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Ulnar neuropathy

March 07, 2024

Ulnar neuropathy is a disorder involving the ulnar nerve. Ulnar neuropathy may be caused by entrapment of the ulnar nerve with resultant numbness and tingling.[3] It may also cause weakness or paralysis of the muscles supplied by the nerve.

Ulnar neuropathy
Nerves of the left upper extremity. (Ulnar labeled at center)
SpecialtyNeurology 
SymptomsNumbness(fingers)[1][2]
CausesNerve entrapment, Tumor[2]
Diagnostic methodCBC, Urinalysis[2]
TreatmentNSAIDs, Surgery[2]

Signs and symptoms edit

In terms of the signs/symptoms of ulnar neuropathy trauma and pressure to the arm and wrist, especially the elbow, the medial side of the wrist, and other sites close to the course of the ulnar nerve are of interest in this condition. Many people complain of sensory changes in the fourth and fifth digits. Rarely, an individual actually notices that the unusual sensations are mainly in the medial side of the ring finger (fourth digit). Sometimes the third digit is also involved, especially on the ulnar (medial) side. The sensory changes can be a feeling of numbness or a tingling, pain rarely occurs in the hand. Complaints of pain tend to be more common in the arm, up to and including the elbow area, which is probably the most common site of pain in an ulnar neuropathy.[1][2]

Causes edit

Among the causes of ulnar neuropathy are the following-

 
Olecranon

Much more commonly, ulnar neuropathy is caused by overuse of the triceps muscle and repetitive stress combined with poor ergonomics. Overused and hypertonic triceps muscle causes inflammation in the tendon and adhesions with the connective tissue surrounding that tendon and muscle. These in turn impinge on or trap the ulnar nerve. Ulnar neuropathy resulting from repetitive stress is amenable to massage and can usually be fully reversed without cortisone or surgery.[5] Center for Occupational and Environmental Neurology, Baltimore, MD has this to say: “Repetitive Strain Injuries (RSI) refers to many different diagnoses of the neck/shoulder, arm, and wrist/hand area usually associated with work-related ergonomic stressors. Other terms used for Repetitive Strain Injuries are overuse syndrome, musculoskeletal disorders, and cumulative trauma disorders. Some of the more common conditions under these headings include: Cubital Tunnel Syndrome-compression of the ulnar nerve in the cubital tunnel at the elbow.”[6]

Pathophysiology edit

In regards to the pathophysiology of ulnar neuropathy:the axon, and myelin can be affected. Within the axon, fascicles to individual muscles could be involved, with subsequent motor unit loss and amplitude decrease. Conduction block means impaired transmission via a part of the nerve. Conduction block can mean myelin damage to the involved area, slowing of conduction or significant spreading out of the temporal profile of the response with axonal integrity is a hallmark of demyelination.[2][7]

Diagnosis edit

 
Nerve conduction study (Calculation of NCV)

Among the diagnostic procedures done to determine if the individual has ulnar neuropathy are (but may not be limited to the following):[2][8][9]

Ulnar nerve neuropathy at the elbow or the wrist can be assessed by testing for a positive Froment's sign. Little finger abduction and adduction can be tested as well.[11]

Treatment edit

Treatment for ulnar neuropathy can entail: NSAID (non-steroidal anti-inflammatory) medicines. there is also the option of a cortisone injection. Another possible option is splinting, to secure the elbow, a conservative procedure endorsed by some. In cases where surgery is needed, cubital tunnel release, where the ligament of the cubital tunnel is cut, thereby alleviating pressure on nerve can be performed.[8][12][13]

Treatment for the common occurrence of ulnar neuropathy resulting from overuse, with no fractures or structural abnormalities, is treatment massage, ice, and anti-inflammatories. Specifically, deep tissue massage to the triceps, myofascial release for the upper arm connective tissue, and cross-fiber friction to the triceps tendon.[medical citation needed]

Prognosis edit

In terms of the prognosis of ulnar neuropathy early decompression of the nerve sees a return to normal ability (function), which should be immediate. Severe cubital tunnel syndrome tends to have a faster recovery process in individuals below the age of 70, as opposed to those above such an age. Finally, revisional surgery for cubital tunnel syndrome does not result well for those individuals over 50 years of age.[1]

