Neuropathy of the ulnar nerve

Elbow neuropathy is one of the forms of involvement of the ulnar nerve. With this pathology, the normal functioning of the elbow is disrupted, the sensitivity of the wrist is reduced, and the tone of the surrounding muscles is disturbed. Today, this is one of the most common diseases that modern medicine has to face.

[1], [2], [3]

Epidemiology

According to statistics, most often ulnar nephropathy occurs in working machines and workbenches, which are forced to rely on elbows. This is their professional disease. Among workers this pathology is found in 54% of cases. It is also often observed among civil servants, and other employees who lead a sedentary lifestyle and are forced to lean on their elbows. Among them, this pathology occurs in 49% of cases. In 11% of cases it is a consequence of trauma, damage, or consequence of surgical intervention.

[4], [5]

Causes Neuropathy of the ulnar nerve

The prerequisites for the emergence of pathology are many. The disease is a pinched nerve, which occurs in the elbow joint. The main causes are trauma, and compression. Pincing occurs as a result of stretching, tearing or rupture of the ulnar nerve. This happens when the subluxation of the elbow, dislocated forward with a fracture of the elbow process.

Compression is the compression of the nerves, the trunk in a narrow cannula. Most often, a similar pathology is observed in the cubital canal on the elbow and the canal of Guyon on the hand. The cause of pinching can be swelling, inflammation, changes in the structural and functional states of tissues, muscles.

The development of ulnar neuropathy can lead to rheumatoid arthritis, arthrosis, chondromatosis, deformation of bones and connective tissue, tumors, thickening of the walls of tendons, synovial cysts. Also, the development of ulnar neuropathy can contribute to the anatomical features of the body, in particular, the compression of the nerve muscle, which removes the little finger in the canal Guyon.

Neuritis caused by trauma, various manipulations in the elbow area, damage when directing a dislocation, or combining bone fragments during a fracture are not excluded. It is also possible to passively stretch the nerve with intensive physical exertion, muscle stretching. It develops with secondary injuries, as well as against the background of autoimmune diseases.

[6], [7], [8]

Risk factors

The risk group includes people who, due to their professional activities, have permanent clamps in their elbow. This may be due to the constant position of the hands, in which the position of the hands is with the support of the elbows. These are predominantly working professions, people who, in the course of their work, need to focus on the tool of labor: workers of machine tools, workbenches. It also often occurs in people who are forced to sit at the desk for a long time, or rely on the armrests.

People with such diseases as arthrosis, arthritis also fall into the risk group . Especially dangerous are these diseases for those who have a major pathology located in the elbow joint area. The risk of developing pathology in people who have transferred dangerous infectious diseases, such as typhoid, parotitis, as well as those who suffer from autoimmune disorders, is significantly increased. With injuries, especially repeated, surgical manipulations on the elbow, the risk increases.

[9], [10], [11], [12]

Pathogenesis

The pathogenesis is based on squeezing the ulnar nerve muscles, ligaments and other structures. In this case, the normal passage of the nerve impulse from the receptors to the brain and in the opposite direction is disrupted. Also, metabolic processes in the nerve fiber, trophic acid and supply of oxygen and nutrients are disturbed. Accordingly, the removal of carbon dioxide and other breakdown products from the nerve is also reduced. This leads to a decrease in the sensitivity of the innervated areas, mainly the brush.

[13], [14], [15], [16], [17], [18],

Symptoms Neuropathy of the ulnar nerve

Neuropathy can manifest itself in different ways, depending on the stage of the disease and the degree of nerve damage. There may be complete or partial defeat. In this case, there is a loss of sensitivity of the entire little finger, or half, as well as the normal functioning of the flexor muscles and the adductor muscles of the thumb. Their full paralysis can develop .

It also paralyzes the muscle cells, which are normally responsible for flexion of the fingers and metacarpophalangeal articulation. This is observed mainly in the place where the palms pass into the fingers. In severe lesions, clawlike fingers develop, in which simultaneous flexion of the fingers in the metacarpophalangeal joints and extension in the interphalangeal joints occur.

