Post by Master Kim on Jul 12, 2015 20:38:51 GMT -5
Ulnar nerve entrapment - en.wikipedia.org/wiki/Ulnar_nerve_entrapment
Ulnar nerve entrapment is a condition where the ulnar nerve becomes trapped or pinched due to some physiological abnormalities.
Anatomy of Ulnar Nerve
Classification
Ulnar nerve entrapment is classified by location of entrapment. The ulnar nerve passes through several small tunnels and outlets through the medial upper extremity, and at these points the nerve is vulnerable to compression or entrapment—a so-called "pinched nerve". The nerve is particularly vulnerable to injury when there has been a disruption in the normal anatomy. The most common site of ulnar nerve entrapment is at the elbow, followed by the wrist.
Ulnar entrapment can also be classified by specific local causes, including:
- Problems originating at the neck: thoracic outlet syndrome, cervical spine pathology, tight anterior scalene muscles
- Problems originating in the chest: tight pectoralis minor muscles
- Brachial plexus abnormalities
- Elbow pathology: fractures, growth plate injuries, cubital tunnel syndrome, flexorpronator aponeurosis, arcade of Struthers[3]
- Forearm pathology: tight flexor carpi ulnaris muscles[4]
- Wrist pathology: fractures, ulnar tunnel syndrome, hypothenar hammer syndrome
- Artery aneurysms or thrombosis
- Other: Infections, tumors, diabetes, hypothyroidism, rheumatism, and alcoholism
Cubital tunnel syndrome
Cubital tunnel syndrome is used to describe ulnar nerve impingement along the cubital tunnel at the medial edge of the elbow. It is the most common location of nerve impingement in the elbow area.[5] The cubital tunnel is a channel which allows the ulnar nerve to travel over the elbow. It is bordered by the medial epicondyle of the humerus, the olecranon process of the ulna and the tendinous arch joining the humeral and ulnar heads of the flexor carpi ulnaris muscle.[6] Compression of the nerve may lead to a tingling or 'pins and needles' sensation along the 4th and 5th fingers of the hand. While most cases are minor and resolve spontaneously with time, chronic compression or repetitive trauma may cause more persistent problems. Commonly cited scenarios include:
- Sleeping with the arm folded behind neck, elbows bent.
- Pressing the elbows upon the arms of a chair while typing.
- Resting or bracing the elbow on the arm rest of a vehicle.
- Bench pressing.
- Intense exercising and strain involving the elbow.
Guyon's canal syndrome
Guyon's canal syndrome, or ulnar tunnel syndrome, refers to nerve compression affecting the ulnar nerve as it passes through an anatomical space in the wrist called Guyon's canal. It can present with either motor or sensory or mixed symptoms. A typical presentation consist of weakness of the 4th and 5th fingers of one hand; it may be described as a feeling of "pins & needles" that may progress to decreased sensation in those same fingers or a burning pain in the wrist. This form of ulnar entrapment has been associated local trauma, fractures, ganglion cysts, avid cyclists who experience repetitive trauma against bicycle handlebars.[9] Ulnar nerve entrapment has been described as part of two work-related syndromes: so-called "hypothenar hammer syndrome," seen in workers who repetitively use a hammer, and "occupational neuritis" due to hard, repetitive compression against a desk surface.
Signs and symptoms
In general, ulnar neuropathy will result in symptoms affecting the fourth and fifth —the ring & pinky—fingers, as well as various intrinsic muscles of the hand. Proximally, the ulnar nerve consists of a "mix" of both sensory and motor innervation, more distally separating into distinct motor and sensory branches in the hand. Thus, symptoms of ulnar nerve entrapment are variably either motor, sensory, or a mixture of both depending on which part of the nerve is affected. Motor symptoms are weakness in muscles normally controlled by ulnar nerve. Sensory symptoms or paresthesias include numbness or tingling in the areas of the hand that receive sensory input via the ulnar nerve.
Compression at the elbow, known as cubital tunnel syndrome, causes numbness in the 5th (pinky) finger, along the half (lengthwise) of the 4th (ring) finger closest to the 5th finger, and the back half of the hand over the 5th finger. Initially, the numbness is transient and primarily occurs in the middle of the night or in the morning. The sensation is similar to hitting one's "funny bone," but lasts a bit longer. Over time, the numbness is there all of the time, and weakness of the hand sets in. The "ulnar claw," or a position where the small and ring fingers curl up, occurs late in the disease and is a sign the nerve is severely affected.
The claw hand is worse for Guyon canal stenosis, or nerve compression at the wrist. This is an example of the ulnar paradox. Also, if the nerve is compressed at the wrist, the back of the hand will have normal sensation.
