treatment it is necessary to diagnostic measures. This is done using some tests.

In the first case, you should clench your hand into a fist, and fingers that cannot bend completely will show how severely the area is affected. In the second case, with the hand tightly pressed to the table, it is impossible to make movements with the little finger that resemble scratching.

In the same position, it will not be possible to spread and bring in the 4th and 5th fingers.

How to treat ulnar nerve neuritis? It all depends on the duration of the disease, as well as on the identified cause.

How to get rid

If the cause is infection, then the patient is advised to take appropriate medicines. If this is vascular damage, resulting in ischemia, you should use drugs that normalize blood circulation and expand the lumen of the vessel.

If this is an injury, then immobilization of the hand is necessary with further use of anti-inflammatory drugs, and in the most severe cases, surgical treatment may be required.

After complete fusion of the bone, as well as removal of the plaster, it is recommended to perform a massage. But the massage technique for post-traumatic ulnar nerve neuritis is individual and should only be carried out by a specialist.

TO adjuvant therapy refers to exercise therapy, which is also prescribed strictly individually and depends on general condition patient. But from traditional methods Treatment for elbow neuritis should be abandoned, since none of them can save a person from this serious disease.

If the diagnosis was made correctly and treatment was prescribed in a timely manner, then it is quite possible to get rid of this pathology.

Ulnar nerve neuritis

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 with the modern lifestyle, when people spend large number time, leaning on your elbows. The ulnar nerve runs shallow in this area, so it is easily damaged. After all, even slight pressure on it can lead to inflammation.

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

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 herniated disc;
lack of minerals and vitamins in the body;
cardiovascular pathologies leading to circulatory disorders;
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.

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 trophic ulcers appear.

Diagnostics

It is advisable to begin treatment of neuritis as early as possible, when the first signs of inflammation appear. Indeed, as the pathology progresses, atrophy of the hand muscles and complete loss of its functions are possible. Usually, a specialist can immediately determine the presence of neuritis, since the hand has 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 forefinger, 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.

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:

taking medications;
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 an auxiliary therapy, it is necessary to prescribe B vitamins. Diuretics may be required to relieve swelling. Potassium-sparing agents are mainly used, for example, Veroshpiron. In addition, medications are prescribed that improve blood circulation and metabolic processes. Biogenic stimulants, for example, Lidaza, are useful.

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, impulse currents, mud therapy. In addition, electrical myostimulation of the muscles innervated by the ulnar nerve is prescribed.

Therapeutic exercise

The use of special exercises begins after the fixator is removed. Both passive and active movements are used. Main goal gymnastics - prevent contractures and muscle atrophy, restore their function.

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

An important exercise aimed at developing 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 must be done with the index and middle fingers.

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

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 used various compresses, decoctions of 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 comes 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.

A tumor tumor such as a neuroma of the ulnar nerve causes the development of neuropathy with pain and loss of motor and sensory function of the 4th and 5th fingers. You can fix the problem using surgical intervention. After it is carried out, it is recommended to take non-steroidal anti-inflammatory drugs, which reduce unpleasant symptoms and contribute to the speedy restoration of hand function.

With neuropathy, sensitivity and motor activity of several fingers are lost.

Compressive neuropathy also causes ulnar nerve palsy.

Causes of the disease

The immediate cause of the development of neuropathy is trauma that occurs as a result of a lateral dislocation or fracture of the olecranon, as well as other types of damage. More often this phenomenon is observed when a person falls on bent arms and legs. This injury is combined with a lesion knee joint. This pathology can also be provoked prolonged compression nerve roots, which is caused by compression of the nerve in Guyon's canal. The development of these diseases is influenced by the type labor activity and the patient's lifestyle.

In addition, the following predisposing factors for the occurrence of neuropathy can be identified:

arthritis;
autoimmune disorders;
tumors;
pathologies of vessels that are located nearby;
dystrophy cartilage tissue joints;
history of elbow or hand fractures;
long-term intravenous infusions;
inflammation of the synovium.

Trauma or prolonged hypoxia of nerve fibers has a demyelinating effect and also causes hemorrhage into the nerve tissue. As a result, impulses are transmitted through neurons very slowly, and sometimes this process is completely disrupted. Compression-ischemic neuropathy of the ulnar nerve is associated with damage to these formations due to anatomical features buildings upper limb, since in these places the bone tissues are as close as possible to the nerve fibers.

Symptoms of ulnar nerve neuropathy

The muscles below the wrist gradually atrophy if the nerve in the hand area is affected.

For damage to the canal in the hand area it is typical:

the appearance of symptoms observed after a hand injury;
increased pain when bending the palm;
muscle atrophy of the arm below the wrist.

Damage to the ulnar nerve, which manifests itself as cubital tunnel syndrome, has the following distinctive features:

pain in the elbow area;
decrease muscle mass arms below the elbow;
increased pain when bending or damaging the elbow joint.

Damage to the right ulnar nerve is more common.

How is it diagnosed?

Neurolysis of the ulnar nerve can be suspected by the presence characteristic complaints the patient and medical history. To confirm the diagnosis use radiographic examination, with the help of which the displacement of the bone elements of the hand is clearly visualized, which has a traumatic effect. Soft tissue abnormalities can be identified using ultrasound diagnostics, and if visualization is insufficient, magnetic resonance imaging is used. Electromyography is used to determine the speed at which nerve impulses travel through fibers. In addition, the patient passes the mandatory minimum laboratory research - general analysis blood and urine.

Treatment of the problem

When treating a disease, therapeutic and surgical methods treatment.