References edit

  1. ^ a b c "Ulnar Nerve Disorders Free Medical Information | Patient". Patient. Retrieved 2016-07-23.
  2. ^ a b c d e f g h i j k l "Ulnar Neuropathy Clinical Presentation: History, Physical Examination, Ulnar neuropathy at elbow". emedicine.medscape.com. Retrieved 2016-07-23.
  3. ^ "Ulnar nerve dysfunction: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 2016-07-22.
  4. ^ a b c d e Thatte, Mukund R.; Mansukhani, Khushnuma A. (1 January 2011). "Compressive neuropathy in the upper limb". Indian Journal of Plastic Surgery. 44 (2): 283–297. doi:10.4103/0970-0358.85350. ISSN 0970-0358. PMC 3193641. PMID 22022039.
  5. ^ Chin, DH; Jones, NF (February 2002). "Repetitive motion hand disorders". Journal of the California Dental Association. 30 (2): 149–60. doi:10.1080/19424396.2002.12223260. PMID 11883427. S2CID 24441458.
  6. ^ Apprill, P; Schmitz, JM; Campbell, WB; Tilton, G; Ashton, J; Raheja, S; Buja, LM; Willerson, JT (August 1985). "Cyclic blood flow variations induced by platelet-activating factor in stenosed canine coronary arteries despite inhibition of thromboxane synthetase, serotonin receptors, and alpha-adrenergic receptors". Circulation. 72 (2): 397–405. doi:10.1161/01.cir.72.2.397. PMID 2988822.
  7. ^ Robertson, Chad; Saratsiotis, John (June 2005). "A Review of Compressive Ulnar Neuropathy at the Elbow". Journal of Manipulative and Physiological Therapeutics. 28 (5): 345. doi:10.1016/j.jmpt.2005.04.005. PMID 15965409.
  8. ^ a b "Ulnar Nerve Entrapment at the Elbow (Cubital Tunnel Syndrome)-OrthoInfo - AAOS". orthoinfo.aaos.org. Retrieved 2016-07-23.
  9. ^ Benatar, Michael (2007-11-06). Neuromuscular Disease: Evidence and Analysis in Clinical Neurology. Springer Science & Business Media. p. 291. ISBN 9781597451062. Retrieved 23 July 2016.
  10. ^ "Nerve conduction velocity: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 2016-07-23.
  11. ^ Bertelli, J. A.; Tavares, K. E. (2018-12-01). "Little finger abduction and adduction testing in ulnar nerve lesions". Hand Surgery and Rehabilitation. 37 (6): 368–371. doi:10.1016/j.hansur.2018.09.006. ISSN 2468-1229. PMID 30361046. S2CID 53101000.
  12. ^ Caliandro, Pietro; La Torre, Giuseppe; Padua, Roberto; Giannini, Fabio; Padua, Luca (2016-11-15). Cochrane Neuromuscular Group (ed.). "Treatment for ulnar neuropathy at the elbow". Cochrane Database of Systematic Reviews. 2016 (11): CD006839. doi:10.1002/14651858.CD006839.pub4. PMC 6734129. PMID 27845501.
  13. ^ Frontera, Walter R.; Silver, Julie K.; Rizzo, Thomas D. Jr. (2014-09-05). Essentials of Physical Medicine and Rehabilitation. Elsevier Health Sciences. p. 135. ISBN 9780323222723. Retrieved 23 July 2016.

Further reading edit

  • "NIOSHTIC-2 Publications Search - 20045060 - Do comorbid ulnar symptoms or ulnar neuropathy affect the prognosis of workers with carpal tunnel syndrome?". www.cdc.gov. Retrieved 2016-07-22.
  • Yoon, Joon Shik; Walker, Francis O.; Cartwright, Michael S. (1 February 2010). "Ulnar Neuropathy With Normal Electrodiagnosis and Abnormal Nerve Ultrasound". Archives of Physical Medicine and Rehabilitation. 91 (2): 318–320. doi:10.1016/j.apmr.2009.10.010. ISSN 0003-9993. PMC 2892824. PMID 20159139.
  • Warner, Mark A.; Warner, David O.; Matsumoto, Joseph Y.; Harper, Michel C.; Schroeder, Darrell R.; Maxson, Pamela M. (1 January 1999). "Ulnar Neuropathy in Surgical Patients". The Journal of the American Society of Anesthesiologists. 90 (1): 54–59. doi:10.1097/00000542-199901000-00009. ISSN 0003-3022. PMID 9915312. Retrieved 23 July 2016.

External links edit

 
Scholia has a topic profile for Ulnar neuropathy.

