Types of neuropathy of the ulnar nerve

Elbow neuropathy is a fairly common phenomenon in the modern world. This is due to the increased level of injuries, high stresses and stresses at work and at home. Many people are forced to work, stay for a long time in one position: sitting at the computer, driving a car, being at the workplace at the bench, bench. The essence of the pathology is the violation of innervation and conduction of the nerve as a result of trauma, inflammation or pinching. First, the sensitivity is disturbed, then the muscle tone and mobility are disturbed. In the absence of treatment, the disease will progress. Ultimately, complete loss of sensation, muscle atrophy is possible .

Neuropathy of the right ulnar nerve

The defeat of the ulnar nerve can occur both on the right and on the left. At the same time, there is a certain specificity: on the right, the ulnar nerve is mostly affected in people who lead a sedentary lifestyle and experience a load on the elbows. This is primarily programmers, computer specialists, people who spend a long time at the computer. Also amazed at many athletes who experience a load mainly on the right side. This is, first of all, tennis players, volleyball players, hockey players. People who have suffered a trauma to the right arm are also more at risk of further development of neuropathy.

Neuropathy of the left ulnar nerve

Most often, this pathology affects people who experience increased stress on the left arm. Often suffer drivers, truckers, who for a long time are behind the wheel. At this left hand is usually located on an open window. First, there is compression (compression) of the nerve. Secondly, hypothermia and blowing of the hand by wind, drafts occur, resulting in the development of pathology. It is often observed in people suffering from heart and aortic diseases, a violation of blood circulation.

Neuropathy of the radial and ulnar nerve

Radial and ulnar nerve are most often subjected to pathology. If the damage to the radial nerve is most often the patient notes a decrease in sensitivity. First of all, the skin becomes less sensitive. Secondly, muscle hypotension develops. It often develops after a severe infectious disease, such as typhoid fever, cholera. It can also be a consequence of trauma, constant squeezing during work, sleep. It can develop as a complication in people who have suffered a trauma, and for a long time moved on crutches, squeezing the elbow.

Patients complain of muscle weakness, the fact that they can not raise their hand. With all attempts to raise her, she remains in a hanging position. Also, the skin has almost no sensitivity. It is impossible to unbend the forearm and hand. Later there is a strong pain that gives in the wrist. With severe nerve damage, the pain spreads throughout the nerve, affecting the shoulder and forearm.

Diagnose easily enough on the basis of inspection and several functional tests. Thus, in patients with ulnar nerve damage, flexion of the fingers is violated, the brush weakens, a feeling of numbness and burning sensation of a local character appears. Violated the basic reflexes, eventually develops atrophy. Because of the strong weakness of the muscles, a person is practically unable to hold anything in his hands. At a neuropathy the person can not turn a palm a hand upwards.

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, surgery is performed, the success of which depends on the stage of the disease. The earlier it was revealed, the more favorable the forecast will be.

Often in parallel with damage to the radial nerve, the ulna is also affected. These two pathologies are closely interrelated. This may be a consequence of an infectious disease, trauma, nerve compression. Often the ulnar nerve is injured in athletes with high loads. Especially in those who work with heavy weight. Bench press is the most traumatic exercise for the elbow. With lesion of the ulnar nerve, after a while 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 adjacent areas, including the radial nerve.

Often occurs as a result of changes in the anatomical structure of the bones of the forearm: with severe dislocations, bone fractures, the imposition of tires, prostheses. After fractures, a bone spur is often formed, which puts pressure on the nerve. Also, pathology can develop with a strong bruise, which is accompanied by severe bruising and bruising.  

The ulnar nerve is affected by a feeling of stiffness, numbness. First, the little finger grows numb, gradually this sensation affects the ring finger. After that, muscle weakness, spasm, a feeling of tightness develops. It ends with all the pain that can spread throughout the entire course of the nerve. Often these sensations increase in the morning, after sleep. Usually it is difficult for a person to move a brush. If the syndrome is not treated, it can intensify. If the symptom does not pass within a few days, you should immediately call your doctor.

To make a diagnosis, you need to see a doctor. It is usually 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 worthwhile to conduct instrumental diagnostics. Analyzes are rarely prescribed. Functional tests are also conducted. The main research methods are ultrasound, radiography, MRI. Treatment is first tried conservative, with its ineffectiveness resorted to surgical intervention.

Neuropathy of the median and ulnar nerve

Damage to the ulnar nerve is rarely a single pathology. Basically, it entails the defeat of neighboring nerves. Often one can find a combined pathology of the median and ulnar nerve, which pass almost side by side, and are mutually involved in the pathological process.

There is a pathology in the form of reduced sensitivity of the skin and muscles, weakening of the muscles. Man is not able to perform certain movements, in particular, movements with a brush. Violated the sensitivity of the fingers. A man can not hold his fingers in a level position.

To make a diagnosis, you need to see a doctor. He will carry out a check-up, prescribe a treatment. If you do not treat the forecast can be extremely unfavorable, even disability is possible. 

