Neuropathy of the ulnar nerve.

Ulnar neuropathy is one of the forms of damage to the ulnar nerve. With this pathology, the normal functioning of the elbow is disrupted, the sensitivity of the hand is reduced, and the tone of the surrounding muscles is disrupted. Today, this is one of the most common diseases that modern medicine has to deal with.

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Epidemiology

According to statistics, elbow nephropathy most often occurs in workers at machine tools and workbenches, who are forced to lean on their elbows. This is their professional disease. Among workers, this pathology occurs in 54% of cases. It is also often observed in 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, injury, or a consequence of surgical intervention.

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Causes Neuropathy of the ulnar nerve.

There are many prerequisites for the development of pathology. The disease is a pinched nerve that occurs in the elbow joint. The main causes are trauma and compression. Pinched nerve occurs as a result of stretching, tearing or rupture of the ulnar nerve. This happens with subluxation of the elbow, forward dislocation with fracture of the olecranon.

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

Rheumatoid arthritis, arthrosis, chondromatosis, bone and connective tissue deformities, tumors, thickening of tendon walls, synovial cysts can lead to the development of ulnar neuropathy. Also, the development of ulnar neuropathy can be facilitated by anatomical features of the body, in particular, compression of the nerve by the muscle that abducts the little finger in the Guyon canal.

Neuritis resulting from trauma, various manipulations in the elbow area, damage during reduction of dislocation or aligning of bone fragments during fractures are also possible. Passive stretching of the nerve during intense physical activity, muscle stretching is also possible. It develops with secondary injuries, as well as against the background of autoimmune diseases.

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Risk factors

The risk group includes people who, due to their professional activities, experience constant elbow clamps. This may be due to the constant position of the hands, in which the position of the hands occurs with support on the elbows. These are mainly blue-collar jobs, people who need to lean on a tool during work: machine tool workers, workbenches. It also often occurs in people who are forced to sit at a desk for a long time, or lean on armrests.

People with diseases such as arthrosis and arthritis are also at risk. These diseases are especially dangerous for those whose main pathology is localized in the elbow joint. The risk of developing pathology increases significantly in people who have had dangerous infectious diseases such as typhoid, mumps, as well as in those who suffer from autoimmune disorders. In case of injuries, especially repeated, surgical manipulations on the elbow, the risk increases.

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Pathogenesis

The pathogenesis is based on compression of the ulnar nerve by muscles, ligaments and other structures. This disrupts the normal passage of nerve impulses from receptors to the brain and back. Metabolic processes in the nerve fiber, trophism and supply of oxygen and nutrients are also disrupted. Accordingly, the removal of carbon dioxide and other decay products from the nerve is reduced. This leads to a decrease in sensitivity of the innervated areas, mainly the hand.

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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 can be complete or partial damage. In this case, there is a loss of sensitivity of the entire little finger, or half, and the normal functioning of the flexor and adductor muscles of the thumb is disrupted. Their complete paralysis can develop.

It also paralyzes the mesoskeletal muscles, which are normally responsible for flexion of the fingers and metacarpophalangeal joints. This is observed mainly in the place where the palms pass into the fingers. In severe cases, claw fingers develop, in which there is simultaneous flexion of the fingers at the metacarpophalangeal joints and extension at the interphalangeal joints.

If the nerve damage is partial, then weakness develops in the arms, especially in the area of the hands, and muscle volume is significantly reduced. In this case, the area between the thumb and index finger and other interdigital areas suffer. Often, paralysis and weakness are accompanied by tingling and burning on the inside of the palm. Then the little finger and the nearby area related to the ring finger begin to go numb. Gradually, these areas completely lose sensitivity. Painful sensations develop along the nerve, 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 gradual loss of sensitivity. It all begins with damage to the little finger and ring finger, gradually the damage spreads to the area adjacent to the nerve, along the entire course of the nerve. These symptoms are accompanied by a decrease in muscle strength in the abductor muscles. Pain is usually not present at this stage, it occurs after the disease has moved to a later stage, and complete or partial paralysis, paresthesia has developed. At first, the pain is local, then it can spread along the entire nerve.

