Neuropathy - damage to the nerve of the elbow joint. Causes of neuropathy of the ulnar nerve and its treatment

Tingling in the fingers
Spread of pain to other areas
Numbness of fingers
Loss of sensation in the fingers
Pain in the elbow joint
Tingling in the palms
Difficulty bending the wrist
Pain when clenching the hand into a fist
Atrophy of the muscles of the hand
Weakness of the muscles of the hand
Tingling in the forearm
Brush in the form of a clawed paw
Difficulty bending fingers

Etiology
Classification
Symptoms
Diagnostics
Treatment
Prevention and prognosis

In the vast majority of cases, an injury to the arm, forearm or shoulder leads to the onset of the disease. In addition, there are a large number of other predisposing factors, both pathological and physiological.

Such a disease has a specific clinical picture, which is why there are no problems with establishing the correct diagnosis. The main symptoms are the inability to clench the hand into a fist, the lack of sensitivity in the fifth and fourth fingers, as well as the characteristic appearance of the hand.

The diagnosis can be confirmed with the help of instrumental examinations, which are necessarily preceded by a physical examination. The tactics of therapy can be medical, physiotherapeutic and surgical, but often the treatment is complex.

The International Classification of Diseases does not allocate a separate cipher for such a disease and classifies it in the category of "Injury to individual nerves", which has a code according to ICD-10 - G 50 - G 59.

The widespread occurrence of such an ailment lies in the fact that, due to its anatomical localization, the ulnar nerve is the most vulnerable place, compared, for example, with the radial or median nerve.

Often there is a traumatic mechanism for the development of the disease. Thus, the most common causes of the development of pathology are presented:

bruises of the upper limbs;
dislocation of the forearm;
supracondylar fracture of the shoulder;
fracture of the medial condyle of the shoulder;
forearm fracture;
fracture of the ulna of the isolated form;
dislocation of the hand;
fracture of the olecranon.

The above factors lead not only to traumatization of the nerve, but also to its compression in the cubital canal.

and osteodystrophy;
deforming form;
demyelinating pathologies - during their course, the destruction of the myelin sheath of the nerve that covers it occurs. This category of ailments includes multiple and concentric sclerosis, acute optic neuromyelitis and disseminated, as well as diffuse leukoencephalitis. In such situations, they talk about demyelinating neuropathy of the ulnar nerve;
radial joint;
aneurysms located near the joints;
swollen lymph nodes;
compression of this nerve by a neoplasm of any nature.

In addition to pathological predisposing factors, pathology often develops against the background of:

habits of constantly leaning on the elbow, in particular while talking on the phone;
regular and monotonous work with tools, for example, a screwdriver and pliers, tongs and hammers, as well as vibrating tools;
riding a bicycle or motorcycle, but only in situations of professional practice in the respective sports;
working conditions associated with the support of the elbows of the right and left hands on the desk, machine, as well as the side of the door on the machine;
prolonged stay under a dropper, in which the upper limb for a long period of time is fixed in an unbent position - while the nerve is amenable to compression.

Disease classification

In the medical field, only one division of the disease is used - according to the etiological factor. From this it follows that neuropathy of the ulnar nerve is:

post-traumatic- the disease often develops against the background of stretching, rupture or other damage to the ulnar nerve, which is due to the above predisposing factors;
compression- this should include cubital canal syndrome and Guyon's syndrome. The main source is nerve compression against the background of professional activity and various diseases. In such situations, the formation of inflammation, swelling and bone changes in the areas of passage of this nerve occurs.

Location of the ulnar nerve

Symptoms of the disease

The clinical signs of the disease will differ somewhat depending on the type of neuropathy. For example, with cubital canal syndrome, the symptoms will be as follows:

soreness in the area of the fossa of the elbow, which is located on the inner surface of the elbow. At the beginning of the course of the disease, the pain will be periodic, but as it progresses, it will be constant and intense;
irradiation of pain on the forearm, the fourth and fifth fingers (both in the palm and on the back), as well as on the ulnar edge of the hand (near the little finger);
tingling and other discomfort in the above areas;
violation of the susceptibility of the skin to external stimuli in the ulnar edge of the hand, the fourth and fifth fingers. It is worth noting that there is one distinguishing feature - first of all, sensitivity disappears in the little finger;
difficulty in the process of bending the hand and fingers;
the brush takes the form of a clawed paw;
an attempt to clench the hand into a fist causes pain, and the affected fingers do not press against the surface of the palm, and it is difficult or impossible to take them aside;
muscle atrophy, which is expressed in a decrease in the size of the hand, retraction of the interdigital spaces and a clearer protrusion of the bone. It is noteworthy that the rest of the affected limb and healthy hand have a normal appearance.

