Edit concept Question Editor Create issue ticket

Ulnar Neuropathy

Ulnar Nerve Dis

Ulnar neuropathy is a general term primarily referring to any disease associated with ulnar nerve entrapment. Patients suffering from ulnar neuropathy may present with neuropathic pain as well as sensory and motor deficits in dependent areas of their forearm, wrist or hand.


Presentation

As has been implied above, UNP may refer to a variety of conditions that share common features: affected individuals often claim pain, motor deficits, and sensory alterations. Of note, intense pain may limit mobility and thus mimic motor dysfunctions such as reduced grip strength. Sensory deficits may comprise, but are not limited to, numbness, paresthesias, and dysesthesias. Determined arm positions and movements such as extension, flexion, or rotation, may exacerbate complaints. The palpation of compromised segments may elicit pain. Extensive knowledge regarding the anatomical structures innervated by the UN, their position and function, are required to associate a clinical picture of upper limb neuropathy with lesions of the UN. To this end, the following disorders should be considered:

These categories are not mutually exclusive. For instance, space-occupying lesions may exert mass effects and trigger compressive entrapment of the UN [9].

Constitutional Symptom
  • We present a case of multiple large juxta-articular painless masses involving both the elbows and right hip in a 27-year old south Asian male who presented with ulnar neuropathy and constitutional symptoms.[ncbi.nlm.nih.gov]
Musculoskeletal Pain
  • Practical, clinically relevant material facilitates the diagnosis and treatment of musculoskeletal, pain, and chronic disabling conditions.[books.google.com]
Short Extremities
  • In short, extreme care must be taken when creating a fasciodermal sling during anterior subcutaneous transposition of the ulnar nerve.[ncbi.nlm.nih.gov]
Distractibility
  • Both 3D qualitative and quantitative analyses were used to assess the presence of nerve 'kinking', displacing the nerve from its normal course and causing nerve compression/distraction in the distal forearm and Guyon's canal.[ncbi.nlm.nih.gov]
Waardenburg Syndrome
  • Variations in the medial triceps in conjunction with bilateral ulnar neuropathy have been identified in three generations of one family also possessing the phenotype of Waardenburg syndrome (a rare autosomal-dominant disorder with clinical features including[ncbi.nlm.nih.gov]
Numbness of the Hand
  • The main symptoms are pain and numbness in your ring finger and little finger, as well as a general weakness and numbness in the hand that can make it hard to grip things securely.[irwinmitchell.com]
  • Curious if any of this sounds familiar. 07-13-2012 #17 I have also had issues with numbness in the hands in addition to minor issues with muscle tightness and associated strain in the lower back.[forums.roadbikereview.com]
  • If you have thickness or nodules in your hands or fingers, color change in your hands and fingers that is not due to weather, or tingling and numbness in your hands and fingers, you may have a serious condition.[carpaltunnelpros.com]

Workup

The diagnosis of UNP is based on anamnestic and clinical data. Results obtained in a general examination may also indicate an underlying pathology, but additional diagnostic measures are usually required to identify the primary disorder. In this context, diagnostic imaging plays a primordial role: plain radiography is mainly carried out to assess osseous structures, but the UN cannot be visualized using this technique. Therefore, sonography is to be preferred [1]. For high-resolution images of soft tissues, magnetic resonance imaging may be conducted [10]. UN function may be assessed by means of nerve conduction tests, which are generally combined with electromyographic studies. Moreover, laboratory analyses of blood samples (blood counts, blood chemistry, immunohistochemical studies) are recommended and may reveal enhanced inflammatory parameters and the presence of autoantibodies, among other pathological alterations.

Neurophysiologic Abnormalities
  • Two groups with different electrophysiological abnormalities, namely: participants with pathological motor conduction velocity across the elbow and no other neurophysiological abnormality; participants with concomitant pathological motor conduction velocity[doi.org]

Treatment

  • AUTHORS' CONCLUSIONS: We found only two studies of treatment of ulnar neuropathy using conservative treatment as the comparator.[ncbi.nlm.nih.gov]
  • To determine the effectiveness and safety of conservative and surgical treatments in ulnar neuropathy at the elbow.[ncbi.nlm.nih.gov]
  • There is scant literature reporting the expected outcomes of the treatment of these injuries. This study examined the results of treatment in a series of these patients.[ncbi.nlm.nih.gov]
  • To review the anatomy, etiology, and symptoms associated with compressive ulnar neuropathy at the elbow and to discuss the diagnosis and treatment of this condition.[ncbi.nlm.nih.gov]
  • PURPOSE: The choice of surgical treatment for ulnar neuropathy at the elbow (UNE) remains controversial. A cost-utility analysis was performed for 4 surgical UNE treatment options.[ncbi.nlm.nih.gov]