If the lesion of the nerve is partial, then weakness develops in the hands, especially in the region of the hands, the volume of muscles decreases substantially. This affects the area between the thumb and forefinger and other interdigital areas. Often, paralysis and weakness are accompanied by tingling and burning on the inside of the palm. Then the little finger begins , and the nearby area, referring to the ring finger. Gradually these areas completely lose sensitivity. In the course of the nerve, pain develops, which tend to intensify in the evening and at night. If treatment is not carried out in a timely manner, muscle atrophy may develop .

The earliest sign that can directly or indirectly indicate the development of pathology is numbness of the fingers and a gradual loss of sensitivity. Everything begins with the defeat of the little finger and ring finger, gradually the damage extends to the area adjacent to the nerve, along the entire course of the nerve. These symptoms are associated with a decrease in muscle strength in the abduction muscles. Pain usually does not occur at this stage, it occurs after the disease has passed to a later stage, and full or partial paralysis, paresthesia has developed. First, the pain is local in nature, then it can spread throughout the entire nerve.

Complications and consequences

If left untreated, the disease will progress and end with complete muscle atrophy and decreased sensitivity. Perhaps the development of polyneuropathies, in which there is a similar damage to other nerves: upper and lower extremities, other peripheral nerves. Plexia, paresis, hemiparesis, paralysis can occur, which are accompanied by a pronounced loss of sensitivity and a violation of the trophism of the muscles and nerves.

The ulnar neuropathy  can pass into a chronic form, with frequent recurrent inflammatory processes, which are accompanied by severe pain syndrome. Also, motor, sensory and trophic disorders increase. The disease can be transmitted to other nerves, which are also damaged, and the innervation of the corresponding sites is impaired. Such conditions require long-term outpatient and inpatient treatment. Even the brain can be damaged. The final stage is complete paralysis and muscle atrophy.

[19], [20], [21]

Diagnostics Neuropathy of the ulnar nerve

In order to make a diagnosis, you need to see a doctor who will conduct a full diagnosis and examination, and give a conclusion. To begin with, an anamnesis is collected. It is important to assess in what conditions a person lives and works, whether there are negative factors around him that could trigger the development of the disease. Perhaps a person works in conditions of harmful work, production, where there is a high load on the elbow, the nerve is permanently damaged.

After that the doctor will need an anamnesis of the disease. The doctor needs to get as much information as possible from the patient: when the disease first manifested itself, how long it takes, what measures were taken, under what circumstances there is relief, or deterioration. After the doctor has received an anamnesis, it is necessary to analyze it, as well as to conduct a survey and examination of the patient, which will provide further objective and subjective data.

Upon examination, the doctor applies the basic methods of clinical research: percussion, palpation, auscultation. With the help of palpation, it is possible to detect the degree of nerve damage, its soreness, and determine the stage of the pathological process. With the help of percussion, deep palpation, the doctor determines the muscle tone, the condition of the tendons, the nerve soreness and its inflammation. The doctor may be asked to move his hand to assess the degree of mobility or limited movement in the joint. The degree of sensitivity is assessed by touching, patting and light pricking of various parts of the brush, both from the rear and from the outside. It is quite easy to determine a sick hand: on a sick hand, the sensitivity will be reduced, or completely absent. While on a healthy hand, sensitivity will be preserved to the full.

In addition, the sensitivity of the fingers of the hand is checked, mobility and reactions of the forearm, elbow joint are evaluated. The Tinnel symptom is shown, which is manifested in the intensification of symptoms during the process of pinching the fingers on the cubital canal. This research can be very unpleasant and even painful, but it is very informative, and allows the doctor to quickly determine the cause of the damage, its location, source. This study is almost the most decisive in the diagnosis.

From this point on, you may also need to conduct Frohman's tests. In the first test, the patient is faced with the task of putting his fingers in front of him on the table in such a position that he wants to hold the table and hold it between the thumb and forefinger. It is necessary to hold hands for a while in this position. Pathology can be detected almost immediately, by the way fingers straighten. The patient is not able to hold his hands in this position on a sore arm, whereas a healthy arm can be in a given position for a long time. The patient's hand gradually straightens on the table smoothly, straightening occurs in the interphalangeal joint.

