Neuropathy of the ulnar nerve: causes, symptoms and treatment

Neuropathy of the ulnar nerve is a lesion of the ulnar nerve, as a result of which its function is impaired, which affects the sensitivity in the area of ​​the hand and causes a decrease in the strength of individual muscles brushes. There are quite a few reasons for this state. On the arm along the ulnar nerve there are places in which it is most often subjected to compression. Compression in these areas has even separate names: the syndrome of the cubital canal, Guyon canal syndrome. Each of these syndromes has its own clinical features, but they all belong to the category of neuropathy of the ulnar nerve. From this article you will get information about the causes, clinical features of neuropathy of the ulnar nerve at different levels of lesion, the ways of its treatment.

A little anatomy

To understand the originality of ulnar nerve lesions at different levels is difficult without the elementary knowledge of its anatomy and topography, so let us dwell on the basic information about the course of the ulnar nerve fibers.

The ulnar nerve is the long nerve of the brachial plexus. It consists of fibers CVII-CVIII (7th and 8th cervical) roots, which come out of the spinal cord. The nerve enters the arm from the axillary fossa, then perforates the medial intermuscular septum in the middle of the shoulder, lies in the osteo-fibrous the canal formed by the internal epicondyle of the shoulder, the ulnar process of the ulna and the epicondyle ligament, the tendon of the ulnar flexor wrists. This channel is called the cubital channel (the Mushe channel). It turns out that in this place the nerve is located rather superficially and at the same time close to the bone formations. This circumstance determines the high frequency of compression of nerve fibers in this place. Everyone who at least once struck with his elbow, felt this particular feature of the superficial location of the ulnar nerve. It can even be felt in this place.

After exiting the canal, the ulnar nerve follows between the muscles of the forearm (simultaneously giving a part of the branches to the muscles). At the border of the lower and middle third of the forearm, the nerve divides into the back branch of the hand (which innervates the skin in the back part IV, V and the second segment of the third finger of the hand) and the palmar branch that passes from the forearm to the hand through the canal Guyon. Guyon's channel is formed by small bones of the hand, palmar ligament of the wrist. In this place, the ulnar nerve is also often subjected to compression. The palmar branch of the ulnar nerve innervates the muscles of the hand and the skin of the palmar surface V, the ulnar half of the IV finger of the hand.

Knowledge of the topographic features of the nerve stroke helps in the diagnosis of its lesions. For example, if the 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 the weakness of the muscles is detected only in the area of ​​the fingers of the hand, then the nerve lesion is located at the level channel of Guyon. The level of damage is important if there is a need for surgical treatment.

The causes of neuropathy of the ulnar nerve

The ulnar nerve can be damaged when:

• fractures, dislocations of the bones of the shoulder, forearm and hand;
• compression in the field of fibrous-bone channels (cubital and Guyon).

Most often, the ulnar nerve is damaged precisely during compression. Nerve compression does not need to be sharp, sudden. On the contrary, it often develops slowly, as a result of a prolonged impact of the traumatic factor. What is the cause of compression of the ulnar nerve? In the area of ​​the cube channel, compression provokes:

• often repeated flexion movements in the elbow joint;
• work related to the support of elbows on the machine, a desk, a workbench;
• the habit of drivers to put a bent hand in the window, leaning elbow not his edge;
• the habit of long talking on the phone, having leaned a hand on the table with an elbow (this problem is more of a concern for women, as they like to chat with their friends for a very long time);
• prolonged intravenous infusion, when the hand is for a considerable period of time fixed in the extended position (and the nerve is subjected to compression). This is possible only in severe patients who are almost continuously administered infusion therapy.

The compression of the ulnar nerve in the region of the Guyon canal is called the ulnar wrist syndrome. This state provokes:

• Regular work with the tool (screwdrivers, pliers, forceps, vibrating tools, including jackhammers, etc.), that is, they are professional issues. Of course, the use of pliers or a screwdriver only a few times the lesion of the ulnar nerve will not arise. Perhaps the compression of the nerve in this area among violinists;
• constant use of the cane;
• frequent cycling or motorcycle riding (for professional sports with these vehicles).