Prognosis

  • CONCLUSIONS: NCS confirmation of ulnar neuropathy identified patients with a poorer prognosis regarding symptoms.[ncbi.nlm.nih.gov]
  • In terms of the prognosis of ulnar neuropathy early decompression of the nerve sees a return to normal ability (function), which should be immediate.[en.wikipedia.org]
  • Careful electrodiagnostic studies provide an accurate diagnosis, help localize the lesion site, exclude alternate diagnoses, reveal unsuspected diagnoses, determine pathophysiology of lesions, and assess severity, timeframe, and prognosis of lesions.[ncbi.nlm.nih.gov]
  • INTRODUCTION: In this study we aimed to identify prognostic factors of ulnar neuropathy at the elbow (UNE) and developed a scoring system to establish the prognosis.[ncbi.nlm.nih.gov]
  • As stated in The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and goal of the patient or client Common interventions[twinboro.com]

Etiology

  • PURPOSE: Patients with ulnar neuropathy of unclear etiology occasionally present with lesion extension from elbow to upper arm level on MRI.[ncbi.nlm.nih.gov]
  • ) to designate this variant, several synonyms have been used in the literature, leading to confusion and misleading conclusions concerning its traumatic etiologies and their consequences: (a) recurrent or habitual ulnar nerve luxation (or subluxation)[ncbi.nlm.nih.gov]
  • The clinical, radiologic, and electrodiagnostic abnormalities are reviewed, and the possible etiologies of ulnar neuropathy are discussed.[ncbi.nlm.nih.gov]
  • To review the anatomy, etiology, and symptoms associated with compressive ulnar neuropathy at the elbow and to discuss the diagnosis and treatment of this condition.[ncbi.nlm.nih.gov]
  • The etiology is also complex, due to the numerous potential causes of entrapment. Clinical examination, neurophysiological testing, and imaging are all used to support the diagnosis.[ncbi.nlm.nih.gov]

Epidemiology

  • Neuritic leprosy: epidemiology and therapeutic responsiveness. Lepr Rev 1992;63:263-268 [ Links ] 3. Shahani BT, Halperin JJ, Boulu P, Cohen J.[scielo.br]
  • Keywords: Adult, Comorbidity, Cubital Tunnel Syndrome, epidemiology, etiology, Cumulative Trauma Disorders, complications, epidemiology, Female, France, epidemiology, Humans, Incidence, Logistic Models, Male, Middle Aged, Musculoskeletal Diseases, classification[ncbi.nlm.nih.gov]
  • The epidemiology of reactions and nerve damage. Workshop proceedings. Leprosy research at the new millennium. Lepr Rev 2000;71(Suppl):S106-S110. [ Links ] 24. Van Brakel WH. Peripheral neuropathy in leprosy and its consequences.[scielo.br]
Sex distribution
Age distribution

Pathophysiology

  • CONCLUSION: Although we found significant differences in patterns of muscle bulk and strength between groups of UNE patients with different UNE pathophysiologies, in the majority of arms, neurologic examination could not reliably predict UNE pathophysiology[ncbi.nlm.nih.gov]
  • SIGNIFICANCE: Sonographic abnormalities may reflect secondary pathophysiological changes in segments adjacent to regions of nerve compression. Copyright 2014 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd.[ncbi.nlm.nih.gov]
  • Careful electrodiagnostic studies provide an accurate diagnosis, help localize the lesion site, exclude alternate diagnoses, reveal unsuspected diagnoses, determine pathophysiology of lesions, and assess severity, timeframe, and prognosis of lesions.[ncbi.nlm.nih.gov]
  • The aims of this review are to highlight personal experience and current knowledge of the rare position-related ulnar neuropathy, both from a clinical and anatomical-pathophysiological perspective, and to raise awareness about this rare but serious complication[ncbi.nlm.nih.gov]
  • NOTES: (1) neuropathy should be viewed as a broad definition as signs of nerve irritation/inflammation, and independently of the pathophysiology and etiology; (2) because no specific term exists in the international anatomic nomenclature (Nomina Anatomica[ncbi.nlm.nih.gov]

Prevention

  • Awareness of the association between acute ulnar neuropathy and chest tube placement will alert the physician to reposition the tube and prevent ongoing compression.[ncbi.nlm.nih.gov]
  • An early and accurate diagnosis of any form of hypermobility of ulnar nerve, informing patients about it, prevention of an ulnar nerve injury as well as compliance with ergonomic rules are essential to avoid development of occupational and non-occupational[ncbi.nlm.nih.gov]
  • Preventive measures and diligent health care are required for this category of worker.[ncbi.nlm.nih.gov]
  • To help prevent further injury and relieve symptoms, your doctor may prescribe a supportive splint for the wrist or elbow.[brain-surgeon.com.au]
  • Fortunately, with an adequate knowledge of surgical anatomy and types of procedures and positions in which the ulnar nerve is particularly vulnerable, and familiarity with measures to minimize the potential for neuropathy, this serious complication can be prevented[ncbi.nlm.nih.gov]

