Ulnar nerve entrapment

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Ulnar nerve entrapment is a condition in which the ulnar nerve is trapped physically or pinched, resulting in pain, numbness, or weakness.

Video Ulnar nerve entrapment

Signs and symptoms

In general, ulnar neuropathy will produce symptoms in a particular anatomical distribution, affecting the little finger, half of the ring finger, and the intrinsic muscles of the hand.

The specific symptoms experienced in the distribution of characteristics depend on the specific location of the ulnar nerve suppression. The symptoms of ulnar neuropathy may be motoric, sensory, or both depend on the location of the injury. Motor symptoms consistent with muscle weakness; Sensory symptoms or paresthesias consist of numbness or tingling in areas supplied by the ulnar nerve.

• Proximal collisions are associated with mixed symptoms, because the proximal nerve is composed of mixed sensory and motor innervation.
• Distal withdrawal is associated with variable symptoms, because the ulnar nerve separates close hands into different motor and sensory branches.

In cubital tunnel syndrome (proximal collision), sensory and motor symptoms tend to occur in a particular sequence. Initially, there may be numbness of the fourth and ulnar fingers that may be temporary. If impingement is not corrected, numbness can become constant and develop into hand weakness. The resting hand position typical of the "ulnar claw," in which the small fingers and the ring are curled up, occurs at the end of the disease and is a sign of severe neuropathy.

In contrast, in Guyon's canal syndrome (distal impingement) motor symptoms and hand claws may be more pronounced, a phenomenon known as ulnar paradox. Also the back of the hand will have a normal sensation.

Maps Ulnar nerve entrapment

Diagnosis

Different nerves from the hands usually allow the diagnosis of ulnar nerve suppression by symptoms alone. Ulnar nerve damage that causes paralysis of these muscles will result in ulnar position characteristics of the hand claws at rest. Clinical tests such as card tests for the Froment sign can be easily performed for ulnar nerve assessment. However, a complete diagnosis should identify the source of penetration, and radiographic imaging may be necessary to determine or rule out the underlying cause.

Imaging studies, such as ultrasound or MRI, may reveal an anatomic or mass disorder responsible for impingement. In addition, imaging may show signs of secondary nerve damage that further confirm the diagnosis of the collision. Signs of nerve damage include nerve alignment, proximal nerve swelling to the site of injury, abnormal nerve appearance, or characteristic changes in muscles innervated by nerves.

Differential diagnosis

Symptoms of ulnar neuropathy or neuritis do not always show actual physical neurological disorders; indeed, any injury to the ulnar nerve can produce identical symptoms. In addition, other functional disorders may cause nerve irritation and improper "impingement". For example, anterior dislocation and "snapping" of the ulnar nerve in the medial epicondyle of the elbow joint may cause ulnar neuropathy.

Other major sensory nerve barriers of the upper limb cause deficits in other distribution patterns. Entrapment of the median nerve causes carpal tunnel syndrome, which is characterized by numbness in the thumb, index, middle, and half of the ring finger. Radial nerve compression causes numbness to the back of the hand and thumb, and much less frequently.

A simple way to distinguish between significant median and ulnar nerve injuries is to test for weakness in stretching and extending a particular finger. The median nerve injury is associated with the difficulty of stretching the index and middle finger while trying to make a fist. However, with ulnar nerve lesions, the little finger and ring finger can not not glow when trying to extend the finger.

Some people are affected by multiple nerve compression, which can complicate the diagnosis.

Classification

Ulnar nerve traps are classified based on the location of the traps. The ulnar nerve passes through some small space as it passes over the medial side of the upper extremity, and at these points the nerve is susceptible to compression or entrapment - the so-called "pinched nerve." The nerves are very susceptible to injury when there is a disturbance in normal anatomy. The most common site of ulnar nerve pain is in elbow , followed by wrist .