March 07, 2024
ulnar, neuropathy, disorder, involving, ulnar, nerve, caused, entrapment, ulnar, nerve, with, resultant, numbness, tingling, also, cause, weakness, paralysis, muscles, supplied, nerve, nerves, left, upper, extremity, ulnar, labeled, center, specialtyneurology,. Ulnar neuropathy is a disorder involving the ulnar nerve Ulnar neuropathy may be caused by entrapment of the ulnar nerve with resultant numbness and tingling 3 It may also cause weakness or paralysis of the muscles supplied by the nerve Ulnar neuropathyNerves of the left upper extremity Ulnar labeled at center SpecialtyNeurology SymptomsNumbness fingers 1 2 CausesNerve entrapment Tumor 2 Diagnostic methodCBC Urinalysis 2 TreatmentNSAIDs Surgery 2 Contents 1 Signs and symptoms 2 Causes 3 Pathophysiology 4 Diagnosis 5 Treatment 6 Prognosis 7 References 8 Further reading 9 External linksSigns and symptoms editIn terms of the signs symptoms of ulnar neuropathy trauma and pressure to the arm and wrist especially the elbow the medial side of the wrist and other sites close to the course of the ulnar nerve are of interest in this condition Many people complain of sensory changes in the fourth and fifth digits Rarely an individual actually notices that the unusual sensations are mainly in the medial side of the ring finger fourth digit Sometimes the third digit is also involved especially on the ulnar medial side The sensory changes can be a feeling of numbness or a tingling pain rarely occurs in the hand Complaints of pain tend to be more common in the arm up to and including the elbow area which is probably the most common site of pain in an ulnar neuropathy 1 2 Causes editAmong the causes of ulnar neuropathy are the following nbsp OlecranonOlecranon fractures 4 Distal humerus fractures 4 Medial epicondylar fractures 4 Valgus stress 4 Childhood supracondylar fracture 4 Transient occlusion brachial artery surgery 2 Subdermal contraceptive implant 2 Hemophilia 2 Tumor 2 Blunt injuries 2 Much more commonly ulnar neuropathy is caused by overuse of the triceps muscle and repetitive stress combined with poor ergonomics Overused and hypertonic triceps muscle causes inflammation in the tendon and adhesions with the connective tissue surrounding that tendon and muscle These in turn impinge on or trap the ulnar nerve Ulnar neuropathy resulting from repetitive stress is amenable to massage and can usually be fully reversed without cortisone or surgery 5 Center for Occupational and Environmental Neurology Baltimore MD has this to say Repetitive Strain Injuries RSI refers to many different diagnoses of the neck shoulder arm and wrist hand area usually associated with work related ergonomic stressors Other terms used for Repetitive Strain Injuries are overuse syndrome musculoskeletal disorders and cumulative trauma disorders Some of the more common conditions under these headings include Cubital Tunnel Syndrome compression of the ulnar nerve in the cubital tunnel at the elbow 6 Pathophysiology editIn regards to the pathophysiology of ulnar neuropathy the axon and myelin can be affected Within the axon fascicles to individual muscles could be involved with subsequent motor unit loss and amplitude decrease Conduction block means impaired transmission via a part of the nerve Conduction block can mean myelin damage to the involved area slowing of conduction or significant spreading out of the temporal profile of the response with axonal integrity is a hallmark of demyelination 2 7 Diagnosis edit nbsp Nerve conduction study Calculation of NCV Among the diagnostic procedures done to determine if the individual has ulnar neuropathy are but may not be limited to the following 2 8 9 Nerve conduction exam study Nerve Conduction Velocity is a measurements made in a nerve conduction exam 10 Physical exam Medical history X ray CBC Urinalysis MRI Ultrasound Histology studyUlnar nerve neuropathy at the elbow or the wrist can be assessed by testing for a positive Froment s sign Little finger abduction and adduction can be tested as well 11 Treatment editTreatment for ulnar neuropathy can entail NSAID non steroidal anti inflammatory medicines there is also the option of a cortisone injection Another possible option is splinting to secure the elbow a conservative procedure endorsed by some In cases where surgery is needed cubital tunnel