During the second test, the patient needs to grab a piece of paper between the two thumbs so that he can safely hold them, but the fingers should remain straight, straightened. Pathology is also easy to detect by the way the finger on the sore arm is gradually bent and the patient is unable to hold the sheet.

In most cases, the results of the examination and questioning of patients are sufficient to diagnose and determine the exact cause of the pain. But in case of difficulties, in various doubtful situations, additional laboratory and instrumental studies can be assigned. Differential diagnostics may be required.

[22], [23], [24], [25], [26]

Analyzes

In most cases, additional tests are not required, since it is sufficient to perform an examination and to set up functional tests to make a diagnosis. When there is a lack of information, mainly instrumental methods are used, which allow to quickly and accurately identify the cause of the disease. Laboratory tests are very rarely prescribed because they can not show any meaningful information.

In exceptional cases, a clinical or biochemical blood test may be prescribed , which may indicate the presence of an inflammatory process, or an allergic reaction. Biochemical analysis can also indicate the development of inflammation, or metabolic disorders.

If necessary, an immunogram can be assigned that will indicate a malfunction in the immune system that may have caused nerve damage. For example, an autoimmune process can be seen in which a failure occurs in the defense mechanisms. The body begins to perceive its own cells as alien, gradually destroying them, which leads to the development of the inflammatory process, damage.

[27], [28], [29], [30], [31], [32], [33]

Instrumental diagnostics

These methods are resorted to if the examination of the patient failed to establish a diagnosis. The main methods that are most often used in practice are X-ray, computer, or magnetic resonance imaging.

Using an X-ray, you can enlighten the bones and see possible bone pathology or anomaly. Especially distinctly this method can visualize fractures of bones, displacement and pinched nerves, bone spurs, and even arthritis. With the help of tomography, soft tissues can be considered. At the same time, muscles, ligaments, tendons, and even cartilages are well visualized.

Sometimes ultrasound is used for research, which allows to track the processes in dynamics. These three studies are a comprehensive survey, according to the results of which it is already possible to accurately diagnose, comprehensively assessing the condition of the ulnar nerve. Also, using ultrasound, one can see structural changes in the nerve trunk, which are most often located in the region of the entrance to the constriction channel.

In rare cases, mainly for the further refinement of the diagnosis, specific methods of investigation such as EMNG- electromyoneurography are used. With the help of this method, it is possible to estimate how much the conductivity of the nerve is disturbed. It is estimated by the conductivity of the nerve impulse. Most lesions are localized below the area of nerve damage. Also this method is used to assess how much the ulnar nerve is squeezed, in what place it is squeezed. Sometimes even bilateral compression can be detected, which is localized in two places simultaneously.

Differential diagnosis

Usually lesions of the ulnar nerve are clearly differentiated after the instrumental diagnosis, which shows a complete picture of the pathology. It is necessary to identify the exact cause of pathology. At this stage, most often differentiate trauma, inflammation, compression. The defeat of soft tissues or bones is assessed.

[34], [35], [36], [37], [38], [39], [40]

Treatment Neuropathy of the ulnar nerve

Treatment is etiologic, that is determined by the cause that caused the pathology. Conservative or surgical treatment is used.

Conservative treatment is effective in the early stages of the development of pathology, in the event that muscular atrophy has not yet developed, or a stable deformation of the fingers.

It is used strictly prescribed to the patient's motor regime, which is selected individually. It involves reducing loads, eliminating monotonous, repetitive processes, movements. The patient is contraindicated finding a long time in one position, especially in the bent.

Anti-inflammatory drugs are prescribed, which help to relieve pain and reduce edema, hyperemia. For the normalization of metabolic processes requires a full meal and intake of vitamins. It is especially recommended to take vitamins of group B, which restore damaged nerves, accelerate the processes of tissue regeneration. You may need drugs aimed at improving peripheral circulation. When the nerve is trapped in Guyon's canal, local glucocorticoids are administered.