Ulnar nerve entrapment is a condition where the ulnar nerve becomes trapped or pinched due to some physiological abnormalities.
Anatomy of Ulnar Nerve
Classification
Ulnar nerve entrapment is classified by location of entrapment. The ulnar nerve passes through several small tunnels and outlets through the medial upper extremity, and at these points the nerve is vulnerable to compression or entrapment—a so-called "pinched nerve". The nerve is particularly vulnerable to injury when there has been a disruption in the normal anatomy. The most common site of ulnar nerve entrapment is at the elbow, followed by the wrist.
Ulnar entrapment can also be classified by specific local causes, including:
- Problems originating at the neck: thoracic outlet syndrome, cervical spine pathology, tight anterior scalene muscles
- Problems originating in the chest: tight pectoralis minor muscles
- Brachial plexus abnormalities
- Elbow pathology: fractures, growth plate injuries, cubital tunnel syndrome, flexorpronator aponeurosis, arcade of Struthers[3]
- Forearm pathology: tight flexor carpi ulnaris muscles[4]
- Wrist pathology: fractures, ulnar tunnel syndrome, hypothenar hammer syndrome
- Artery aneurysms or thrombosis
- Other: Infections, tumors, diabetes, hypothyroidism, rheumatism, and alcoholism
Cubital tunnel syndrome
Cubital tunnel syndrome is used to describe ulnar nerve impingement along the cubital tunnel at the medial edge of the elbow. It is the most common location of nerve impingement in the elbow area.[5] The cubital tunnel is a channel which allows the ulnar nerve to travel over the elbow. It is bordered by the medial epicondyle of the humerus, the olecranon process of the ulna and the tendinous arch joining the humeral and ulnar heads of the flexor carpi ulnaris muscle.[6] Compression of the nerve may lead to a tingling or 'pins and needles' sensation along the 4th and 5th fingers of the hand. While most cases are minor and resolve spontaneously with time, chronic compression or repetitive trauma may cause more persistent problems. Commonly cited scenarios include:
- Sleeping with the arm folded behind neck, elbows bent.
- Pressing the elbows upon the arms of a chair while typing.
- Resting or bracing the elbow on the arm rest of a vehicle.
- Bench pressing.
- Intense exercising and strain involving the elbow.
Guyon's canal syndrome
Guyon's canal syndrome, or ulnar tunnel syndrome, refers to nerve compression affecting the ulnar nerve as it passes through an anatomical space in the wrist called Guyon's canal. It can present with either motor or sensory or mixed symptoms. A typical presentation consist of weakness of the 4th and 5th fingers of one hand; it may be described as a feeling of "pins & needles" that may progress to decreased sensation in those same fingers or a burning pain in the wrist. This form of ulnar entrapment has been associated local trauma, fractures, ganglion cysts, avid cyclists who experience repetitive trauma against bicycle handlebars.[9] Ulnar nerve entrapment has been described as part of two work-related syndromes: so-called "hypothenar hammer syndrome," seen in workers who repetitively use a hammer, and "occupational neuritis" due to hard, repetitive compression against a desk surface.
Signs and symptoms
In general, ulnar neuropathy will result in symptoms affecting the fourth and fifth —the ring & pinky—fingers, as well as various intrinsic muscles of the hand. Proximally, the ulnar nerve consists of a "mix" of both sensory and motor innervation, more distally separating into distinct motor and sensory branches in the hand. Thus, symptoms of ulnar nerve entrapment are variably either motor, sensory, or a mixture of both depending on which part of the nerve is affected. Motor symptoms are weakness in muscles normally controlled by ulnar nerve. Sensory symptoms or paresthesias include numbness or tingling in the areas of the hand that receive sensory input via the ulnar nerve.
Compression at the elbow, known as cubital tunnel syndrome, causes numbness in the 5th (pinky) finger, along the half (lengthwise) of the 4th (ring) finger closest to the 5th finger, and the back half of the hand over the 5th finger. Initially, the numbness is transient and primarily occurs in the middle of the night or in the morning. The sensation is similar to hitting one's "funny bone," but lasts a bit longer. Over time, the numbness is there all of the time, and weakness of the hand sets in. The "ulnar claw," or a position where the small and ring fingers curl up, occurs late in the disease and is a sign the nerve is severely affected.
The claw hand is worse for Guyon canal stenosis, or nerve compression at the wrist. This is an example of the ulnar paradox. Also, if the nerve is compressed at the wrist, the back of the hand will have normal sensation.
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