7 Mars 2017
The upper limb usually consists of numerous muscles that work in unison for us to be able to make movements we require. For this processes to work out properly, the muscles depend on the functioning of the nerves. The nerve of the hand also known as the ulnar nerve innervates the majority of the hand muscles intrinsically. As much as it is one of the most applicable nerves clinically due to its crucial role in hand functioning, it can get complications even with a slight injury.
Ulnar neuropathy is characterized by the feeling of constant tingling and numbness. This is because of the ulnar nerve that normally runs parallel to the ulna bone getting entrapped. The nerve is usually a medical cord extension of the brachial plexus. It supplies the forearm muscles with innervations hence.
This enables sensation of the ulnar aspect on the palm, as well as to the dorsal ulnar cutaneous. This kind of neuropathy is the 2nd most common in the upper extremity just after the median nerve entrapment.
The elbow and its surrounding areas prove to be the most common sites for entrapment of the ulnar nerve in an area named ‘cubital tunnel’. Also in the ulnar groove; near the wrist is the second most common site especially in the area surrounding the ‘canal of Guyon’. In some isolated cases, the entrapment can also occur in these two regions of the forearm, above the elbow or below the wrist.
The ulnar nerve has got three branches that play a role in innervation. One of these branches runs into the hand while the other two arise runs through the forearm.
1. Superficial branch - innervates the palmer
2. Palmer cutaneous branch - innervates the medical half skin of the palm
3. The dorsal cutaneous branch - innervates the medial one skin as well as half the fingers and the dorsal area
Any kind of injury to the ulnar nerve causes paralysis and denervation to most or all the muscles that get supply from the nerve. Often, patients experience tingling along the small finger and also at the ring finger. The affected patients also experience numbness in this particular finger. This is usually accompanied by some kind of weakness of the finger’s grip as well as intrinsic wasting.
This is one of the worst consequences of losing intrinsic muscle function. After the ulnar nerve has been divided between the wrist of the hand, only the flexor pollicis (the superficial head), as well as only two lumbricals, tend to function.
• A direct physical injury to the arm
• The nerve having been under intense pressure for a long time
• An illness affecting the general health of the body might also be a contributor in damaging the ulnar nerve
When managing this condition, the first option will always be to try a conservative non-surgical procedure. If it fails and the patient still experiences loss of function and progressive weakness, then a surgical procedure might be considered.
Physical therapy is often recommended as a conservative treatment method when trying to relieve its signs and symptoms of ulnar neuropathy.
NSAIDs such as ibuprofen are recommended when trying to relieve the pain. Corticosteroid injections at the affected part of the nerve pathway are also indicated. This provides relief for an extended period of time.
Over the years, severe surgical procedures have been done and their results seem to be highly satisfactory. Ulnar nerve decompression surgery divides the ligament which is a part of the cubital tunnel. After nerve decompression, there is more room for the ulnar nerve to pass through the tunnel, relieving the signs and symptoms. This surgical procedure is often performed as a minimally invasive procedure.