Summary

The ulnar nerve (UN) originates from the brachial plexus and descends along the medial side of the upper limb. Its proximal segment is embedded in the medial bicipital groove of the upper humerus, and more distally, the UN pierces through the medial intermuscular septum to reach the epicondylar groove located posterior to the medial epicondyle of the humerus. Here, the UN reaches its most superficial position, which is best illustrated by this well-known scenario: an unfortunate bump to the elbow may provoke a tingling sensation along the respective forearm and hand if the UN is struck. Subsequently, the UN enters the cubital tunnel, a fibro-osseous channel delimited by the medial epicondyle of the humerus (medially), the olecranon (laterally), the elbow joint capsule and medial collateral ligament (anteriorly), and Osborne's ligament (posteriorly) [1]. Distal to the elbow, the UN travels between the humeral and ulnar heads of the flexor carpi ulnaris muscle and above the flexor digitorum profundus muscle. In close proximity to the wrist, the UN divides into a superficial sensory and deep motor branch. On its way towards the fourth and fifth digit, the latter has to pass through the Guyon's canal (also referred to as ulnar canal), which extends over approximately 4 cm, from the pisiform to the hook of the hamate [2]. It is further confined by the flexor retinaculum of the carpal tunnel, pisohamate and palmar carpal ligament, palmaris brevis and abductor digiti minimi muscle.

The UN contains both motor and sensory nerve fibers and gives off branches to innervate the following structures:

  • Flexor carpi ulnaris and flexor digitorum profundus muscle (motor control)
  • Third and fourth lumbrical muscles, hypothenar muscles, palmar and dorsal interossei muscles, and adductor pollicis muscle (motor control)
  • Medial half of the palm, medial half of the back of the hand (sensation)
  • Fifth digit and ulnar side of the fourth digit (sensation)

Ulnar neuropathy (UNP) is a general term referring to lesions of the UN without specifying the site, degree, and cause of injury. Consequently, any of the aforementioned anatomical structures may be compromised. The precise clinical picture may allow to narrow down the possible sites of UN damage.

References

Article

  1. Choi SJ, Ahn JH, Ryu DS, et al. Ultrasonography for nerve compression syndromes of the upper extremity. Ultrasonography. 2015;34(4):275-291.
  2. Vezeridis PS, Yoshioka H, Han R, Blazar P. Ulnar-sided wrist pain. Part I: anatomy and physical examination. Skeletal Radiol. 2010;39(8):733-745.
  3. Hoogvliet P, Coert JH, Friden J, Huisstede BM. How to treat Guyon's canal syndrome? Results from the European HANDGUIDE study: a multidisciplinary treatment guideline. Br J Sports Med. 2013;47(17):1063-1070.
  4. Chen SH, Tsai TM. Ulnar tunnel syndrome. J Hand Surg Am. 2014;39(3):571-579.
  5. Rota E, Zavaroni D, Parietti L, et al. Ulnar entrapment neuropathy in patients with type 2 diabetes mellitus: an electrodiagnostic study. Diabetes Res Clin Pract. 2014;104(1):73-78.
  6. Beekman R, Slooff WB, Van Oosterhout MF, Lammens M, Van Den Berg LH. Bilateral intraneural perineurioma presenting as ulnar neuropathy at the elbow. Muscle Nerve. 2004;30(2):239-243.
  7. Kawanishi Y, Miyake J, Omori S, Murase T, Shimada K. The association between cubital tunnel morphology and ulnar neuropathy in patients with elbow osteoarthritis. J Shoulder Elbow Surg. 2014;23(7):938-945.
  8. Burakgazi AZ, Russo M, Bayat E, Richardson PK. Ulnar neuropathy with prominent proximal Martin-Gruber anastomosis. Int J Neurosci. 2014;124(7):542-546.
  9. Rohilla S, Yadav RK, Dhaulakhandi DB. Lipoma of Guyon's canal causing ulnar neuropathy. J Orthop Traumatol. 2009;10(2):101-103.
  10. Andreisek G, Crook DW, Burg D, Marincek B, Weishaupt D. Peripheral neuropathies of the median, radial, and ulnar nerves: MR imaging features. Radiographics. 2006;26(5):1267-1287.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2019-07-11 21:40