Treatment is perhaps conservative, but it must necessarily be comprehensive. Includes medicamental therapy, physiotherapy. Necessarily need a massage, exercise therapy, acupuncture or reflexology. Sessions of physiotherapy exercises are conducted under the guidance of instructors and at home. It is necessary to include exercises for relaxation, meditation, breathing exercises, isometric gymnastics. 

The disease develops in three stages. At the first stage, there is a slight numbness in the little finger and ring finger. At the second stage there is a weakening of the muscles, a loss of sensitivity in the hand. The normal position and functional state of the brush is disrupted. At the third stage, painful sensations appear in the hand or throughout the entire nerve. The disease progresses until complete loss of sensation and complete muscular atrophy. Some consider this process as the fourth stage.

Types of neuropathy of the ulnar nerve

There are many varieties and classifications of ulnar neuropathy. Often a classification is used for the etiologic factor. With this classification, 7 main types of neuropathy are distinguished. Let's consider each of them.

Neuropathy Guillain-Barre is a neuropathy of an inflammatory nature that occurs in the main in acute form. Constantly progressing, developing muscle weakness, loss of sensitivity. Violations start from the periphery and gradually rise upwards. Damage to various areas occurs symmetrically. Almost simultaneously, both the right and left elbows are affected, after which pathology is transmitted to other parts of the body, in particular, legs, neck, trunk. In severe pathological processes, the respiratory system is affected, up to the development of respiratory failure. This form is particularly difficult. A favorable forecast should not be expected.

Diphtheria polyneuropathy is often caused by diphtheria bacillus, or its toxins. Can affect both endotoxin and exotoxin. Toxins affect primarily the nervous system. Different nerves suffer, first of all, the nerves of the extremities, including the elbow. After the defeat of the ulnar nerve develops inflammation of the radial, rarely - the median nerve. In severe cases, the lesion spreads throughout the body. Characterized by severe pain syndrome, weakness in the extremities.

Serum neuropathies develop in response to the introduction of serum against tetanus, rabies. First, at the place of their introduction, there is a slight reddening, then swelling, hyperemia develops, after which the nerve is affected. These are signs of serum sickness, which is accompanied by paresis, hyperkinesis, and plethys. Recovery, as a rule, does not occur, even during therapy. Cases of recovery are almost unknown.

For alcoholic polyneuropathies, there is a long latency period in which no symptoms of pathology are observed. However, with a preventive examination, it is already possible to detect visible damage. First hands are affected. A person can not hold anything in his hands, he can not straighten his fingers completely. Then pain joins. Symptoms are transmitted to the lower extremities, in which similar changes occur. Then there comes a loss of sensitivity, peripheral ones are affected, then - the central nerves. There are changes in the psyche, the function of the pelvis is disrupted. As a rule, against the background of alcohol intake, the elbow form of neuropathy gradually turns into encephalopylinic neuropathy, in which both upper and lower extremities are affected, as well as the head, and more rarely the spinal cord.  

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

Diabetic polyneuropathies are accompanied by numbness, burning in the hands and feet. Then a person loses the dexterity of movements, limbs begin to freeze, blood circulation is disrupted. There is a muscle weakness, tremor.

Under vegetative neuropathies are meant pathologies that develop as occupational diseases. Most often, those people who are forced to stay in one position for a long time or who work with harmful factors of production are manifested. They often develop when working with manganese, hydrogen sulphide, carbon monoxide, bacterial toxins. Can develop as a result of vibration. As a complication, degenerative-dystrophic disease of the spine can develop.

According to another classification, often used in medicine, four main types of neuropathies are distinguished.

Diabetic neuropathy develops in people with diabetes. At the same time, a high level of sugar in the blood contributes to the damage of small vessels. Especially dangerous is the damage to those vessels that nourish the nerves. It is this pathology that causes the disease. A distinctive feature is a partial or total loss of sensitivity in those areas that are in the area of damage.

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

With toxic neuropathy, various intoxications develop. The defeat of nerves can be a consequence of exposure to toxins of various origins, alcohol, poisons of harmful factors of production. The nerves of the hands and feet often suffer.

Post-traumatic neuropathy develops as a result of the traumatic and damaging effects of any factors on the nerve. It can be a consequence of fracture, edema of tissues, scar formation. Most often suffer from ulnar nerves. There is a decrease in reflexes, a violation of the sensitivity and tone of the muscles.

Mixed neuropathy is represented by a tunnel and compression-ischemic form. The tunnel form is characterized by damage of both exogenous and endogenous nature. With a compression-ischemic form, compression of the nerve trunk occurs in narrow canals. Most often, nerve damage occurs in the carpal and cubital canals. Vessels are also damaged. Most often the reason is to find a person for a long time in one position.

Compression neuropathy of the ulnar nerve

The main cause of its appearance is the squeezing of the ulnar nerve directly in the elbow joint. Most often, the nerve is squeezed when passing narrow channels, in particular, carpal and cubital. This is more typical of people suffering from rheumatoid arthritis, various types of arthrosis, thyroiditis, diabetes mellitus. Often is the result of various injuries, for example, fracture of the radial or ulnar bone, prolonged wearing of a tire or gypsum.