Complications and consequences

If left untreated, the disease will progress and end in complete muscle atrophy and decreased sensitivity. Polyneuropathies may develop, which cause similar damage to other nerves: upper and lower extremities, other peripheral nerves. Plexia, paresis, hemiparesis, paralysis may develop, which are accompanied by a pronounced loss of sensitivity and disruption of muscle and nerve trophism.

Elbow neuropathy can become chronic, with frequent recurrent inflammatory processes, which are accompanied by severe pain syndrome. Motor, sensory and trophic disorders also increase. The disease can be transmitted to other nerves, which are also damaged, and the innervation of the corresponding areas is disrupted. Such conditions require long-term outpatient and inpatient treatment. Even the brain can be damaged. The final stage is complete paralysis and muscle atrophy.

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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 issue a conclusion. First, anamnesis is collected. It is important to assess the conditions in which a person lives and works, whether there are negative factors around him that could provoke the development of the disease. Perhaps a person works in conditions of harmful labor, production, where there is a high load on the elbow, the nerve is constantly damaged.

After this, the doctor will need a medical history. The doctor needs to get as much information from the patient as possible: when the disease first manifested itself, how long it lasts, what measures were taken, under what circumstances relief or deterioration occurs. After the doctor has received the medical history, it is necessary to analyze it, as well as interview and examine the patient, which will allow obtaining further objective and subjective data.

During the examination, the doctor uses the main methods of clinical examination: percussion, palpation, auscultation. With the help of palpation, it is possible to determine 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 muscle tone, the condition of the tendons, the soreness of the nerve and its inflammation. The doctor may ask you to move your hand to assess the degree of mobility or limitation of movement in the joint. The degree of sensitivity is assessed by touching, patting and lightly pricking various parts of the hand, both from the back and from the outside. It is quite easy to determine the sore hand: sensitivity on the sore hand will be reduced or completely absent. Whereas on the healthy hand, sensitivity will be fully preserved.

Additionally, the sensitivity of the fingers is checked, the mobility and reactions of the forearm and elbow joint are assessed. The Tinnel symptom is assessed, which manifests itself in an increase in symptoms during the period of tapping the fingers along the cubital canal. This study can be very unpleasant and even painful, but it is very informative and allows the doctor to quickly determine the cause of the injury, its location, and source. This study is perhaps the most decisive in making a diagnosis.

Froman tests may also be required. In the first test, the patient is asked to place his fingers in front of him on the table in such a position as if he wants to squeeze the table and hold it between the thumb and index finger. It is necessary to hold the hands in this position for some time. Pathology can be detected almost immediately, by how the fingers straighten. The patient is unable to hold his hands in this position on the sore hand, while the healthy hand can remain in the given position for a long time. The sore hand gradually straightens out evenly on the table, straightening occurs in the interphalangeal joint.

When conducting the second test, the patient needs to grasp a sheet of paper between two thumbs so that he can comfortably hold them, but the fingers should remain straight and even. Pathology is also easy to detect by how the finger on the affected hand gradually bends, and the patient is unable to hold the sheet.

In most cases, the results of examination and questioning of patients are sufficient to make a diagnosis and determine the exact cause of pain. But in case of difficulties, in various questionable situations, additional laboratory and instrumental studies may be prescribed. Differential diagnostics may be required.

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Tests

In most cases, no additional tests are required, since an examination and functional tests are sufficient to establish a diagnosis. If there is insufficient information, instrumental methods are used, which allow the cause of the disease to be quickly and accurately identified. Laboratory tests are prescribed very rarely, since they practically cannot show any significant 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. A biochemical analysis may also indicate the development of inflammation or a metabolic disorder.

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

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Instrumental diagnostics

These methods are used when the patient's examination fails to establish a diagnosis. The main methods that are most often used in practice are radiography, computed tomography, or magnetic resonance imaging.