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

Symptoms of neuropathy of the ulnar nerve

With the defeat of the nerve, its functions are primarily violated, that is, sensitive (including painful) and motor problems (associated with muscle strength) appear. Usually, sensitive disorders occur first, and a decrease in muscle strength develops with continued compression of the nerve. With fractures, dislocations and other "acute" causes of neuropathy of the ulnar nerve, sensory and motor disturbances occur simultaneously.

Cubital channel syndrome

Symptoms of ulnar nerve damage in this area are:

• pain in the area of ​​the ulnar fossa (inner surface of the elbow joint), which extend to the forearm, IV and V fingers (both palmar part and back), on the elbow margin of the hand (adjacent to little finger). In the same areas, there may be paresthesia: sensation of tingling, crawling, burning, twitching, and so on. At first, the pains are periodic, worse at night, provoked by movements in the elbow joint (more "guilty" bending). Gradually the pains begin to disturb constantly and intensify in intensity from unpleasant sensations to very pronounced pains;
• decrease sensitivity on the ulnar edge of the hand, in the region of the little finger and ring finger. Moreover, there is one feature - the very first sensitivity changes in the region of the little finger;
• a little later (in comparison with the sensitive disorders) there are motor disorders. Muscular weakness manifests itself by the difficulty of flexion and retraction of the hand to the ulnar side, a violation bending the little finger and ring finger, when you try to squeeze the hand into the fist IV and V fingers do not press against palms. If you put your palm on the table and try to scratch your little finger on the table, in case of a neuropathy of the ulnar nerve, you will not be able to do it. Fingers can not be brought together and spread apart;
• with the prolonged existence of compression of the ulnar nerve develops atrophy of the muscles of the hand. The brush grows thin, bones protrude, interdigital spaces fall. The rest of the hand and the opposite brush look perfectly normal;
• The brush takes the form of "clawed" or "birdlike" (due to the prevalence of the function of the other nerves of the hand that is not affected).

Guyon canal syndrome (elbow wrist syndrome)

Symptoms of this pathological condition are similar in many respects to those in the syndrome of the cubital canal. However, there are a number of differences that make it possible to distinguish the levels of damage. So, the elbow syndrome of the wrist manifests itself:

• sensitive disorders: pain and paresthesia of the area of ​​the wrist joint, palmar surface of the elbow margin of the hand and palmar surface of the little finger and ring finger. The rear part of the brush does not experience such sensations (which distinguishes this syndrome from the syndrome of the cubital canal). Both pain and paresthesia intensify at night and with brush movements;
• decreased sensitivity in 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 impairment: weakness of flexion of IV and V fingers, they can not be completely pressed to the palm, difficulty in breeding and reducing the fingers, it is impossible to bring the thumb to the palm;
• the brush can acquire a "clawed" ("birdlike") form;
• With prolonged existence of the process, muscle atrophy develops, the brush grows thin.

Pressure in the Guyon canal can be subjected to separate fibers of the ulnar nerve. And then the symptoms can arise in isolation: either only sensitive disorders, or only motor disorders. In the absence of seeking medical help and treatment, the entire nerve will inevitably become compressed, and then the symptoms will be mixed.

There is a diagnostic technique that works regardless of the site of compression of the ulnar nerve. This method consists in effleurage (neurological hammer), a slight tapping of anything where the nerve is supposed to be squeezed. And as a result, the above sensitive symptoms occur. That is, if you slightly knock on the inner surface of the elbow joint, you can cause pain and paresthesia in the zone of its innervation. This method confirms the presence of neuropathy of the ulnar nerve.

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 motor disorder. Fracture of the humerus, bones of the forearm with compression of the ulnar nerve with bone fragments will manifest itself in the ulnar region part of the forearm, hand and IV, V fingers, weakness of flexion of the hand, ring finger, little finger, information and breeding of all fingers of the hand. With fractures or dislocations, it is somewhat easier to detect ulnar nerve damage, because the person has a clear cause of such symptoms.

Diagnostics

To establish the diagnosis of neuropathy of the ulnar nerve, a neurological examination with a piercing test should be performed. A very informative method is electroneuromyography, which allows you to determine the level of damage to nerve fibers and even differentiate, if necessary, the defeat of the ulnar nerve from the lesion of the nerve roots that form its trunk (affection of rootlets arises in the area of ​​their exit from the spinal cord and vertebral apertures, although the clinical symptoms may resemble the ulnar neuropathy nerve). Diagnosis of the neuropathy of the ulnar nerve is not particularly difficult with the attentive attitude of the doctor to the existing symptoms.