Symptoms of neuropathy of the ulnar nerve in cases of development of Guyon's canal syndrome practically do not differ from those described above, however, there are several characteristic differences:

pain and tingling are localized in the area of the wrist joint, on the palm, in the little finger and ring finger. The back region of the hand does not experience such signs;
increased pain only at night or with intense movements;
the disappearance of sensitivity is observed only in the area of \u200b\u200bthe fingers - there is no such sign on the back side;
weakness of flexion of diseased fingers, the inability to fully press them to the palm, difficulty in spreading and mixing them;
the development of atrophy and the formation of a "clawed" form of the hand.

In cases of incomplete neuropathy of the ulnar nerve, the clinical picture will include:

weakness of the muscles of the hand;
reducing the gap between the little finger and ring finger;
tingling in the palms;
numbness and sensory disturbances of the fifth finger, as well as the part of the fourth finger adjacent to it;
pain syndrome along the entire length of the ulnar nerve.

Diagnostics

If one or more of the above symptoms occur, it is necessary to consult a neurologist who will conduct primary diagnostic measures and prescribe the necessary instrumental examinations.

The first stage of diagnosis includes:

study of the medical history - to identify pathological predisposing factors;
collection and analysis of the patient's life history - to establish the physiological source of the pathology;
neurological examination - the patient is asked to clench his fingers into a fist, and also check reflexes with a special hammer;
a detailed survey - to determine the nature of the course and the severity of symptoms.

Laboratory studies of blood, urine and feces with neuropathy of the ulnar nerve have no diagnostic value.

The following instrumental procedures help to clarify the diagnosis:

electromyography and electroneurography;
radiography of the elbow joint, forearm and wrist joint;
Ultrasound of the ulnar nerve;
CT of the joints.

Ultrasound of the ulnar nerve

In addition, the clinician needs to conduct a differential diagnosis, during which neuropathy of the elbow joint is distinguished from:

neuropathy of the radial and median nerves;
radicular syndrome;
osteochondrosis and spondylarthrosis;
tunnel neuropathy.

Treatment of the disease

The tactics of how to treat the elbow completely depends on the etiological factor. For example, surgery has the following indications:

malignant or benign formations that compress the nerve;
formation of hematomas and scars;
failure of conservative therapy.

The operation scheme is selected individually for each patient, but can be carried out by:

nerve decompression;
neurolysis;
nerve transposition;
excision of the nerve tumor.

Medical treatment tactics involves taking:

anti-inflammatory drugs;
glucocorticoids;
painkillers;
anticholinesterase;
vasoactive drugs;
vitamin complexes and metabolites.

Therapy with drugs is necessarily supplemented by physiotherapy, namely:

magnetotherapy;
phonophoresis;
electromyostimulation.

After stopping inflammation, a course of therapeutic massage and exercise therapy is indicated. With neuropathy of the ulnar nerve, treatment with gymnastics involves the following exercises:

pressing with a healthy hand on the middle phalanges of the affected fingers until they are fully extended;
alternate abduction of any finger of the diseased hand, with the help of a healthy one - it is recommended to start with the thumb;
alternately lower and raise the fingers of the affected limb;
making circular movements with fingers;
capturing rubber objects of various sizes in water and squeezing them.

A complete list of classes can only be provided by the attending physician.

In total, treatment takes from three months to six months.

Prevention and prognosis

To reduce the likelihood of developing problems with the elbows, or rather, with their nerves, you must:

abandon monotonous movements of the upper limbs, if this is not related to work;
avoid physical overexertion;
regularly perform gymnastics for the upper limbs, especially under specific working conditions;
constantly take vitamin complexes - to improve the condition of nerve fibers;
from time to time undergo a course of therapeutic massage or acupuncture;
prevent fractures and other injuries of the arms, elbows, shoulders and forearms;
several times a year to undergo a complete medical examination - to identify diseases that can lead to the occurrence of such an ailment.

