Cubital tunnel syndrome (ulnar nerve compression syndrome)

Numbness in the fingers can be caused not only by compression of the median nerve, as in carpal tunnel syndrome, but also by compression of the ulnar nerve. In the latter case, the fingers involved in the process change. The ulnar nerve provides sensory innervation to the fourth and fifth fingers, that is, the little and ring fingers. It is they who become numb when conduction along the ulnar nerve is disrupted.

The weak point for the ulnar nerve is, oddly enough, the elbow. At this level, the nerve passes in a special groove between the internal epicondyle and the olecranon process. Because the ulnar nerve runs posterior to the elbow (unlike the other two, the radial and median), its stretch is significantly greater when the elbow is flexed.

If the nerve can slide normally in its groove, then its function does not suffer. And if, for some reason, it is pinched by the surrounding tissues and sliding does not occur, then it is stretched and damaged.

Diagnosis of ulnar nerve neuritis

Damage to the ulnar nerve (as a result of surgery, injury, including after drug injection, blows and prolonged compression, bone fractures and joint dislocations) is accompanied by inflammatory changes in it (ulnar nerve neuritis) and manifests itself as a violation of motor and sensory function in the area of ​​its innervation On the hand.
With damage to the spinal nerves C8–Th1–Th2 of the lower trunk and the internal bundle of the brachial plexus, the function of the ulnar nerve suffers equally in combination with damage to the cutaneous internal nerves of the shoulder and forearm and partial dysfunction of the median nerve, its lower leg (weakening of the flexor muscles of the thenar muscles), which creates a clinical picture of Dejerine-Klumpke palsy.

The motor function of the ulnar nerve mainly consists of palmar flexion of the hand, flexion of the fifth, fourth and partly third fingers, adduction of the fingers, abduction of the fingers and adduction of the thumb. In addition, the motor function of the ulnar nerve is to extend the middle and terminal phalanges of the fingers. With regard to the innervation of movements of the II–III fingers, the function of the ulnar nerve is associated with the function of the median nerve, while the ulnar nerve is predominantly related to the function of V and IV, and the median nerve is related to the function of II and III fingers.

Areas of sensory impairment in ulnar nerve neuritis.

Sensitive fibers of the ulnar nerve innervate the skin of the ulnar edge of the hand, fifth and partially fourth, and less often third fingers. Complete damage to the ulnar nerve causes weakening of the palmar flexion of the hand, lack of flexion of the fourth and fifth fingers, and partly the third, the impossibility of bringing and spreading the fingers, especially the fifth and fourth, and the impossibility of adducting the thumb.

Superficial sensitivity in case of ulnar nerve neuritis is usually impaired on the skin of the fifth and ulnar half of the fourth fingers and the corresponding ulnar surface of the hand. In case of ulnar nerve neuritis, the joint-muscular sensation is upset in the little finger. Pain with damage to the ulnar nerve is not uncommon, usually radiating to the little finger. Possible cyanosis (cyanosis), impaired sweating and a decrease in skin temperature in an area approximately coinciding with the area of ​​sensory disorders.

Atrophy of the muscles of the hand with damage to the ulnar nerve appears clearly, depression of the interosseous spaces, especially the first, as well as a sharp flattening of the hypothenar are noticeable. As a result of damage to the ulnar nerve (with ulnar nerve neuritis), the hand takes on the appearance of a “clawed bird’s paw”; when the main phalanges are extended, the middle and terminal phalanges are bent, due to which the fingers take a claw-like position. This is especially pronounced in relation to the V and IV fingers. At the same time, the fingers are slightly separated, especially the IV and mainly V fingers.

Diagnosis of the level of damage to the ulnar nerve during neuritis is made using electroneurography (ENG).

The ulnar nerve gives off its first branches only to the forearm, so damage to it along the entire length to the elbow joint and the upper part of the forearm gives the same clinical picture.

Damage to the ulnar nerve in the region of the middle and lower thirds of the forearm leaves intact the innervation of the deep flexor muscles of the fingers and palm, due to which palmar flexion of the hand and flexion of the terminal phalanges of the fifth and fourth fingers do not suffer. But the degree of “clawedness” of the hand increases.