Since post-traumatic neuropathy of the radial nerve, ulnar plexus and median nerve are often combined, then therapy for the pathology consists of complex impact on the problem that served as the impetus for the development of the process. Initially, it is necessary to eliminate the cause of permanent injury or compression of the fibers. Pain relief is performed through therapeutic intervention or surgery. At the end of treatment, the patient needs a long course of rehabilitation using physiotherapy and therapeutic exercises.

Drugs

Compression of the nerve causes severe pain and symptoms of inflammation, which are eliminated through the use of non-steroidal anti-inflammatory drugs in the form of ointments or intramuscular injections. The patient is also shown multivitamins, neuroprotectors and substances that improve regional blood flow. For severe swelling, diuretics are used. Such procedures will help with minor manifestations of the pathology, but the cause of the neuropathy will remain, which is a risk of damage to the ulnar nerve again.

Carrying out the operation

Effective treatment for neuropathy involves surgery and enlargement of the ulnar nerve canal. The procedure is performed using an endoscope, which is inserted into a small incision in the skin along with all the necessary instruments. This minimizes the volume of the incision and the degree of tissue damage. The course of the operation consists of removing anatomical formations that cause a demyelinating effect on nerve fibers.

Ulnar nerve neuropathy according to ICD-10 is assigned code G56.2.

Prevention methods and prognosis

In order to prevent the development of the disease, it is necessary to eat properly and avoid injuring your hands.

Pathology can be prevented by avoiding injury to the hand or its nerve plexuses. When identifying inflammatory diseases or neoplasms near the passage of nerves, they must be eliminated in a timely manner. Proper nutrition with sufficient vitamin content is also important for the health of the nervous system. Tunnel neuropathy of the ulnar nerve with a long and progressive course causes paresis or paralysis of the limb with total loss its functions.

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

The nerve is located initially medially from the axillary and upper part of the brachial artery. Then at the level 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, located between the medial head of the triceps brachii muscle 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. 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 the inner lip of the block 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 ulnar artery pass from the Guyon canal into the deep space of the palm. This tunnel is called the pisiform-uncinate tunnel. The roof of the entrance to this channel is formed connective tissue, located between the pisiform bone and the hook of the hamate bone. This dense, convex tendinous arch is the origin of the flexor little finger brevis muscle. The bottom of the entrance to this tunnel is the pisiform-crticular ligament. Passing between these two formations, the ulnar nerve then turns outward around the hook of the hamate and passes under the origin of the flexor little finger brevis and the opponens little finger muscles. At the level of the pisiform-uncinate canal and distal to it, fibers extend from the deep branch to all the intrinsic muscles of the hand supplied by the ulnar nerve, except for the abductor little finger muscle. The branch to it usually arises from the common trunk of the ulnar nerve.

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

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

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

Flexor digitorum profundus; its ulnar part (innervated by the CVIII - TI segment) bends the nail phalanx of the IV - V fingers.

Tests to determine the action of the ulnar portion of this muscle:

The subject’s hand is placed palm down and pressed tightly against a hard surface (table, book), after which he is asked to make scratching movements with a fingernail;
the subject is asked to form a fist with his fingers; with paralysis of this muscle, folding the fingers into a fist occurs without the participation of the fourth and fifth fingers.

A test to determine the strength of this muscle: they suggest bending the distal phalanx of the IV - V fingers; the examiner fixes the proximal and middle phalanges in an extended state and resists flexion of the distal phalanges.

At the level of the middle third of the forearm, a sensitive palmar branch departs from the ulnar nerve, which innervates the skin of the area of the eminence of the little finger and slightly higher. Below (along the border with the lower third of the forearm, 3-10 cm above the wrist) another sensitive dorsal branch of the hand departs. This branch does not suffer from pathology in Guyon's canal. It passes between the tendon of the flexor carpi ulnaris and the ulna bone on the back of the hand and is divided into five dorsal nerves of the fingers, which end in the skin of the dorsum 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 flexor pollicis brevis (innervated by segment CVIII) flexes the phalanx of the fifth finger.

A test to determine its strength: the subject is asked to bend the proximal phalanx of the fifth finger and straighten the remaining fingers; the examiner resists this movement.

The muscle opposing the little finger (innervated by the CVII - CVIII segment) pulls the fifth finger towards midline brushes and contrasts it.

A test to determine the action of this muscle: they suggest bringing 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 ulnar nerve syndrome develops when 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(rear position 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 ones. 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 lesions 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 in the area of the hamate between the abductor and flexor digiti flexor muscles, when the ulnar nerve passes through the opponensis muscle of the little finger, and, less commonly, when the nerve crosses the palm posterior to the digital flexor tendons and anterior to the metacarpals. The number of muscles affected depends on the location of compression along the deep branch of the ulnar nerve. With fractures of the bones of the forearm, tunnel syndromes and compression of the median and ulnar nerve in the wrist area can simultaneously occur - the third type of syndrome.

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

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

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

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

Predisposing factors to the occurrence of neuritis

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

Clinical manifestations of ulnar nerve neuritis

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

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

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

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

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

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

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

Diagnostic criteria for ulnar nerve neuritis

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

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

Therapeutic tactics for ulnar nerve neuritis

The main direction in the treatment of the disease is to identify the cause and eliminate it in the near future. If there is an infectious process, use antibacterial drugs to which you are sensitive pathogenic flora, and antiviral drugs.

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

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

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

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

In addition, massage and physical therapy have proven their effect, thanks to which restoration of affected muscle groups is observed. Physical exercises should begin on the second day after fixing the limb with a bandage. Before this, it is recommended to do gymnastics in water.

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

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

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

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