The prognosis of the disease directly depends on the timing of the start of treatment and the etiology of damage to the ulnar nerve. If the problem was diagnosed in the early stages of progression, and the therapy was complex, then the neuropathy of the elbow joint is successfully treated and passes without a trace.

What to do?
If you think that you have Ulnar nerve neuropathy and symptoms characteristic of this disease, then a neurologist can help you.

A lesion of different etiology n. ulnaris, accompanied by a violation of its sensory and motor function. It is manifested by weakness when trying to clench the hand into a fist and hold objects with the brush, lack of sensitivity of the skin of the V and partially IV fingers, atrophy of the hypotenor and small muscles of the hand, the appearance of the hand, similar to a clawed paw. In the diagnosis of ulnar neuropathy, they rely on the results of a neurological examination, electrophysiological testing, radiography of bones and joints. Therapeutic tactics are built taking into account the genesis of neuropathy and may include both medication and physiotherapy methods, as well as surgical treatment.

General information

Ulnar neuropathy is a fairly common lesion of the peripheral nervous system. It often accompanies injuries to the elbow joint area, and therefore it occurs not only in the practice of neurologists, but also in the field of traumatology.

The anatomical location of the ulnar nerve is such that the most vulnerable place is its site, which is localized in the area of the elbow joint in the so-called. cubital (ulnar) canal. The symptom complex of compression of the ulnar nerve in this canal is called cubital canal syndrome in neurology. Among all neuropathies of compression genesis, it ranks second (the first belongs to carpal tunnel syndrome, one of the variants of median nerve neuropathy).

Anatomy of the ulnar nerve

The nerve originates in the medial bundle (C7-C8, Th1) of the brachial plexus. Without giving off branches, it passes along the inner side of the shoulder, then passes to its postero-medial surface. In the area of the elbow joint, it runs along the posterior surface of the internal epicondyle of the shoulder, where it is actually located subcutaneously. Then it enters the cubital canal formed by the olecranon, internal epicondyle, ligament and tendons of the muscles of the forearm.

Elbow to wrist n. ulnaris runs along the medial edge of the inner surface of the forearm. Here it gives motor branches to the medial portion of the finger flexor muscle and the ulnar flexor of the wrist. At the head of the ulna, the nerve gives off a dorsal branch that innervates the skin of the ulnar side of the rear of the hand, the back surface of the V, IV, and partially III fingers. Passing to the palm, n. ulnaris is divided into superficial and deep branches. The first is responsible for the sensory perception of the skin of the little finger and the half of the ring finger facing it. The second - for the innervation of the muscles of the hypotenor and small muscles of the hand, as well as the joints, ligaments and bones of the hand. After departing from the ulnar nerve, the deep branch passes in Guyon's canal, located between the pisiform bone and the metacarpal palmar ligament.

Causes of neuropathy of the ulnar nerve

The most common mechanisms for the development of ulnar neuropathy are traumatic nerve injury and its compression in the cubital canal. Nerve injury may be accompanied by: bruised arm, dislocation of the forearm, supracondylar fracture of the shoulder, fracture of the medial condyle of the shoulder, fracture of the forearm, isolated fracture of the ulna or fracture of the olecranon, dislocation of the hand. Cubital tunnel syndrome often occurs in people who are used to relying on their elbow. For example, lean with your elbow on a desk, a machine tool, a side of a door in a car, etc.

Nerve compression in the cubital canal and Guyon's canal is possible with inflammatory or anatomical changes in the structures that form these canals. So, compression neuropathy of the ulnar nerve can be observed with osteoma, sprain, synovitis, tendovaginitis, deforming osteoarthritis, rheumatoid arthritis, osteodystrophy, bursitis of the elbow joint, post-traumatic arthrosis of the wrist joint and other diseases. To provoke ulnar neuropathy at the level of Guyon's canal is the work associated with prolonged pressure of tools (screwdrivers, hammers, scissors, forceps, etc.) on this area.