Directly in the channel, the nerve is compressed by thickened walls, various deformations of the canal, thickened shells of tendons and nerves. Also, the nerve can squeeze various neoplasms: cysts, tumors.  

The main symptoms are rapidly progressive hypotension, which changes into a complete muscle atrophy and a sharp decrease in sensitivity. The fingers go numb, especially at night. The strength in the hands drops sharply, paresthesia develops, the brush swells.

For diagnosis, usually a general examination is sufficient, during which areas of high and low sensitivity of the extremities are identified, diagnose Tinel syndrome with the help of 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 stimuli that are simultaneously applied to the skin is impaired.

Specific is the Phalen test, which allows diagnosing the disease at the level of the carpal canal. The positive result is said in the case when the maximal flexion of the hand at the elbow occurs numbness, which is increasing all the time. The flexion surface of 1-4 fingers is especially strongly numb. During the examination, muscular atrophy can be diagnosed. Usually motor disorders precede sensory ones, it is this fact that underlies early diagnosis.

In case of insufficient information, instrumental research can be conducted. Most often resort to electroneuromyography, which allows you to diagnose the passage of a nerve impulse along the nerve. This makes it possible to assess the degree of nerve damage and the level of compression.

Using the methods of ultrasonography and ultrasound can visualize some structures of the elbow, nerve. Magnetic resonance imaging provides the most complete picture, allows you to identify possible pathologies of bones and soft tissues. You can also use this method to identify various neoplasms, including malignant and benign tumors. If surgical treatment is required, Doppler flowmetry is used, by means of which the dynamics of the recovery processes are evaluated. 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 occupies the second place in terms of prevalence among various types of ulnar neuropathy. It is also called the syndrome of the cubital canal, since pinching or squeezing of the nerve occurs precisely in this area. Treatment is quite diverse and varies from dissection of the canal wall to transposition of the nerve into other, unchanged tissues. For example, if the walls of the canal are deformed, the ulnar nerve is moved to the palmar side, which significantly reduces its further trauma.

Also, ischemic neuropathy can occur at the level of the Guyon canal. Pathology is extremely rare. Treatment consists in dissection of one of the canal walls. The choice of the method of anesthesia depends on the complexity of the operation. If this is a simple operation aimed at dissecting the walls of the canal, conductive anesthesia is used. In more complex operations, general anesthesia is used.

After the operation, the operable site is immobilized in the natural position. If the stitching was done with a slight tension, fixation in the forced position is applied. This helps reduce the tension of the nerve.

Treatment is mainly medicated. Apply a variety of drugs aimed at improving neuromuscular transmission. Physiotherapy, methods of physiotherapy exercises are also used. Classes are conducted with an instructor, or at home on an individually developed program. Control of recovery processes is carried out mainly with the help of 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 squeezed. Occurs in the event that a person for a long time is in one position, is forced to work squatting, or to rest for a long time on his elbows. It can develop even if a person has fallen asleep and has been in the same position for a long time. Especially the situation is aggravated if the person at this time was in a state of intoxication.

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Tunnel neuropathy of the ulnar nerve

This type of pathology is also called tunnel syndrome, in which intense compression of the median nerve occurs. The carpal canal is damaged in this case. It can occur as a result of constriction of the canal walls, or in the development of neoplasms, for example, malignant or benign tumors. With a strong change in the envelopes of the tendons of the compressors, the nerve can also be squeezed.

The main type of treatment is surgical treatment, in which the dissection of the canal wall is performed. The operation can be performed by an open method or by means of an endoscopic method. There is no significant difference, except for the method of surgical access. With open access, a full open cut is made.

With the endoscopic method, only small incisions are made through which the endoscope penetrates. With his help, and carry out the necessary manipulations. Many surgeons prefer the second method, because it allows you to perform surgery 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, there is practically no risk of infection or development of complications.

Post traumatic neuropathy of the ulnar nerve

Such damage occurs as a result of trauma and is treated as soon as possible after it is received. At later dates, recovery may not be effective. Neuropathies resulting from injuries are often associated with damage to any nerve trunk in the forearm area. The ulnar, radial and median nerves are most often damaged. The main method of treatment is the restoration of anatomical integrity.

They resort mainly to neurolisis. This is a method that is a surgical method, in which the damaged part of the nerve is released, the scar tissue is eliminated. The sooner the treatment is started, the more chances for successful recovery of the damaged nerve and the lower risk of postoperative complications.

At later dates - after 2-3 months after the development of the lesion, the operation will be less effective, accordingly, the risk of complications will be much higher. In this case, usually measures are taken to reduce the degree of nerve tension, for this, nerves are usually sewn up and the bone fixed in a forced position. You may need plastic (transplant).

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 in the muscle. Ultimately, a transposition of tendons and muscles, as well as a number of different orthopedic operations, may be required. One of the most common methods of correction and prevention of neurogenic contractures is neuroticism, aimed at restoring the lost muscle innervation.