Ulnar nerve entrapment

The Ulnarisrinnensyndrom (synonyms sulcus ulnaris syndrome or cubital tunnel syndrome ) is a compression injury of the ulnar nerve at the elbow.

Ulnar nerve

The ulnar nerve ( " Ulnar Nerve " ) runs in the region of the elbow in an easily palpable groove ( sulcus ulnaris ) protected only by a little connective tissue in direct contact with the ulna and just under the skin. One can therefore easily locate by touch itself and usually trigger at a light touch, a tingling or burning sensation in the hand him. This region is very sensitive to pain even with light bumping, earning her the name " funny bone " has given (also called " funny bone ", " bones musician ", " little mouse "). In Austria often speak of " narrischen Ba ( foolish leg ) ".

Causes

Since the nerve at this point is so unprotected, he is prone to injury due to pressure and train. By repeated movements or constant stress it can cause irritation and damage to the nerve eventually come.

Symptoms

The nerve damage is manifested by numbness in the little finger, the outer side of the ring finger and the adjacent palm area of the corresponding arm. A motor can be a weakness of the muscles supplied in the affected hand muscle atrophy and eventually occur. This results in a restricted range of motion of the hand. Little finger and ring finger fall in flexion of the end joints in hyperextension of the metacarpophalangeal joint and the spreading of the fingers is difficult ( claw or claw hand ).

Diagnosis

The diagnosis can be a neurologist, although usually already set on the basis of symptom description, but clinical (examination of muscle strength and sensation of touch ) and electrophysiological studies, such as the measurement of nerve conduction velocities, are essential. The Froment 's sign is positive.

Differential Diagnosis

The differential diagnosis an injury to the ulnar nerve at the wrist ( Loge de Guyon syndrome) must be excluded.

Multiple and different localized effects on the nerves ( double crush syndrome ) is a cumulative effect attributed ( Upton 1973, Mackinnon 1992). A slight proximally localized pressure alone is not sufficient to cause damage to the sensitivity of the distal nerve shares against pressure increase significantly ( Simpson 1996). At the upper arm localized compression of the nerve are rare and can be triggered by a processus supracondylar or Struthers arcade.

Treatment options

It is important for the patient to understand the triggering mechanism and a change in daily habits (End of the elbow on the window frame of the car, resting the elbow flexed, etc.). Parallel efforts must be made to bring with cushions or by splinting a pressure relief of nervous.

Only in chronic progressive symptoms and further surgery is necessary. A method laid the nerve from the bone trough towards the elbow in a more sheltered location. Simple and especially gentle is the cutting of the tissue surrounding the nerve in the region of the elbow. Wherein associated with the healing of the scar tissue itself and this pressure on the nerve extend decreases.

The surgical procedures are designed primarily to halting the further course of the syndrome. But the chances of a cure of the nerve are good. The acute symptoms, such as an unpleasant tingling sensation in the hand can, after quickly, but heavy sensitive restrictions may disappear after one year depending on the severity of the herniation.

The minimally invasive, endoscopic surgery of the nerves in Elle sulcus ulnaris syndrome (with only 2-3 cm instead of 10-12 cm long cut) is still a relatively new surgical technique that is still not very common, too, because she specialized instruments presupposes.