Types of ulnar nerve neuropathy

Elbow neuropathy is a fairly common phenomenon in the modern world. This is explained by the increased level of trauma, high stress and workload at work and at home. Many people are forced to work for a long time in one position: sitting at a computer, driving a car, being at a workplace at a machine, a workbench. The essence of the pathology is a violation of innervation and conductivity of the nerve as a result of injury, inflammation or pinching. First, sensitivity is impaired, then muscle tone and mobility are impaired. Without treatment, the disease will progress. Ultimately, complete loss of sensitivity and muscle atrophy are possible.

Neuropathy of the right ulnar nerve

Ulnar nerve damage can occur on both the right and left sides. However, there is a certain specificity: on the right, the ulnar nerve is damaged mainly in people who lead a sedentary lifestyle and experience stress on their elbows. These are primarily programmers, computer scientists, people who spend a lot of time at the computer. It is also damaged in many athletes who experience stress mainly on the right side. These are, first of all, tennis players, volleyball players, hockey players. People who have suffered injuries to the right hand are also more susceptible to the risk of further development of neuropathy.

Neuropathy of the left ulnar nerve

Most often, this pathology affects people who experience increased stress on their left hand. Drivers and truck drivers who spend a long time behind the wheel often suffer. In this case, the left hand is usually located on an open window. Firstly, the nerve is compressed. Secondly, hypothermia and exposure to wind or drafts of the hand occur, which can also lead to the development of pathology. It is often observed in people suffering from heart and aortic diseases, circulatory disorders.

Neuropathy of the radial and ulnar nerves

The radial and ulnar nerves are most often subject to pathology. When the radial nerve is damaged, the patient most often notes a decrease in sensitivity. First of all, the skin becomes less sensitive. Secondly, muscle hypotonia develops. Very often it develops after a severe infectious disease, such as typhoid fever, cholera. It can also be a consequence of injury, constant compression during work, sleep. It can develop as a complication in people who have suffered an injury and have been moving on crutches for a long time, squeezing the elbow.

Patients complain of muscle weakness, that they cannot raise their arm. With all attempts to raise it, it remains in a hanging position. Also, the skin has almost no sensitivity. It is impossible to straighten the forearm and hand. Later, severe pain appears, which radiates to the wrist. With severe damage to the nerve, the pain spreads along the entire nerve, affecting the shoulder and forearm.

It is quite easy to diagnose based on examination and several functional tests. Thus, patients with damage to the ulnar nerve have impaired finger flexion, the hand becomes weak, and a feeling of numbness and burning of a local nature appears. Basic reflexes are impaired, and atrophy eventually develops. Due to severe muscle weakness, a person is practically unable to hold anything in his hands. With neuropathy, a person cannot turn the hand palm up.

The disease requires treatment, otherwise it will progress all the time. The most dangerous consequence of the lack of treatment is complete muscle atrophy and loss of sensitivity. Treatment can be conservative. If it is ineffective, surgical intervention is performed, the success of which depends on the stage of the disease. The earlier it is detected, the more favorable the prognosis will be.

Often, along with damage to the radial nerve, the ulnar nerve is also affected. These two pathologies are closely interconnected. This can be a consequence of an infectious disease, injury, or compression of the nerve. The ulnar nerve is often injured in athletes with high loads. Especially in those who work with heavy weights. The bench press is the most traumatic exercise for the elbow. When the ulnar nerve is damaged, after some time the radial nerve also becomes inflamed. This is due to the fact that the inflamed nerve and tendon increase in size and begin to press on neighboring areas, including the radial nerve.

Often occurs as a result of changes in the anatomical structure of the forearm bones: with severe dislocations, bone fractures, splints, prostheses. After fractures, a bone spur often forms, which puts pressure on the nerve. Pathology can also develop with a severe bruise, which is accompanied by severe bruising and the formation of hematomas.

Ulnar nerve damage manifests itself as a feeling of stiffness, numbness. First, the little finger goes numb, and gradually this feeling affects the ring finger. Then muscle weakness, spasm, and a feeling of tightness develop. It all ends with pain, which can spread along the entire course of the nerve. Often these sensations intensify in the morning, after sleep. Usually, it is difficult for a person to move the hand. If the syndrome is not treated, it can intensify. If the symptom does not go away within a few days, you should urgently consult a doctor.