With the help of an X-ray, it is possible to illuminate bones and see possible bone pathology or anomalies. This method can especially clearly visualize bone fractures, displacement and pinching of nerves, bone spurs, and even arthritis. Using tomographic research methods, it is possible to examine soft tissues. In this case, muscles, ligaments, tendons, and even cartilage are well visualized.

Sometimes ultrasound is used for research, which allows tracking processes in dynamics. These three studies are a comprehensive examination, based on the results of which it is already possible to make an accurate diagnosis, comprehensively assessing the condition of the ulnar nerve. Also, with the help of ultrasound, it is possible to see structural changes in the nerve trunk, which are most often located in the area of the entrance to the constricting canal.

In rare cases, mainly for further clarification of the diagnosis, such specific research methods as EMNG - electromyoneurography are used. With the help of this method, it is possible to assess the extent to which nerve conductivity is impaired. It is assessed by the indicators of nerve impulse conductivity. Mostly, lesions are localized below the area of nerve damage. This method also assesses how much the ulnar nerve is compressed, where it is compressed. Sometimes even bilateral compression can be detected, which is localized in two places at the same time.

Differential diagnosis

Usually, lesions of the ulnar nerve are differentiated quite clearly after conducting instrumental diagnostics, which shows the full picture of the pathology. It is necessary to identify the exact cause of the pathology. At this stage, trauma, inflammation, compression are most often differentiated. Damage to soft tissues or bones is assessed.

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Treatment Neuropathy of the ulnar nerve.

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

Conservative treatment is effective in the early stages of pathology development, if muscle atrophy or persistent deformation of the fingers has not yet developed.

A strictly prescribed motor regimen is used for the patient, which is selected individually. It implies a reduction in loads, the exclusion of monotonous, repetitive processes, movements. The patient is contraindicated to stay in one position for a long time, especially in a bent position.

Anti-inflammatory drugs are prescribed to relieve pain and reduce swelling and hyperemia. To normalize metabolic processes, proper nutrition and vitamin intake are required. It is especially recommended to take B vitamins, which restore damaged nerves and accelerate tissue regeneration processes. Drugs aimed at improving peripheral circulation may be required. In case of pinched nerve in Guyon's canal, local administration of glucocorticoids is used.

Medicines

Any medications for diseases related to the nervous system should be taken with special caution. You need to consult a doctor, and only then take them. It is important to follow the dosage and take all precautions. Take strictly according to the prescribed scheme, do not violate it in any way. Otherwise, many side effects may occur, in particular, the situation may only worsen.

If pain occurs, you can use No-shpa. It relieves spasms and eliminates pain. It is recommended to take 1 tablet three times a day (no more than 100 mg per day).

Ketanol is prescribed for severe pain. This is a fairly strong painkiller that is used only on prescription and has many side effects. However, 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 has a prolonged action.

To relieve pain, increase sensitivity, and eliminate spasms, it is recommended to take cabrazepam. The dosage is 3-5 mg/kg of body weight 2-3 times a day.

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

Vitamins

Any organism, both in a normal state and during illness, needs vitamins. Vitamins of group B are especially necessary to maintain the normal functioning of the nervous and muscular systems. 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 – 7-8 mg.

Physiotherapy treatment

Almost always included in complex therapy. Most often, they resort to the use of ultrasound therapy, laser procedures, electrical procedures, as well as electrophoresis, with the help of which lidocaine is administered.

Physiotherapeutic treatment effectively eliminates swelling, significantly improves local metabolic processes, and accelerates tissue regeneration. With their help, it is possible to restore motor function rather quickly and prevent the development of muscle atrophy. These procedures can be carried out only after the acute phase of inflammation and pain syndrome have been removed.

Massage and manual therapy are very effective in recovery. Acupuncture and reflexology are also widely used. Massage helps to normalize blood circulation and improve trophism. Accordingly, cells and tissues receive more nutrients and oxygen, carbon dioxide and metabolic products are removed faster. Manual therapy allows you to quickly and effectively eliminate the inflammatory process, correct bone and soft tissue deformations. With the help of acupuncture and reflexology methods, you can act on biologically active points, which allows you to quickly and effectively restore motor activity and return muscle tone.

