Ulnar Nerve Entrapment at the Elbow (Cubital Tunnel Syndrome)
Ulnar nerve entrapment happens when the ulnar nerve in the arm becomes compressed or irritated.
The ulnar nerve is among the 3 primary nerves within your arm. It travels from your neck down into your hand, and can be constricted in a number of places along the way, like beneath the collarbone or at the wrist. The most common place for compression of the nerve is behind the interior part of the elbow. Ulnar nerve compression at the elbow is referred to as "cubital tunnel syndrome."
Numbness and tingling within the hand and fingers are common symptoms of cubital tunnel syndrome. In many cases, symptoms may be managed with conservative solutions such as changes in activities and bracing. If conservative methods do not greatly improve your symptoms, or if the nerve compression is inducing muscle weakness or damage in your hand, your doctor may highly recommend surgery.
Certainly, it is essential to find a good Mexico, MO orthopedic doctor when handling a condition such as this. You need someone who is going to know what to search for and what treatment will be best for your specific case. Please consider Audrain Orthopaedics in Mexico, MO. They have the following info for you regarding ulnar nerve entrapment at the elbow.
At the elbow joint, the ulnar nerve goes through a tunnel of tissue (the cubital tunnel) which runs under a bump of bone at the inside of your elbow. This bony bump is called the medial epicondyle. The spot where the nerve runs under the medial epicondyle is commonly referred to as the "funny bone." At the funny bone the nerve is close to your skin, and knocking it induces a shock-like feeling.
The ulnar nerve runs behind the medial epicondyle on the interior of the elbow.
Beyond the elbow, the ulnar nerve travels under muscles on the interior of your forearm and into your hand on the side of the palm with the little finger. As the nerve enters the hand, it journeys through another tunnel (Guyon's canal).
The ulnar nerve gives feeling to the little finger and fifty percent of the ring finger. It also controls the majority of the little muscles within the hand that assist with fine movements, and some of the bigger muscles within the forearm that help you make a strong grip.
The ulnar nerve gives sensation (feeling) to the little finger and to 50 percent of the ring finger on both the palm and back side of the hand.
In many cases of cubital tunnel syndrome, the particular cause is not known. The ulnar nerve is most especially vulnerable to compression at the elbow because it must travel through a narrow space with hardly any soft tissue to protect it.
Common Causes of Compression
There are several things that can cause pressure on the nerve at the elbow joint:
- When you bend your elbow, the ulnar nerve should stretch around the boney ridge of the medial epicondyle. Because this stretching can irritate the nerve, keeping your elbow bent for extended periods or repeatedly bending your elbow can cause uncomfortable symptoms. For example, lots of people sleep with their elbows bent. This can easily aggravate symptoms of ulnar nerve compression and cause you to get up at night with your fingers asleep.
- In some individuals, the nerve moves out from behind the medial epicondyle when the elbow is bent. Over time, this sliding back and forth may irritate the nerve.
- Leaning on your elbow for long periods of time can put pressure on the nerve.
- Fluid accumulation in the elbow can cause swelling which may compress the nerve.
- A direct blow to the inside of the elbow joint may cause pain, electric shock sensation, and numbness in the little and ring fingers. This is commonly called "hitting your funny bone."
Some factors put you more at risk for building cubital tunnel syndrome. These include:
- Prior fracture or dislocations of the elbow
- Bone spurs/ arthritis of the elbow
- Swelling of the elbow joint
- Cysts around the elbow joint
- Repetitive or prolonged activities that require the elbow to be bent or flexed
For those in Central Missouri, cubital tunnel syndrome may cause an aching pain on the interior of the elbow. A lot of the symptoms, however, take place in your hand.
Sleeping with your elbow bent could worsen symptoms.
Numbness and tingling within the ring finger and little finger are common symptoms of ulnar nerve entrapment. Commonly, these symptoms come and go. They happen more often whenever the elbow is bent, like when driving or holding the phone. Some individuals get up at night because their fingers are numb.
The sensation of "falling asleep" in the ring finger and little finger, particularly when your elbow joint is bent can be another symptom you see. In some cases, it may be harder to move your fingers in and out, or to shape objects.
Weakening of the grip and hardship with finger coordination (such as typing or playing an instrument) might occur. These symptoms are typically seen in more extreme cases of nerve compression.
If the nerve is extremely compressed or has been compressed for a long time, muscle wasting in the hand may occur. When this takes place, muscle wasting can not be undone. Consequently, it is essential to see your physician if symptoms are severe or if they are much less severe but have been present for over 6 weeks.
There are several things you can do in your home in order to help ease symptoms. If your symptoms hinder normal activities or last more than a few weeks, make sure to schedule an appointment with your doctor.
- Avoid tasks that require you to keep your arm bent for long periods of time.
- If you utilize a computer regularly, make sure that your chair is not too low. Do not rest your elbow on the armrest.
- Stay away from leaning on your elbow or placing pressure on the interior of your arm. For example, do not drive with your arm resting on the open window.
- Keep your elbow straight at night when you are sleeping. This can be done by wrapping a towel around your straight elbow or wearing an elbow pad backwards.
