Ulnar Neuropathy Sane Treatment Of A Crazy Bone

Ulnar Neuropathy Sane Treatment Of A Crazy Bone

Do you remember what it​ felt like when you banged your elbow on a​ hard surface and​ it​ sent shocks through your forearm and​ into your little finger? Not too pleasant, to​ be sure. But on the​ plus side, the​ unpleasantness was merely temporary and, for​ the​ time being, you remembered not to​ do that again.

The part of​ the​ nervous system responsible for​ this annoying symptom is​ the​ ulnar nerve, a​ peripheral nerve-bundle whose individual nerve-fibers originate in​ the​ spinal cord where it​ passes through the​ neck. the​ nerve-fibers run most of​ the​ length of​ the​ arm, including through the​ "ulnar groove" which you may know as​ the​ "funny bone" or​ "crazy bone."

Some people experience a​ more persisting impairment of​ the​ ulnar nerve called ulnar neuropathy. With "-pathy" as​ the​ medical suffix meaning illness or​ impairment, an​ "ulnar neuropathy" means an​ illness or​ impairment of​ the​ ulnar nerve. the​ ulnar nerve is​ vulnerable to​ injury or​ pinch in​ the​ ulnar groove for​ more than one reason. First, instead of​ being surrounded by soft, cushioning muscles and​ tendons, it​ is​ sandwiched between a​ layer of​ skin on its exterior surface and​ nothing but hard bone on its interior surface. Second, when the​ elbow bends, the​ ulnar nerve stretches because it​ has to​ take the​ long way around the​ elbow.

Like a​ telephone cable containing numerous wires, the​ ulnar nerve-bundle contains many individual nerve-fibers, some of​ which tell the​ muscles what to​ do and​ others of​ which carry messages back to​ the​ spinal cord and​ brain about sensations experienced by the​ skin and​ other tissues. So when the​ ulnar nerve is​ injured, both motor and​ sensory symptoms are possible. Most of​ the​ muscles of​ the​ hand receive their marching orders via the​ ulnar nerve, so when the​ ulnar nerve is​ out of​ whack, there can be weakness in​ hand muscles. the​ muscles that spread the​ fingers and​ those that straighten the​ middle joints of​ the​ ring and​ little fingers are often affected. Damage to​ the​ ulnar nerve also causes changes in​ sensation. the​ ring and​ little fingers can become numb, and​ so can the​ heel of​ the​ hand.

The ulnar nerve can come to​ harm in​ more than one way. for​ some people the​ problem might result from leaning on their elbows too much. This can compress the​ ulnar nerve within the​ ulnar groove. Granted, many people lean on their elbows without damaging their ulnar nerves, but like most things in​ medicine, an​ ulnar neuropathy is​ usually caused by a​ combination of​ factors, and​ it​ is​ likely that some people are more vulnerable than others based on their particular anatomies. of​ course, rearranging one's anatomy, as​ for​ example from a​ preceding elbow fracture, may also put one at​ risk for​ an​ ulnar neuropathy.

Another way to​ injure the​ ulnar nerve is​ by over-stretching it. in​ the​ author's clinical practice a​ thin, young lady with loose elbow-joints who worked as​ an​ emergency medical technician injured her ulnar nerves repeatedly while lifting heavy patients. for​ her, it​ was a​ problem that wouldn't go away, and​ she eventually changed professions.

Although, as​ discussed, the​ ulnar nerve at​ the​ elbow is​ especially vulnerable to​ injuries, it​ can also come to​ harm by getting compressed or​ pinched by nearby abnormal tissues. the​ usual culprits are tendons, ligaments, blood vessels, cysts and​ scars.

Sometimes, an​ ulnar neuropathy is​ the​ leading symptom of​ a​ "polyneuropathy," meaning that all the​ peripheral nerves in​ the​ body are somewhat impaired, but the​ ulnar nerve is​ the​ first one to​ cause symptoms noticeable to​ the​ affected individual. Polyneuropathy is​ not the​ result of​ injury, but can be seen in​ a​ variety of​ illnesses, including diabetes, alcoholism and​ also on an​ inherited basis.

Diagnosing an​ ulnar neuropathy starts with the​ story of​ the​ symptoms and​ a​ physician's examination. the​ physician might subsequently order nerve conduction testing which looks at​ the​ nerve and​ muscle electricity, and​ can determine the​ degree of​ impairment. Moreover, nerve conduction studies can also evaluate other nerves to​ see if​ the​ ulnar nerve is​ the​ only one impaired, or​ merely one of​ many.

What if​ a​ simple injury to​ the​ ulnar nerve at​ the​ elbow is​ diagnosed? What can be expected? Fortunately, the​ peripheral nerves have some capacity to​ heal themselves. So if​ the​ degree of​ nerve impairment is​ not too severe, conservative treatment is​ called for. Unfortunately, there are no conservative treatments that have been studied by good, randomized, controlled trials, a​ form of​ evaluation in​ which the​ outcome of​ a​ treated group of​ patients is​ compared to​ that of​ an​ untreated group. Randomized, controlled trials are the​ gold standard for​ deciding whether or​ not a​ treatment is​ effective, so in​ this case all we have to​ go on is​ "clinical judgment" and​ observation.

A typical conservative treatment consists of​ putting a​ sport-pad (not a​ medical brace) on the​ elbow with the​ foam covering the​ ulnar groove. This accomplishes two things. First, if​ the​ elbow gets leaned on, then the​ nerve is​ still protected. Second, a​ well-fitting pad also prevents excessive elbow-bending (including during sleep) that overstretches the​ nerve and​ re-injures it. in​ addition, eating nutritious, well-rounded meals, together with vitamins, gives the​ ulnar nerve the​ building-blocks it​ needs in​ order to​ make the​ best possible recovery.

If the​ nerve injury is​ severe, or​ fails to​ respond to​ conservative treatment, then surgery might be beneficial. When the​ nerve is​ tied up in​ scar tissue or​ compressed by nearby abnormal tissues, a​ simple release operation might suffice in​ which the​ nerve is​ freed up. Otherwise, in​ a​ procedure called "anterior transposition" the​ nerve is​ transferred out of​ the​ ulnar groove so it​ is​ out of​ harm's way from leaning on the​ elbow, and​ also gets to​ take to​ the​ short way around when the​ elbow is​ flexed.

Neurosurgical researchers at​ Radboud University Nijmegen in​ the​ Netherlands conducted a​ randomized, controlled trial of​ patients with ulnar neuropathy at​ the​ elbow in​ which half the​ patients received simple release surgery and​ the​ other half received anterior transposition. in​ this study there was no difference in​ outcomes between the​ two surgeries. About two-thirds of​ the​ patients in​ each group obtained an​ outcome that was considered either excellent or​ good. However, there were more complications in​ the​ patients receiving the​ anterior transposition procedure, so the​ results of​ this study favored the​ simple release approach.

(C) 2018 by Gary Cordingley

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