The methods of therapeutic physical training have also proven themselves well. Under the guidance of an instructor, an individual set of exercises is developed and performed, aimed at restoring the desired function, returning full motor activity, restoring the passage of the impulse, and, accordingly, normalizing sensitivity.

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

It is recommended to supplement all procedures with independent exercise at home. It is better to select exercises for home use with the help of an instructor. He will help to create an optimal complex, as well as calculate the permissible load, make a schedule, determine the frequency and rhythm of the exercises. It is also recommended to perform self-massage at home, paying special attention to the injured hand.

Laserpuncture for Ulnar Neuropathy

It is an effective method of restoring nerve conductivity, mobility and sensitivity of the elbow joint and hand. The method has proven itself as a method aimed at relieving the inflammatory process, preventing further atrophy and paralysis. The laser penetrates deep into the tissue, relieves inflammation, resolves hematomas, seals, normalizes metabolic processes in the tissues, and relieves the inflammatory process in them. The essence lies in the effect of the laser on the affected areas 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.

Folk remedies

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

A vitamin complex will help cure neuropathy and reduce symptoms. To prepare, take 0.1 kg of raisins, dried apricots and prunes, mince. Brew a glass of fireweed separately. Add the decoction, after letting it steep for an hour. Mix the product thoroughly, add 2 tablespoons of honey. Let it steep for 24 hours, then take a tablespoon before each meal.

A beet compress can be applied to the affected area. To do this, take the beet, grate it, then wrap it in gauze and apply it to the affected area. Leave it for 30 minutes, then remove the product and wash off the juice with warm running water. Then lubricate the skin with baby cream or, if the pain is severe, with an anti-inflammatory ointment.

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Herbal treatment

You can relieve inflammation of any nerve and prevent the progression of the disease with the help of the herb geranium vulgare. An old Russian remedy has found wide application, with the help of which you can even cure the disease at an early stage of its development. Take geranium leaves, place them in the pillowcase of the pillow on which the patient will sleep. Geranium will emit an aroma that has a calming and healing effect on the body, normalizes the activity of the nervous system, and tones the muscles. Also brew a geranium decoction separately. For this, you need 2 geranium leaves per glass of water. Pour, insist for an hour, then drink before bed.

A decoction of medicinal chamomile is used as a tea. To do this, take 2 tablespoons of chamomile, pour 500 ml of boiling water, and leave for an hour. Strain and drink the resulting decoction throughout the day. You can also add chamomile to a teapot with tea and drink it as tea.

Club moss also helps relieve inflammation and eliminate pain, and increases tissue conductivity. It can be used both as a decoction and as an infusion. The ratio of solvent and herbal remedy is approximately the same. The only difference is what substance is used for preparation as a base. So, for an infusion, the plant is poured with alcohol or vodka, for the preparation of a decoction, boiling water is required. The decoction is infused 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, under the influence of which a more intensive extraction of active substances and their release into the solution occurs.

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 caution, observing basic precautions. The main thing is to consult a doctor first. Incorrect use can lead to serious complications and side effects. Instead of eliminating the disease, you can only increase its symptoms with improper use. You can also get complications in other organs and systems.

Often, if the treatment regimen is not followed, side effects such as circulatory disorders, brain dysfunction, and decreased vascular tone occur. It is important to remember that medications can have not only a local but also a systemic effect. Also, many of them are cumulative drugs, so they only have an effect after a full course of treatment or after long-term use.

A herbal tea against neuropathy has proven itself well. Birch leaves, lingonberries and raspberries in equal parts are required. The leaves are poured with boiling water, infused for an hour, and drunk like tea. You can drink from 400 to 1000 ml of the decoction per day.

You can also use the ointment to rub the affected areas. To prepare the ointment, take 100 ml of vinegar essence and 50 ml of vodka as a base. Then slowly pour in 50 ml of mercury ointment. Stir thoroughly until smooth. Wait for an hour until the ointment is infused, after which you can apply a thin layer to the affected areas.