Medications

Any medication for diseases associated with the nervous system should be taken with extreme caution. It is necessary to consult a doctor, and only after that take. It is important to follow the dosage and follow all safety precautions. Take strictly according to the prescribed scheme, not to violate it in any way. Otherwise, many side effects may occur, in particular, the situation can only worsen.

If there is a pain syndrome, you can apply no-shpu. It relieves spasm, eliminates pain. Recommended for 1 tablet three times a day (not more than 100 mg per day).

With severe pain, prescribe ketanol. This is a powerful enough anesthetic, which is used only by prescription and has many side effects. Nevertheless, it has a powerful effect in a fairly short time. Take 50 mg twice a day.

Neurovitan is used to eliminate the inflammatory process in the nerves. It also restores the structural and functional state of the nerve, normalizes its conductivity. Take one tablet once a day. The drug is prolonged action.

To stop pain, improve sensitivity, eliminate spasm, it is recommended to take kabrazepam. Dosage is 3-5 mg / kg body weight 2-3 times a day.

Trometamol is taken to prevent further progression of muscle weakening, to prevent paralysis and atrophy. Also relieves pain. Take in a daily dosage of 60 mg, breaking the dose into 2-3 doses.

Vitamins

Any organism, both in a normal state and during an illness, needs vitamins. To maintain the normal functioning of the nervous and muscular system, vitamins of group B are especially necessary. It is recommended to take vitamins in the following daily dosage:

• Vitamin B - 2-3 mg
• Vitamin PP - 30 mg
• Vitamin C - 1000 mg
• Vitamin H is 7-8 mg.

Physiotherapeutic treatment

Almost always is part of complex therapy. Most often resort to the use of ultrasound therapy, laser procedures, electroprocedures, as well as electrophoresis, with which lidocaine is administered.

Treatment with physiotherapy effectively eliminates edema, significantly improves local metabolic processes, accelerates the regeneration of tissues. With their help, you can quickly restore the motor function, prevent the development of muscle atrophy. It is possible to carry out these procedures only after the acute phase of inflammation and pain syndrome is removed.

Very effective in restoring massage and manual therapy. Acupuncture and reflexotherapy are also widely used . Massage helps to normalize blood circulation, improve trophism. Accordingly, cells and tissues receive more nutrients and oxygen, carbon dioxide and metabolic products are rapidly released to the outside. Manual therapy allows you to quickly and effectively eliminate the inflammatory process, correct deformations of bones and soft tissues. With the help of methods of acupuncture and reflexotherapy, it is possible to influence biologically active points, which allows you to quickly and effectively restore motor activity, regain muscle tone.

Also, the methods of physiotherapy have proven themselves well. Under the guidance of the instructor, an individual set of exercises is developed and implemented, aimed at restoring the desired function, returning full motor activity, restoring the passage of the pulse, and, accordingly, normalizing the sensitivity.

The complexes also include breathing exercises, relaxation and meditative practices that help relieve stress, restore the nervous system, the psyche. It is recommended to alternate dynamic and static exercises, which will quickly restore muscle tone, increase receptor sensitivity, and, accordingly, restore nerve conduction.

All procedures are recommended to supplement with self-implementation exercises at home. To choose exercises for home performance is better with the help of an instructor. It will help to make an optimal complex, and also calculate the allowable load, make a schedule, determine the frequency and rhythm of the exercises. Also at home, it is recommended to self-massage, special attention, while paying attention to the injured arm.

Laser puncture with neuropathy of the ulnar nerve

It is an effective method of restoring nerve conduction, mobility and sensitivity of the elbow joint, hand. The method has proved itself as a method aimed at removing the inflammatory process, preventing further atrophy and paralysis. The laser penetrates deeply into the tissues, removes inflammation, resolves bruises, seals, normalizes metabolic processes in tissues, removes inflammation in them. The essence is the effect of the laser on the affected parts of the body, as well as on biologically active points. The laser is a stimulating factor that increases the conductivity and excitability of the nervous tissue.

Alternative treatment

To treat various inflammations along the nerve, normalize the sensitivity of the affected areas, use a decoction of willow. To make it, you need to take 5-10 grams of willow and pour boiling water. Then the agent should be infused for 1-2 hours, after which you can drink on a tablespoon three times a day.

