Ulnar Nerve Entrapment

Ulnar Nerve Entrapment

Ulnar Nerve Entrapment | Johns Hopkins Medicine

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The majority of cases of ulnar nerve entrapment occur as the result of repetitive stress to the elbow over a long period of time. This may happen due to:

Repetitive overuse of the elbow in a bent or flexed position, in cycling
Injuries to the elbow, such as fractures and dislocations

Ulnar nerve entrapment can also develop in individuals who suffer from medial epicondylitis (golfer’s elbow), and in some athletes, with ulnar collateral ligament injuries.

Ulnar nerve entrapment is common in these sports:

• Cycling• Golf

• Baseball

Symptoms generally develop gradually over time, and may include:

• Achiness on the inside of the elbow• Numbness and/or tingling in the ring and pinky fingers

• Weakness of the hand muscles

Your doctor will examine your elbow for signs of tenderness in the elbow over the ulnar nerve. He/she will also assess your range of motion, nerve sensation, and strength in the muscles that are controlled by the nerve. Your doctor may want to do nerve conduction studies to help him/her understand where the nerve is compressed, as well as to assess how well the nerve is functioning.

In order to make a diagnosis, your doctor may prescribe the following imaging tests:

• X-rays• MRI

• Electromyogram (EMG)

Initially, your doctor will prescribe conservative treatments to try to relieve your symptoms. These may include:

• Resting the affected arm• Icing the arm throughout the day• Nonsteroidal anti-inflammatory medications (NSAIDs) to relieve swelling

• Wearing a brace

You can also try these exercises at home to stretch and strengthen the muscles surrounding the elbow:

If your symptoms do not resolve with conservative treatments, or if there is more severe nerve damage as a result of the compression, you may need operative treatment. During surgery to relieve ulnar nerve entrapment, your doctor will remove the cause of compression. This may be a cyst, bone spur, or scar tissue. Once the tissue is removed, the nerve is able to regenerate and heal.

Recovery from ulnar nerve entrapment with conservative treatments may take up to six weeks. If you require surgery, it may take between four to five months for the nerve to heal completely. During this time, you will be asked to work with a physical therapist to regain range of motion and strength in the arm.

You can return to play upon instruction from your doctor. Permission to return to full activities is typically granted once you have regained full range of motion of the elbow with no pain and no weakness in the hand. It may take up to one year for your sensation to fully return.

Source: https://upswinghealth.com/conditions/ulnar-nerve-entrapment/

Ulnar Nerve Entrapment (Cubital Tunnel Syndrome)

Ulnar Nerve Entrapment | Johns Hopkins Medicine

Cubital Tunnel Syndrome is a condition characterized by compression of the ulnar nerve in an area of the elbow called the cubital tunnel.

The ulnar nerve travels down the back of the elbow behind the bony bump called the medial epicondyle, and through a passageway called the cubital tunnel. The cubital tunnel is a narrow passageway on the inside of the elbow formed by bone, muscle, and ligaments with the ulnar nerve passing through its center. The roof of the cubital tunnel is covered with a soft tissue called fascia.

When the elbow is bent, the ulnar nerve can stretch and catch on the bony bump. When the ulnar nerve is compressed or entrapped, the nerve can tear and become inflamed leading to a variety of symptoms, called cubital tunnel syndrome.

Signs and Symptoms

In general, signs and symptoms of Cubital Tunnel Syndrome arise gradually, progressing to the point where the patient seeks medical attention. Left untreated, Cubital Tunnel Syndrome can lead to permanent nerve damage in the hand. Commonly reported symptoms associated with Cubital Tunnel Syndrome include:

  • Intermittent numbness, tingling, and pain to the little finger, ring finger, and the inside of the hand. These symptoms occur more frequently at night, and with elbow bending or prolonged resting on the elbow.
  • Aching pain to the inside of the elbow
  • Weakness in hand with diminished grip strength
  • Diminished sensation and fine motor control in the hand causing the person to drop objects or have difficulty in handling small objects.
  • Muscle wasting in the hand and permanent nerve damage, if left untreated.

Causes

The common causes responsible for cubital tunnel syndrome, include:

  • Trauma
  • Repetitive motion
  • Frequent pressure on the elbow for extended periods due to sitting posture
  • Medical Conditions such as bone spurs, ganglion cysts, or tumors in the cubital tunnel leading to pressure and irritation of the ulnar nerve.

Diagnosis

Your physician will perform the following:

  • Medical History
  • Physical Examination

Your physician may order X-ray and electro diagnostic tests such as electromyography and nerve conduction studies. These tests can assist your doctor in determining how well the nerve is functioning and locate areas of muscle wasting and nerve compression.

Treatment

Your physician will recommend conservative treatment options initially to treat the symptoms unless muscle wasting or nerve damage is present.

Conservative treatment options may include:

  • Avoid frequent bending of the elbow.
  • Avoid pressure to the elbow by not leaning on it. Elbow pads may be worn to decrease pressure when working at a desk.
  • Wear a brace or splint at night while sleeping to keep the elbow in a straight position.

    You can also wrap the arm loosely with a towel and apply tape to hold in place.

  • Avoid activities that tend to bring on the symptoms.
  • NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) such as ibuprofen or aspirin may be ordered to reduce swelling.

  • Referral to OT (Occupational Therapy) for instruction in strengthening and stretching exercises may be recommended.

If conservative treatment options fail to resolve the condition or if muscle wasting or severe nerve compression is present, your surgeon may recommend a surgical procedure to treat your condition.

The goal of Cubital Tunnel surgery is to reduce the pressure on the ulnar nerve by providing more space for the nerve to move freely and to increase blood flow to promote healing of the ulnar nerve. There are different surgeries that can be performed to treat your condition, such as:

  • Medial Epicondylectomy: This surgery involves removing the medial epicondyle, the bony bump on the inside of the elbow, enabling the ulnar nerve to glide smoothly when the elbow is flexed and straightened.
  • Ulnar Nerve Transposition: This surgery involves creating a new tunnel in front of the medial epicondyle and transposing (moving) the ulnar nerve to the new tunnel.

Your surgeon will decide which options are best for you depending on your specific circumstances.

Post-Operative Care

After surgery, your surgeon will give you guidelines to follow depending on the type of repair performed and the surgeon's preference. Common post-operative guidelines include:

  • A bulky dressing with a plaster splint is usually applied following surgery for 10-14 days.
  • Elevating the arm above heart level and moving the fingers are important to prevent swelling.
  • The arm dressing is removed after 10-14 days for removal of the sutures.
  • Elbow immobilization for 3 weeks after surgery is usually indicated, longer depending on the repair performed.
  • Ice packs are applied to the surgical area to reduce swelling. Ice should be applied over a towel to the affected area for 20 minutes every hour. Keep the surgical incision clean and dry. Cover the area with plastic wrap when bathing or showering.
  • Occupational Therapy will be ordered a few weeks after surgery for strengthening and stretching exercises to maximize use of the hand and forearm

Risks and Complications

The majority of patients suffer no complications following Cubital Tunnel surgery, however, complications can occur following elbow surgery and include:

  • Infection
  • Nerve damage causing permanent numbness around the elbow or forearm.
  • Elbow instability
  • Elbow flexion contracture
  • Pain at site of scar
  • Symptoms unresolved even after the surgery
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Source: https://www.swsportsmedicine.com/ulnar-nerve-entrapment-cubital-tunnel-syndrome-orthopaedics-specialist-southwest-texas.html