Also widely used is a lotion for wiping the affected areas. It can be bought ready-made or prepared independently. For preparation, you need 50 grams of ichthyol ointment, 50 grams of lard. 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 bodyagi (a freshwater sponge from the coelenterate family). The finished lotion is wiped on the damaged areas at night. Apply a thin layer, rub into the skin, then apply dry heat (preferably woolen fabric).

Compress pads are also used. You can buy them ready-made or make them yourself. Take a small cotton or linen bag. Place chamomile flowers, peppermint and elderberry inside. Sew up, dry in a hot place. Before use, dip in boiling water, squeeze out and apply to the affected area for 15-20 minutes.

A stearin compress is also recommended. To prepare it, take stearin and melt it in a water bath. Apply it to the skin in layers using a wide paintbrush. Allow it to dry slightly, then apply a new layer on top of each layer. A total of 40 layers are needed. The product stings a lot, but it is quite effective, and helps eliminate inflammation and pain. It does not damage the skin.

Surgical treatment

Surgical treatment methods are used when conservative therapy is ineffective. The main indication for surgery is narrowing of the canal in which the nerve is localized. It is also used in the presence of pronounced cicatricial formations in the place where the nerve passes.

The essence of the operation is to dissect and remove those elements that compress the nerve. With an increased risk of repeated injury to the nerve in the elbow joint, it is moved to the inner surface of the joint.

The postoperative period is quite long, long-term rehabilitation is required, aimed at restoring motor function. Various methods are used for this, mainly complex therapy is carried out. Medicines are prescribed, mainly painkillers and anti-inflammatory drugs, as well as physiotherapy. Paraffin applications, massage, acupuncture are very effective. Myostimulation, electrical stimulation, thermal procedures are carried out.

After the operation, immobilization (immobilization) of the injured limb is required. Movements will be limited for approximately 7-10 days, after which you can begin to perform light passive movements, then active-passive, after which they move on to active movements. A person begins to actively move the limb approximately at the 3-4 week of rehabilitation. After 8 weeks, you can already perform exercises with a load.

Prevention

The essence of prevention is the need to exclude long-term monotonous load on the elbow joints. If a person is forced to spend a lot of time in one position, leaning on the elbows, it is necessary to take short breaks, during which to perform various exercises aimed at increasing the mobility of the elbow joints. It is also necessary to take vitamin and mineral complexes for prevention, eat right.

Since compressions and injuries are often observed in athletes involved in professional sports, it is necessary to carefully monitor the hygiene of the joints, periodically change the types of loads, take the necessary complexes and vitamins.

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

It is important to undergo regular preventive examinations, avoid injuries and damage, especially dislocations and fractures of the ulna. It is also important to control the position of the elbow at work, in everyday life. So, when working at the computer, it is important that the elbow is pointing down, the arms are relaxed. You cannot put your hands on the armrests and hold them in this position. It is also important to ensure that the back is straight, the shoulder blades are not rounded. You should avoid leaning 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 during sleep. But since we have almost no control over our movements during sleep, you can control it in a special way. For example, you can wrap your hand in a towel or a special pillow that will prevent your elbow from bending. It is important to maintain a high level of physical activity. Stretching exercises and strengthening exercises for the elbow are especially important for the elbows. Of particular importance are isometric exercises, which alternate relaxation and tension exercises, which allows you to train not only the muscle, but also the nerve.

It is important to control your diet, lifestyle, and not abuse alcohol, since there is currently a known disease called alcoholic polyneuropathy, which affects various nerves, including the ulnar nerve. The main effect is the toxic effect of alcohol on the human body.

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Forecast

The prognosis may vary and is determined by the degree and severity of the pathology. Thus, if ulnar neuropathy is detected at an early stage, the necessary measures can be taken and the disease can be cured. The function can be restored completely. If treatment is not timely, the prognosis can be unfavorable, up to muscle atrophy and complete paralysis of the arm. The prognosis is more favorable for young people, while for older people the probability of complete restoration of function is significantly reduced. For people over 50, even surgical intervention may not always be effective.

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