Treatment of neuropathy of the ulnar nerve

The approach to the treatment of neuropathy of the ulnar nerve is determined, first of all, by the cause of its occurrence. If the disease has arisen as a result of fracture of the arm bones with traumatic damage to the nerve fibers, then, perhaps, immediate surgery will be needed to restore the integrity of the nerve. If the cause lies in the prolonged and gradual compression of the ulnar nerve, then at the beginning resort to conservative methods of treatment and only in the case of their ineffectiveness, surgical treatment.

Restoration of the integrity of the ulnar nerve in fractures of the hand with a rupture of the fibers is done by sewing the nerve. To restore the function in this case it may take about 6 months. The earlier the integrity of the nerve is restored, the more favorable the prognosis.

If the 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 fixation devices (orthoses, tires, bandages). Some of these tools can only be used at night to reduce the domestic difficulties that arise in connection with the fixation of the hand. It is necessary to change the motor stereotype, that is, if there is a habit of leaning on the table with the elbows at the office work or telephone conversations or lay your hand on the glass in the car while driving, you need to get rid of her. Also, movements that increase nerve compression should be avoided.

From drug preparations, non-steroidal anti-inflammatory drugs (Diclofenac, Ibuprofen, Nimesulid, Meloxicam and others) are first used. These drugs can reduce pain, swelling in the nerve and adjacent areas, remove inflammation. For the purpose of anesthesia, you can locally use a patch with lidocaine (Versatis). With anti-edema, diuretics (Lasix), L-lysine escinate, Cyclo-3-fort can be used. Some anesthetic and trophic effect is provided by vitamins of group B (Neurorubin, Neurovitan, Kombilipen, Milgamma). To improve nerve conduction, Neuromidine is prescribed.

If immobilization and non-steroidal anti-inflammatory drugs do not produce an effect, then they resort to injection Hydrocortisone with an anesthetic in the area where the nerve is subjected to compression (Guiyon's channel or the cubital canal). Usually this procedure has a good therapeutic effect.

In the treatment of neuropathy of the ulnar nerve, physiotherapy is widely used. Ultrasound, electrophoresis with various drugs, electric muscle stimulation are the most commonly used procedures. Effective massage, acupuncture. Not the least role is played by physical therapy, which helps restore muscle strength.

Nevertheless, sometimes with the late application for medical help to restore the normal operation of the ulnar nerve only conservative ways is not possible.In such cases, resort to surgery. The essence of surgical treatment is to release the ulnar nerve from compression. In the syndrome of the cubital canal, this can be the plastic of the canal, the creation of a new canal and the movement there ulnar nerve, the removal of a part of the epicondyle, with Guyon's canal syndrome is the dissection of the palmar ligament of the wrist over channel. With the help of such methods, the nerve is released, but only this is not enough to restore the function completely. After a successful operation, it is necessary to use medications (vitamins, drugs that improve the nervous trophic and conduction, decongestants, anesthetics), physiotherapy and therapeutic physical education. To fully restore the function of the ulnar nerve may take from 3 to 6 months. In neglected cases, when the medical treatment was very late and there is a pronounced muscle atrophy, complete recovery is impossible. Part of the motor and sensitive disorders can stay with the patient forever. Therefore, do not hesitate to contact your doctor if you have any symptoms that indicate a possible neuropathy of the ulnar nerve.

Thus, neuropathy of the ulnar nerve is a pathological condition that arises as a result of a number of reasons. The main clinical symptoms of the disease are pain, sensitivity disorders and muscle weakness in the region of the elbow margin of the hand and I, fingers of the hand. Neuropathy of the ulnar nerve is treated conservatively and operatively. The choice of method of treatment depends on the cause that caused neuropathy, and the individual characteristics of the course of the disease. Success in treatment is largely determined by the timeliness of seeking medical help.

Educational film "Neuropathies of peripheral nerves. Clinic, the basis of diagnosis and treatment "(with: 5):