It will help cure neuropathy and reduce the symptoms of the vitamin complex. For cooking, take 0.1 kg of raisins, dried apricots and prunes, pass through a meat grinder. Separately, brew a glass of willow-tea. Add the broth, after letting it brew for an hour. Stir thoroughly, add 2 tablespoons of honey. Give the opportunity to brew for a day, after which you can take a tablespoon before each meal.

On the affected area, you can apply a beetroot compress. To do this, take the beets, rub it on the grater, then wrap it in gauze and apply it to the affected area. Withstand for 30 minutes, after which the product is removed, the juice is washed off with running warm water. Then the skin is lubricated with a baby cream or, with severe pain, with an anti-inflammatory ointment.

[41], [42], [43], [44]

Herbal Treatment

To remove the inflammation from any nerve, to prevent the progression of the disease can be with the help of herbs of geranium vulgaris. Widespread use of the ancient Russian means, with which you can even cure the disease at an early stage of its development. Take the leaves of geranium, put them in a pillow case on which the patient will sleep. Geranium will emit a fragrance that has a calming and healing effect on the body, normalizes the activity of the nervous system, leads to muscle tone. The broth of geranium is also separately brewed. This requires 2 sheets of geranium per glass of water. Pour, insist for an hour, then drink before bed.

Decoction of chamomile medicinal used as a tea. To do this, take 2 tablespoons of chamomile, pour 500 ml of boiling water, insist for an hour. Filter, and drink the resulting broth throughout the day. You can also add chamomile to the brewer with tea and drink like tea.

Plune clavate also helps to relieve inflammation and eliminate pain, and also increases the conductivity of tissues. It can be used as a decoction, and in the form of infusion. The ratio of solvent to plant is approximately the same. The difference is only what substance is used for cooking as a basis. So, for the present the plant is poured with alcohol or vodka, boiling water is required to prepare the broth. The broth is insisted for an hour, while the infusion should be infused for at least a day. The infusion is more concentrated, since alcohol is a strong solvent, which causes a more intensive extraction of the active substances and their release into solution.

Homeopathy

Homeopathic remedies are quite effective. They quickly eliminate the symptoms of the disease, and also affect the nerves and muscles, normalizing their anatomical and functional state. They should be taken with care, observing the basic precautions. The main thing is to consult the doctor first. Improper intake can lead to serious complications and side effects. Instead of eliminating the disease, you can only strengthen its symptoms if it is not properly taken. It is also possible to get complications to other organs and systems.

Often, if the treatment regimen is not adhered to, there are side effects in the form of circulatory disorders, brain dysfunction, decreased vascular tone. It should be remembered that drugs can have not only local, but also systemic effects. Also, many of them are preparations of cumulative effect, so they have an effect only after a full course of treatment, or after a long reception.

A plant harvest against neuropathy proved to be well established. Wanted leaves of birch, cowberries and raspberries in equal parts. The leaves are poured with boiling water, insisted for an hour, they drink like tea. During the day you can drink from 400 to 1000 ml of decoction.

You can also use an ointment to rub the affected areas. To prepare the ointment as a base, take 100 ml of acetic essence and 50 ml of vodka. Then slowly pour in 50 ml of mercury ointment. Stirring thoroughly, bring to a homogeneous state. Wait for an hour, while the ointment is infused, after which it can be applied to the affected areas with a thin layer.

A lotion also used for rubbing the affected areas. You can buy it in ready-made form or cook yourself. It takes 50 grams of ichthyol ointment, 50 grams of interior fat. Both components are melted in a water bath with constant stirring. Remove from heat, allow to cool slightly (no more than 10 minutes), then add 50 ml of formic alcohol and liquid water sponge (a freshwater sponge from the coelenterate family). A ready lotion wipes the damaged areas for the night. Apply a thin layer, rubbed into the skin, and then impose a dry heat (better wool fabric).