Medical History and Physical Examination
Your doctor will take a look at your clinical history and overall health. He or she might also inquire about your work, your activities, and exactly what medications you are taking.
After going over your symptoms and medical history, your physician is going to examine your arm and hand to determine which nerve is compressed and where it is compressed. A few of the physical examination tests your doctor may do consist of:
- Tap over the nerve at the funny bone. If the nerve is irritated, this can induce a shock into the little finger and ring finger-- though this may happen when the nerve is normal also.
- Examine whether or not the ulnar nerve slides out of normal position when you bend your elbow.
- Move your neck, shoulder, elbow, and wrist to see if various positions cause symptoms.
- Check for feeling and strength in your hand and fingers.
X-rays. These imaging tests provide detailed images of dense structures, like bone. Most causes of compression of the ulnar nerve can not be seen on an x-ray. However, your physician might take x-rays of your elbow or wrist to look for bone spurs, arthritis, or other locations that the bone might be compressing the nerve.
Nerve conduction studies measure the signals traveling within the nerves of your arm and hand.
Nerves resemble "electrical cables" which travel through your body carrying messages in between your brain and muscles. Whenever a nerve is not working well, it takes too long for it to conduct.
In the course of a nerve conduction test, the nerve is stimulated in one place and the time it takes for there to be a reaction is gauged. A number of places along the nerve are going to be tested and the area where the response takes too long is very likely to be the location where the nerve is compressed.
Nerve conduction studies can also determine whether the compression is also causing muscle damage. During the test, small needles are positioned into some of the muscles that the ulnar nerve controls. Muscle damage is a sign of more serious nerve compression.
Unless your nerve compression has triggered a lot of muscle wasting, your doctor will probably first suggest nonsurgical treatment.
Non-steroidal anti-inflammatory medicines. If your signs and symptoms have barely begun, your doctor might recommend an anti-inflammatory medicine, such as ibuprofen, to help lessen swelling around the nerve.
Despite the fact that steroids, like cortisone, are quite effective anti-inflammatory medications, steroid injections are typically not utilized because there is a risk of damage to the nerve.
Bracing or splinting. Your physician might suggest a padded brace or split to use at night to keep your elbow in a straight position.
Nerve gliding exercises. Certain physicians believe that exercises to help the ulnar nerve slide through the cubital tunnel at the elbow and the Guyon's canal at the wrist may improve symptoms. These exercises could also help prevent stiffness within the arm and wrist.
Your physician may suggest surgery to take pressure off of the nerve if:
- Nonsurgical methods have not improved your condition
- The ulnar nerve is extremely compressed
- Nerve compression has created muscle weakness or damage
There are a few surgical procedures which will relieve pressure on the ulnar nerve at the elbow. Your orthopaedic surgeon will speak with you about the option which would be best for you.
These procedures are most frequently done on an outpatient basis, but some patients do best with an overnight stay at the hospital.
Cubital tunnel release. In this operation, the ligament "roof" of the cubital tunnel is cut and divided. This increases the size of the tunnel and reduces pressure on the nerve.
After the procedure, the ligament starts to heal and new tissue grows across the division. The new growth mends the ligament, and allows more space for the ulnar nerve to slide through.
Cubital tunnel release tends to work best when the nerve compression is mild or moderate and the nerve does not slide out from behind the bony ridge of the medial epicondyle whenever the elbow joint is bent.
Ulnar nerve anterior transposition. In many cases, the nerve is moved from its place behind the medial epicondyle to a new place in front of it. Relocating the nerve to the front of the medial epicondyle prevents it from becoming caught on the bony ridge and stretching when you bend your elbow. This procedure is called an anterior transposition of the ulnar nerve.
For anterior transposition of the ulnar nerve, an incision is made along the interior of the elbow or along the back side of the elbow.
The nerves may be moved to lie below the skin and fat but atop the muscle (subcutaneous transposition), or within the muscle (intermuscular transposition), or beneath the muscle (submuscular transposition).
Medial epicondylectomy. Another option to release the nerve is to remove part of the medial epicondyle. Like ulnar nerve transposition, this procedure also prevents the nerve from getting caught on the boney ridge and stretching whenever your elbow is bent.
Depending on the kind of surgery you have, you may need to wear a splint for a couple of weeks after the operation. A submuscular transposition ordinarily requires a longer time (3 to 6 weeks) in a splint.
Your surgeon might recommend physical therapy exercises to help you regain strength and motion in your arm. He or she will also converse with you regarding when it will be safe to return to all of your normal activities.
The results of surgical treatment are normally good. Each method of surgery has a comparable success rate for routine cases of nerve compression. If the nerve is quite badly compressed or if there is muscle wasting, the nerve may not have the ability to go back to normal and some symptoms may remain after the surgery. Nerves recover slowly, and it might take a long period of time to know how well the nerve will do following surgery.
When it comes down to it, having a physician who knows what they're doing is one of the absolute most crucial factors whenever it pertains to recovery from Cubital Tunnel Syndrome in Mexico, Moberly, and Columbia, Missouri. Please arrange an appointment with Audrain Orthopaedics to see what they can do for your orthopaedic health condition.