The causes or structures that have been reported to cause ulnar nerve inflammation include:

• Problems that appear in the neck: chest outlet syndrome, cervical spine pathology, compression by anterior scalena muscle
• Problems that arise in the chest: compression by pectoralis minor muscle
• Brachial plexus abnormalities
• Elbow: fracture, growth plate injury, cubital tunnel syndrome, aponeurosis floborpronator, arcade Struthers
• Lower arm: muscle flexor carpi ulnarus
• Wrist: fracture, ulnar tunnel syndrome, hypotenar hammer syndrome
• Artery aneurysm or thrombosis
• Other : Infection, tumor, diabetes, hypothyroidism, rheumatism, and alcoholism

cubital tunnel syndrome

The most common location of the ulnar nerve puncture at the elbow is inside the cubital tunnel, and is known as cubital tunnel syndrome. The tunnel is formed by the medial epicondyle of the humerus, the olecranon process of the ulna and the tendinous curl that joins the humerus head and ulnar muscle flexor carpi ulnaris. While most cases of injury are small and disappear spontaneously with time, chronic compression or recurrent trauma can lead to more persistent problems. Commonly cited scenarios include:

• Sleep with arms folded behind the neck, elbows bent.
• Pressing your elbows on the arm of a chair while typing.
• Rest or brace the elbow on the vehicle's remaining arm.
• Stage editing.
• Intense exercise and tension involving the elbow.

Ulnar nerve compression in the medial elbow can sometimes be caused by epitrocheloanconeus muscle, anatomical variant.

Guy Guyon's canal syndrome

The withdrawal of the ulnar nerve along the anatomical space on the wrist called Guyon channel is known as Guyon's canal syndrome, or ulnar tunnel syndrome. Acknowledged causes of ulnar nerve piercings at this site include local trauma, fractures, ganglion cysts, and classic cyclists who experience repetitive trauma to the bicycle handlebars. This form of ulnar neuropathy consists of two work-related syndromes: the so-called "hypothenar hammer syndrome," seen in workers who repeatedly use a hammer, and "occupational neuritis" due to the harsh repeated compression of the tabletop surface.

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Prevention

Cubital tunnel syndrome can be prevented or mitigated by maintaining good posture and proper use of the elbow and arm, such as wearing the arm splint while sleeping to keep the arm in a straight position instead of keeping the elbow bent. The latest example of this is popularizing the concept of the elbow of the phone and the game of the hand .

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Treatment

While pain symptoms can be effectively controlled using drugs such as NSAIDs, amitriptyline, or vitamin B6 supplements, effective treatment generally requires the solution of the underlying cause.

Mild to moderate symptoms, such as pain or paresthesias, are treated conservatively with a non-surgical approach. Physiotherapy treatments have been shown to be effective in treating the symptoms of cubital tunnel syndrome and may include:

• Shared mobilization
• Neural flossing/sliding
• Strengthening/stretching exercises
• Modify events

It is important to identify positions and activities that aggravate symptoms and find ways to avoid them. For example, if the person is experiencing symptoms while holding the phone to the head, then the use of a telephone headset will immediately relieve symptoms and reduce the possibility of further damage and inflammation of the nerves. For cubital tunnel syndrome, it is recommended to avoid repeated elbow flexion and also avoid prolonged elbow flexion during sleep, as this position places stress on the ulnar nerve.

Surgery is recommended for those who do not improve with conservative therapy or those who have serious or progressive symptoms. Surgical approaches vary, and may depend on the location or cause of impingement. The discharge of cubital and ulnar tunnels can be done extensively without general anesthesia, no regional anesthesia, no sedation and no tourniquets, and usually performed by plastic surgeons.

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Prognosis

Most patients diagnosed with cubital tunnel syndrome have advanced disease (atrophy, static numbness, weakness) that may reflect permanent nerve damage that will not recover after surgery. When diagnosed before atrophy, weakness or static numbness, the disease may be caught with treatment. Mild and intermittent symptoms often resolve spontaneously.

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Epidemiology

People with diabetes mellitus are at higher risk for any type of peripheral neuropathy, including ulnar nerve traps.

Cubital tunnel syndrome is more common in people who spend a long time with flexed elbows, such as when holding the phone to the head. Flexing the elbow as the arm is pressed to a hard surface, like leaning against the edge of the table, is a significant risk factor. The use of vibrating tools at work or other causes of repetitive activity increases the risk, including throwing a baseball.

Elbow joint damage or deformity increases the risk of cubital tunnel syndrome. In addition, people who have other neural tangles elsewhere in the arms and shoulders are at high risk for ulnar nerve entrapment. There is some evidence that soft-tissue compression of the neural pathways on the shoulders by bra straps over the years can lead to symptoms of ulnar neuropathy, especially in very large-breasted women.

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References

src: nervesurgery.wustl.edu

External links

Source of the article : Wikipedia