To make a diagnosis, you need to see a doctor. Usually, it is enough to conduct a survey and examine the patient to make a conclusion about the state of health. If this information is not enough, it is worth conducting instrumental diagnostics. Tests are rarely prescribed. Functional tests are also carried out. The main research methods are ultrasound, radiography, MRI. Conservative treatment is first tried, and if it is ineffective, surgical intervention is resorted to.

Neuropathy of the median and ulnar nerves

Damage to the ulnar nerve is rarely a single pathology. It usually entails damage to adjacent nerves. Often, one can encounter a combined pathology of the median and ulnar nerves, which pass almost next to each other and are mutually involved in the pathological process.

The pathology manifests itself in the form of decreased sensitivity of the skin and muscles, weakening of the muscles. The person is unable to perform certain movements, in particular, movements of the hand. The sensitivity of the fingers is impaired. The person cannot keep the fingers in a straight position.

To make a diagnosis, you need to see a doctor. He will conduct an examination and prescribe treatment. If left untreated, the prognosis can be extremely unfavorable, even disability is possible.

Treatment may be conservative, but it must be comprehensive. It includes drug therapy, physiotherapy. Massage, therapeutic exercise, acupuncture or reflexology are essential. Therapeutic exercise sessions are conducted under the guidance of instructors and at home. It is essential to include relaxation exercises, meditation, breathing exercises, isometric gymnastics.

The disease develops in three stages. At the first stage, a slight numbness of the little finger and ring finger is felt. At the second stage, the muscles weaken and sensitivity in the hand is lost. The normal position and functional state of the hand is disrupted. At the third stage, painful sensations appear in the hand or along the entire nerve. The disease progresses to complete loss of sensitivity and complete muscle atrophy. Some consider this process to be the fourth stage.

Types of Ulnar Neuropathy

There are many types and classifications of ulnar neuropathy. Classification by etiologic factor is often used. This classification distinguishes 7 main types of neuropathy. Let's consider each of them.

Guillain-Barre neuropathy is an inflammatory neuropathy that occurs mainly in an acute form. It is constantly progressing, muscle weakness and loss of sensitivity develop. The disorders begin from the periphery and gradually move upward. Damage to various areas occurs symmetrically. Almost simultaneously, both the right and left elbows are affected, after which the pathology spreads to other parts of the body, in particular, the legs, neck, and torso. In severe pathological processes, the respiratory system is affected, up to the development of respiratory failure. This type is especially severe. A favorable prognosis should not be expected.

Diphtheritic polyneuropathy is often caused by the diphtheria bacillus or its toxins. Both endotoxin and exotoxin may act. Toxins primarily affect the nervous system. Various nerves are affected, primarily the nerves of the extremities, including the ulnar nerve. Following damage to the ulnar nerve, inflammation of the radial nerve develops, less often - the median nerve. In severe cases, the damage spreads throughout the body. Pronounced pain syndrome, weakness in the extremities are characteristic.

Serum neuropathies develop in response to the introduction of serum against tetanus, rabies. At first, a slight redness appears at the injection site, then edema, hyperemia develops, after which the nerve is affected. These are signs of serum sickness, which is accompanied by paresis, hyperkinesis, plegia. Recovery, as a rule, does not occur, even with therapy. Cases of recovery are practically unknown.

Alcoholic polyneuropathies are characterized by a long latent period, during which no symptoms of the pathology are observed. However, during a preventive examination, visible damage can already be detected. The arms are affected first. A person cannot hold anything straight in his hands, cannot straighten his fingers completely. Then pain joins in. Symptoms are transmitted to the lower limbs, in which similar changes occur. Then there is a loss of sensitivity, peripheral nerves are affected, then the central nerves. Changes in the psyche occur, pelvic function is impaired. As a rule, against the background of alcohol intake, the elbow form of neuropathy gradually turns into encephalopolyneuropathy, in which both the upper and lower limbs, as well as the brain, and less often the spinal cord, are affected.