The use of acupuncture is very effective in the treatment of ulnar neuritis.

To determine the movement disorders that occur when the ulnar nerve is damaged (with ulnar nerve neuritis), when clenching the hand into a fist, there are the following basic tests:

1. When the hand is clenched into a fist, fingers V and IV, and partly III, are not bent enough.
2. Bending the terminal phalanx of the fifth finger or “scratching” the little finger on the table with the palm tightly fitting to it is not possible.
3. It is impossible to adduct the fingers, especially V and IV.
4. Thumb test: the patient stretches a strip of paper, grasping it with both hands between the bent index finger and straightened thumb; When the ulnar nerve is affected and, consequently, the adductor pollicis muscle is paralyzed, adduction of the thumb is impossible and the strip of paper is not held by the straightened thumb. In an effort to hold the paper, the patient flexes the terminal phalanx of the thumb using the flexor pollicis muscle, innervated by the median nerve.

Causes and symptoms (cubital tunnel syndrome)

Cubital tunnel syndrome—also known as ulnar neuropathy—is caused by excess pressure on the ulnar nerve, which runs close to the surface of the skin at the elbow. You are more likely to develop cubital tunnel syndrome if you have the following factors:

• Repeated use of the elbow, especially on a hard surface.
• Keeping the elbow in a bent position for a long time, for example, while talking on a cell phone or sleeping with the arm bent at the elbow.
• Sometimes, cubital tunnel syndrome develops as a result of abnormal bone growth in the elbow or intense physical activity that increases pressure on the ulnar nerve. Baseball players, for example, have an increased risk of developing cubital tunnel syndrome because of the rotational motion required to hit the ball, which can lead to ulnar ligament damage and nerve injury.

Early symptoms of cubital tunnel syndrome include:

• Pain and numbness in the elbow.
• Tingling, especially in the ring and little fingers.

More severe symptoms of cubital tunnel syndrome include:

• Weakness in the ring and little fingers
• Decreased ability to flex fingers (thumb and little finger)
• Decreased hand strength
• Arm muscle atrophy
• Deformation of the hand

If any of these symptoms are present, your doctor may diagnose cubital tunnel syndrome based on a physical examination alone. In addition, it is possible to use special neurophysiological tests (such as EMG), which can determine the degree of conduction disturbance in a nerve fiber or muscle.

Treatment of ulnar nerve neuritis

Treatment for ulnar nerve neuritis is selected individually in each specific case. It includes a set of conservative procedures:

• acupuncture
• nerve and muscle stimulation
• vitamins of group “B”, “C” and “E”
• antiviral drugs
• homeopathic remedies
• surgical treatment (neurolysis, suturing of the nerve trunk, etc.)

Elimination of paresthesia and pain, restoration of muscle strength in the treatment of ulnar nerve neuritis is accelerated by the use of physiotherapy.

Causes and symptoms (radial tunnel syndrome)

Radial tunnel syndrome is caused by increased pressure on the radial nerve, which runs in the bones and muscles of the forearm and elbow. Causes of radial tunnel syndrome include:

• Injury
• Benign tumors (lipomas)
• Bone tumors
• Inflammation of surrounding tissues

Symptoms of radial tunnel syndrome include:

• Sharp, burning or stabbing pain in the upper forearm or back of the hand, especially when trying to straighten the wrist and fingers.
• Unlike cubital tunnel syndrome and carpal tunnel syndrome, radial tunnel syndrome rarely causes numbness or tingling because the radial nerve primarily affects the muscles.

Just like with cubital tunnel syndrome, if any of these symptoms are present, your doctor may diagnose radial tunnel syndrome based on a physical examination alone. If necessary, electromyography may be prescribed to confirm the diagnosis, determine the level of damage and the degree of damage to the nerve fiber.

Active lateral neck tilt

While sitting on a chair, keep your back and neck straight. Slowly tilt your head to the side so that your right ear is as close as possible to your right shoulder, the movement should be smooth until you feel pain in the muscles, and then return to the starting position. Relax and repeat the movement in the other direction. Make sure that you do not twist your head or raise your shoulder while doing the exercise. Repeat this exercise 10 times in each direction.