release where the ligament of the cubital tunnel is cut thereby alleviating pressure on nerve can be performed 8 12 13 Treatment for the common occurrence of ulnar neuropathy resulting from overuse with no fractures or structural abnormalities is treatment massage ice and anti inflammatories Specifically deep tissue massage to the triceps myofascial release for the upper arm connective tissue and cross fiber friction to the triceps tendon medical citation needed Prognosis editIn terms of the prognosis of ulnar neuropathy early decompression of the nerve sees a return to normal ability function which should be immediate Severe cubital tunnel syndrome tends to have a faster recovery process in individuals below the age of 70 as opposed to those above such an age Finally revisional surgery for cubital tunnel syndrome does not result well for those individuals over 50 years of age 1 References edit a b c Ulnar Nerve Disorders Free Medical Information Patient Patient Retrieved 2016 07 23 a b c d e f g h i j k l Ulnar Neuropathy Clinical Presentation History Physical Examination Ulnar neuropathy at elbow emedicine medscape com Retrieved 2016 07 23 Ulnar nerve dysfunction MedlinePlus Medical Encyclopedia medlineplus gov Retrieved 2016 07 22 a b c d e Thatte Mukund R Mansukhani Khushnuma A 1 January 2011 Compressive neuropathy in the upper limb Indian Journal of Plastic Surgery 44 2 283 297 doi 10 4103 0970 0358 85350 ISSN 0970 0358 PMC 3193641 PMID 22022039 Chin DH Jones NF February 2002 Repetitive motion hand disorders Journal of the California Dental Association 30 2 149 60 doi 10 1080 19424396 2002 12223260 PMID 11883427 S2CID 24441458 Apprill P Schmitz JM Campbell WB Tilton G Ashton J Raheja S Buja LM Willerson JT August 1985 Cyclic blood flow variations induced by platelet activating factor in stenosed canine coronary arteries despite inhibition of thromboxane synthetase serotonin receptors and alpha adrenergic receptors Circulation 72 2 397 405 doi 10 1161 01 cir 72 2 397 PMID 2988822 Robertson Chad Saratsiotis John June 2005 A Review of Compressive Ulnar Neuropathy at the Elbow Journal of Manipulative and Physiological Therapeutics 28 5 345 doi 10 1016 j jmpt 2005 04 005 PMID 15965409 a b Ulnar Nerve Entrapment at the Elbow Cubital Tunnel Syndrome OrthoInfo AAOS orthoinfo aaos org Retrieved 2016 07 23 Benatar Michael 2007 11 06 Neuromuscular Disease Evidence and Analysis in Clinical Neurology Springer Science amp Business Media p 291 ISBN 9781597451062 Retrieved 23 July 2016 Nerve conduction velocity MedlinePlus Medical Encyclopedia medlineplus gov Retrieved 2016 07 23 Bertelli J A Tavares K E 2018 12 01 Little finger abduction and adduction testing in ulnar nerve lesions Hand Surgery and Rehabilitation 37 6 368 371 doi 10 1016 j hansur 2018 09 006 ISSN 2468 1229 PMID 30361046 S2CID 53101000 Caliandro Pietro La Torre Giuseppe Padua Roberto Giannini Fabio Padua Luca 2016 11 15 Cochrane Neuromuscular Group ed Treatment for ulnar neuropathy at the elbow Cochrane Database of Systematic Reviews 2016 11 CD006839 doi 10 1002 14651858 CD006839 pub4 PMC 6734129 PMID 27845501 Frontera Walter R Silver Julie K Rizzo Thomas D Jr 2014 09 05 Essentials of Physical Medicine and Rehabilitation Elsevier Health Sciences p 135 ISBN 9780323222723 Retrieved 23 July 2016 Further reading edit NIOSHTIC 2 Publications Search 20045060 Do comorbid ulnar symptoms or ulnar neuropathy affect the prognosis of workers with carpal tunnel syndrome www cdc gov Retrieved 2016 07 22 Yoon Joon Shik Walker Francis O Cartwright Michael S 1 February 2010 Ulnar Neuropathy With Normal Electrodiagnosis and Abnormal Nerve Ultrasound Archives of Physical Medicine and Rehabilitation 91 2 318 320 doi 10 1016 j apmr 2009 10 010 ISSN 0003 9993 PMC 2892824 PMID 20159139 Warner Mark A Warner David O Matsumoto Joseph Y Harper Michel C Schroeder Darrell R Maxson Pamela M 1 January 1999 Ulnar Neuropathy in Surgical Patients The Journal of the American Society of Anesthesiologists 90 1 54 59 doi 10 1097 00000542 199901000 00009 ISSN 0003 3022 PMID 9915312 Retrieved 23 July 2016 External links edit nbsp Scholia has a topic profile for Ulnar neuropathy Retrieved from https en wikipedia org w index php title Ulnar neuropathy amp oldid 1191689570, wikipedia, wiki, book, books, library,

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