Fungal polyneuropathies are characterized by sharp pains in the joints, swelling and contractures. Tendon reflexes are lost, vegetative disorders appear. Sensitivity disorders may or may not be observed.

Diabetic polyneuropathies are accompanied by numbness, burning in the hands and feet. Then the person loses dexterity of movement, the limbs begin to freeze, blood circulation is disrupted. Muscle weakness and tremors appear.

Vegetative neuropathies are pathologies that develop as occupational diseases. They most often occur in people who are forced to stay in one position for a long time, or who work with harmful production factors. They often develop when working with manganese, hydrogen sulfide, carbon monoxide, bacterial toxins. They can develop as a result of exposure to vibration. Degenerative-dystrophic disease of the spine can develop as a complication.

According to another classification, often used in medicine, there are 4 main types of neuropathies.

Diabetic neuropathy develops in people suffering from diabetes. In this case, high blood sugar levels contribute to damage to small vessels. Damage to those vessels that feed the nerves is especially dangerous. It is this pathology that causes the disease. A distinctive feature is partial or complete loss of sensitivity in those areas that are in the damaged area.

It is divided into three forms: peripheral, proximal and autonomous. In the peripheral form, the nerves that innervate the limbs are affected. It is accompanied by tingling, numbness, and numbness of the fingers. In the proximal form, the lower limbs are mainly affected, and only then the damage is transmitted to the upper limbs. In the autonomous form, the normal functioning of the digestive organs and genitourinary system is disrupted, after which the peripheral nerves are affected, and subsequently the nerves that innervate the upper and lower limbs. All three forms end in complete muscle atrophy.

Toxic neuropathy is caused by various intoxications. Nerve damage can be a consequence of exposure to toxins of various origins, alcohol, poisons, and harmful production factors. Most often, the nerves of the arms and legs are affected.

Post-traumatic neuropathy develops as a result of traumatic and damaging effects of any factors on the nerve. It can be a consequence of a fracture, tissue edema, or scar formation. Most often, the ulnar nerves are affected. There is a decrease in reflexes, impaired sensitivity, and muscle tone.

Mixed neuropathy is represented by tunnel and compression-ischemic forms. The tunnel form is characterized by damage of both exogenous and endogenous nature. In the compression-ischemic form, the nerve trunk is compressed in narrow canals. Most often, nerves in the carpal and cubital canals are damaged. Vessels are also damaged. Most often, the cause is a person staying in one position for a long time.

Compression neuropathy of the ulnar nerve

The main reason for its occurrence is compression of the ulnar nerve directly in the elbow joint. Most often, the nerve is compressed when passing through narrow canals, in particular, the carpal and cubital. This is more common in people suffering from rheumatoid arthritis, various types of arthrosis, thyroiditis, diabetes. It is often a consequence of various injuries, such as a fracture of the radius or ulna, long-term wearing of a splint or plaster.

Directly in the canal, the nerve is compressed by thickened walls, various canal deformations, thickened tendon and nerve sheaths. The nerve can also be compressed by various neoplasms: cysts, tumors.

The main symptoms are rapidly progressing hypotension, which turns into complete muscle atrophy and a sharp decrease in sensitivity. The fingers become very numb, especially at night. The strength in the hands decreases sharply, paresthesia develops, and the hand swells greatly.

A general examination is usually sufficient for diagnosis, during which zones of increased and decreased sensitivity of the extremities are identified, Tinel's syndrome is diagnosed using functional tests. Also, a distinctive feature of this type of neuropathy is a violation of discriminatory sensitivity, during which the ability to perceive and distinguish 2 identical irritants that are simultaneously applied to the skin is impaired.

Phalen's test is also specific, allowing the disease to be diagnosed at the level of the carpal tunnel. A positive result is indicated if numbness occurs with maximum flexion of the wrist at the elbow, which increases all the time. The flexor surface of the 1st to 4th fingers becomes especially numb. Muscle atrophy can be diagnosed during the examination. Motor disorders usually precede sensory ones, and this fact is the basis for early diagnostics.

If there is insufficient information, an instrumental examination can be performed. Most often, they resort to electroneuromyography, which allows diagnosing the passage of a nerve impulse along a nerve. This makes it possible to assess the degree of nerve damage and the level of compression.