How to treat elbow pain

Adequate treatment of elbow pain syndrome is possible only after a preliminary examination. It is impossible to carry it out at home. Non-severe patients are examined on an outpatient basis, but for acute illnesses and injuries, patients with elbow pain often require hospitalization.

Diagnostics

First, the doctor conducts a clinical examination of the patient, then he is sent for additional examination, including:

• Laboratory diagnostics - clinical, biochemical and immunological blood tests reveal inflammatory, metabolic and autoimmune processes.
• Instrumental studies:
  X-ray of the elbow joint - reveals dislocations, fractures and bone changes in inflammatory and degenerative diseases;
• MRI and CT are more accurate studies needed in doubtful cases when clarification of the diagnosis is required;
• Ultrasound – changes in soft articular and periarticular tissues;
• Diagnostic arthroscopy - performed according to indications when a purulent inflammatory process and the presence of blood in the joint cavity are suspected.

Methods for treating elbow pain

Specialists at the Moscow Paramita clinic treat diseases of the elbow joint only based on the results of the examination. Patients who require surgical care are hospitalized with a recommendation for rehabilitation in our clinic after discharge from the hospital.

If the patient does not require hospitalization, he is provided with qualified medical care. An individual treatment plan is drawn up for each patient, taking into account his underlying and concomitant diseases. Complex therapy includes:

• modern Western methods of treating diseases and injuries of the elbow joint, including drug therapy, effective complexes of therapeutic exercises, physiotherapy;
• traditional oriental treatment methods that help restore energy potential and eliminate pathological foci (courses of acupuncture, moxibustion, acupressure;
• various types of joint immobilization to eliminate additional injury to the elbow area, for example, taping; fixation with adhesive elastic tape, etc.

The Paramita Clinic has extensive experience in treating and restoring the function of the elbow joint. Carrying out preventive courses of conservative therapy allows our patients to forget about pain in the elbow and lead a normal life.

Diagnostic measures

The diagnosis is made based on the patient’s complaints, external examination, and medical history. Indirect confirmation of a pinched nerve is the presence of previous injuries, endocrine, neurogenic, and articular pathologies. The Froman tests are the most informative in diagnosing compression of nerve fibers. The doctor asks the patient to squeeze the table top so that it is between his thumbs and forefingers. Even with minor pinching, the thumbs will move sideways or bend at the interphalangeal joints.

The next test is to grip a paper sheet with the side surfaces of straightened fingers. A patient with a pinched ulnar nerve will not be able to cope with the task. He will be able to hold a sheet of paper, but at the same time he will bend his fingers (“claw-shaped bird’s hand”).

Froman test.

Then the doctor identifies Tinnel’s symptom and determines the degree of its severity. It presses on the skin located above the cubital canal of the elbow joint. This movement causes a tingling sensation in the thumb, index and middle fingers. The severity of the symptom is detected by changing the intensity of pressure.

Anatomy of the ulnar nerve and cubital tunnel

The ulnar nerve originates in the cervical plexus, being one of the three main nerves of the upper limb. It runs along the inner surface of the shoulder, then lies in the canal formed by the olecranon process, the internal epicondyle and the ligament that connects these two bone formations, forming a rather narrow cubital canal.

Next, the nerve passes through the intermuscular space of the forearm, flowing into another channel, this time on the wrist. This canal is called the Guyon Canal. It is at the level of this canal that the ulnar nerve begins to divide into 3, sometimes 4 branches, ending with the sensory branches of the 5th and inner half of the 4th fingers, as well as the motor branches of the 3-4-5 lumbrical muscles of the hand.

Dragonfly

Lie on your stomach with a small pillow under your chest. Extend your arms out to the sides, elbows straight, and thumbs pointing toward the ceiling. Slowly raise your arms toward the ceiling, tense your shoulders, and lower them smoothly. 2 sets of 15 reps. To increase the effectiveness of the exercise, you can pick up small weights.