Also apply pads for compress. You can buy them in ready-made form, or cook yourself. Take a small bag of cotton or linen cloth. Put inside the flowers are chamomile, peppermint and elderberry. Sew up, dry in a hot place. Before use, immerse in boiling water, squeeze and apply to the affected area for 15-20 minutes.

A compress made of stearin is also recommended. For cooking, take the stearin, melt in a water bath. Using a wide paint brush put on the skin layers. Allow to dry slightly, then apply a new layer to each layer. In total it is necessary to make 40 layers. The product strongly bakes, but it is quite effective, it helps to eliminate inflammation and pain. The skin does not damage at the same time.

Surgery

Surgical methods of treatment are resorted to ineffectiveness of conservative therapy. The main indication for the operation is the narrowing of the canal, in which the nerve is localized. Also used in the presence of pronounced scar formation in the passage of the nerve.

The essence of the operation is the dissection and removal of those elements that squeeze the nerve. With increased rice re-injuring the nerve in the area of the elbow joint, it is moved to the inner surface of the joint.

The postoperative period is quite long, long rehabilitation is required, aimed at restoring the motor function. For this, various methods are used, mainly complex therapy is conducted. Prescribe medications, mainly painkillers and anti-inflammatory drugs, as well as physiotherapy. Very effective paraffin baths, massage, acupuncture. Myostimulation, electrical stimulation, thermal procedures are carried out.

After the operation, immobilization (immobilization) of the injured limb is required. Movement will be limited to about 7-10 days, after which you can begin to perform light passive movements, then - actively passive, then move on to active movements. Actually moving the limb, a person begins at about 3-4 weeks of rehabilitation. After 8 weeks, you can already exercise with exercise.

Prevention

The essence of prevention is the need to exclude a prolonged monotonous load on the elbow joints. If a person has to spend a lot of time in one position, leaning on his elbows, you need to take small breaks during which to perform various exercises aimed at increasing mobility in the elbow joints. Also, you need to take vitamin and mineral complexes for prevention, eat right.

Since often the compression and trauma are observed in sportsmen engaged in professional sports, you need to carefully monitor the hygiene of joints, change periodically the types of load, take the necessary complexes and vitamins.

Effective measure of prevention is massage, manual therapy, reflexotherapy. It is necessary to undergo periodic preventive courses of treatment, which will allow early diagnosis and timely prevent the development of pathology. It is better to take preventive courses 2 times a year, which will not allow the pathological process to develop, even if it starts to develop.

It is important to undergo regular preventive examinations, avoid injuries and injuries, especially dislocations and fractures of the ulna. It is also important to monitor the position of the elbow during work, in everyday life. So, when working at a computer it is important that the elbow look down, the hands are relaxed. Do not put your hands on the armrests and keep them in this position. It is also important to ensure that the back is flat, the shoulder blades are not rounded. You must avoid tilting forward with an emphasis on the elbows and hands. When driving a car, the elbow should not be placed on an open window, the elbows should also be lowered down.

It is also advisable to keep your elbow straight while you sleep at night. But since in a dream we can not practically control our movements, we can control it in a special way. So, you can wrap your hand with a towel, or a special pillow that will prevent the elbow bending. It is important to maintain a high level of physical activity. For elbows, stretching exercises that strengthen elbow exercises are especially important. Especially important are isometric exercises, in which alternate exercises for relaxation and tension, which allows you to train not only the muscle, but also the nerve.

It is important to control one's diet, lifestyle, not to abuse alcohol, since at the present time such a disease as alcoholic polyneuropathy is known, in which various nerves, including the ulnar, are affected. The main action is the toxic effect of alcohol on the human body.

[45], [46], [47], [48]

Forecast

The prognosis can be different and is determined by the degree and severity of the pathology. So, if  ulnar neuropathy  is detected at an early stage, you can take the necessary measures and cure the disease. The function can be restored completely. In untimely treatment, the prognosis may be unfavorable, up to muscle atrophy and complete paralysis of the hand. More favorable will be the prognosis for young people, whereas in elderly people the probability of complete restoration of function is significantly reduced. For people older than 50 years, even surgery can not always be effective.

[49], [50], [51]