Using ultrasonography and ultrasound methods, it is possible to visualize some structures of the elbow and nerve. Magnetic resonance imaging provides the most complete picture, allows identifying possible pathologies of bones and soft tissues. It is also possible to identify various neoplasms, including malignant and benign tumors, using this method. If surgical treatment is required, Doppler flowmetry is used, which is used to assess the dynamics of recovery processes. This method is especially relevant in the preoperative and early postoperative period. The main method of treatment is surgical.

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Ischemic neuropathy of the ulnar nerve

It is the second most common type of ulnar neuropathy. It is also called cubital tunnel syndrome, since the nerve is pinched or compressed in this area. Treatment is quite varied and ranges from dissection of the canal wall to transposition of the nerve to other, unaltered tissues. For example, if the canal walls are deformed, the ulnar nerve is moved to the palmar side, which significantly reduces its further injury.

Ischemic neuropathy can also occur at the level of Guyon's canal. The pathology is extremely rare. Treatment involves cutting one of the canal walls. The choice of anesthesia method depends on the complexity of the operation. If it is a simple operation aimed at cutting the canal walls, conduction anesthesia is used. For more complex operations, general anesthesia is used.

After the operation, the operated area is immobilized in a natural position. If suturing was performed with slight tension, fixation in a forced position is used. This helps reduce the tension on the nerve.

Treatment is mainly medicinal. Various drugs are used to improve neuromuscular transmission. Physiotherapy and exercise therapy methods are also used. Classes are held with an instructor or at home according to an individually developed program. Monitoring of recovery processes is carried out mainly using electroneuromyography.

Compression-ischemic neuropathy of the ulnar nerve

This form is one of the most common types of neuropathy, in which the nerves and blood vessels are compressed. It occurs if a person is in one position for a long time, is forced to work in a squatting position, or leans on his elbows for a long time. It can develop even if a person falls asleep and is in one position for a long time. The situation is especially aggravated if the person is intoxicated at the time.

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Tunnel neuropathy of the ulnar nerve

This type of pathology is also called tunnel syndrome, in which there is intense compression of the median nerve. The carpal tunnel is damaged. It can occur as a result of narrowing of the canal walls, or during the development of neoplasms, such as malignant or benign tumors. With a strong change in the sheaths of the tendons of the constrictors, compression of the nerve can also occur.

The main type of treatment is surgical treatment, which involves cutting the canal wall. The operation can be performed using an open method or an endoscopic method. There is no significant difference, except for the method of surgical access. With open access, a full open incision is made.

With the endoscopic method, only small incisions are made through which the endoscope penetrates. With its help, the necessary manipulations are carried out. Many surgeons prefer the second method, since it allows the operation to be performed with a minimum of interventions and tissue damage. The technique is minimally invasive, the damage is minimal. At the same time, recovery is much faster, the risk of infection or complications is practically absent.

Posttraumatic neuropathy of the ulnar nerve

Such injuries occur as a result of trauma and are treated as soon as possible after the injury. At later stages, recovery may be ineffective. Neuropathies resulting from trauma are often associated with damage to any nerve trunk in the forearm. Most often, the ulnar, radial, and median nerves are damaged. The main method of treatment is restoration of anatomical integrity.

They resort mainly to neurolysis. This is a method that is a surgical method in which the damaged part of the nerve is released, and scar tissue is removed. The earlier the treatment is started, the greater the chances of successful restoration of the damaged nerve and the lower the risk of postoperative complications.

At a later stage - after 2-3 months from the development of the lesion, the operation will be less effective, respectively, the risk of complications will be much higher. In such a case, measures are usually taken to reduce the degree of tension of the nerve, for this purpose the nerves are usually sewn in and the bone is fixed in a forced position. Plastic surgery (transplantation) may be required.

The danger of untimely treatment is the development of complications. One of the main complications is the development of neurogenic contracture, in which the damaged nerve ceases to innervate certain muscles. This leads to irreversible changes in the nerve and muscle. Ultimately, transposition of tendons and muscles may be required, as well as a number of different orthopedic surgeries. One of the most common methods of correction and prevention of neurogenic contractures is neurotization, aimed at restoring lost muscle innervation.