Symptoms of neuropathy of the ulnar nerve

Defeat n. ulnaris at the level of the cubital canal is characterized by weakness in the hand, which manifests itself when you try to take something in your hand (for example, pick up a kettle from the stove), play the piano, type on the keyboard, etc. Sensory disturbances are manifested by a feeling of numbness of the little finger, partially the ring finger and ulnar edge of the palm. A typical feeling of discomfort in the area of the elbow joint, often - pain in it, radiating to the hand along the elbow edge of the forearm. Often, an increase in these symptoms is noted in the morning, which is associated with the habit of many patients to sleep with their hands under the pillow or under the head, which means bending them at the elbow joints.

On examination, attention is drawn to hypotrophy of the hypotenor and small muscles of the palm, the position of the fingers in the form of a clawed paw (the main phalanges are in the extension position, and the middle ones are bent).

Ulnar neuropathy in Guyon's canal has similar manifestations. The difference is the localization of the pain syndrome only in the area of the base of the hand and the hypotenor, the presence of sensory disorders exclusively on the palmar surface of the little finger and half of the ring finger, with full preservation of the sensitivity of the back of the hand.

Diagnosis of neuropathy of the ulnar nerve

In the acute period of neuropathy of the ulnar nerve, an important point is the exclusion/limitation of static and dynamic load, which enhances the pathological manifestations of the disease. Patients suffering from cubital tunnel syndrome are advised to bandage a rolled-up towel to the flexor surface of the elbow to limit bending of the arm at the elbow for the period of night sleep. Subsequently, when the inflammatory process subsides and the pain syndrome decreases, a special exercise therapy complex is prescribed.

The anatomical structure of some areas through which the ulnar nerve passes creates many prerequisites for its compression. Such places are the cubital canal (Mouchet's canal), formed by several structures in the area of the elbow joint, and Guyon's canal, formed in the wrist area. Compression of the nerve fibers in these areas leads to neuropathy of the ulnar nerve. These conditions are accompanied by a number of sensory disturbances and a decrease in the strength of some muscles of the hand.

Signs of neuropathy of the ulnar nerve depend on the place of compression. In this regard, two variants of the course of this disease are distinguished - cubital canal syndrome and Guyon's syndrome (ulnar wrist syndrome). Their manifestations are largely similar, but they also have characteristic features. In this article, we will acquaint you with the causes, main manifestations and methods of treatment of such neuropathies.

Causes

There are many reasons for the development of neuropathies of the ulnar nerve. They are conditionally divided into two groups:

Post-traumatic neuropathies. Nerve damage is caused by a sprain, tear, or tear caused by a lateral dislocation of the elbow, subluxation of the elbow, or dislocation of the elbow with a fracture of the olecranon.
Compression neuropathies (cubital canal syndrome and Guyon's syndrome). Nerve compression can be caused by some professional skills or habits, as well as by various diseases accompanied by inflammation, swelling or bone changes in the nerve passage areas.

Nerve compression in the cubital canal can be provoked by:

long-term intravenous infusions (droppers);
the habit of leaning your hand on the surface of the table during a long telephone conversation;
frequent movements in the elbow joint;
work in which the elbow rests on a machine, office table or other object for a long time;
the habit of motorists to lean on the edge of an open window.

Nerve compression in Guyon's canal can be provoked by:

prolonged use of a cane;
frequent driving of a motorcycle or bicycle;
work associated with the frequent use of various tools (pliers, screwdrivers, jackhammers, drills or other vibrating devices).

In addition to these factors, compression neuropathy can be caused by such diseases and conditions:

tumors;
aneurysms of nearby vessels;
deformities of bones or connective tissue in the area of the elbow joint after a fracture;
, chondromatosis and chondromalacia;
synovial cysts and tendon sheath thickening in tenosynovitis.

Symptoms

Symptoms of cubital tunnel syndrome:

reduced sensitivity of the ulnar edge of the hand, ring finger and little finger;
pain in the cubital fossa, spreading to the forearm, ulnar edge of the hand, ring finger and little finger, aggravated by movement in the elbow;
paresthesia in the cubital fossa, ring finger and little finger, forearm, ulnar edge of the hand;
motor disorders, expressed in muscle weakness, difficulty in abduction and flexion of the hand, flexion of the ring finger and little finger;

Symptoms of Guyon's canal syndrome:

reduced sensitivity of the ring finger and little finger from the side of their palmar surface (at the same time, sensitivity is preserved from the back side);
painful sensations of the ring finger and little finger from the side of their palmar surface, the ulnar edge of the hand and the wrist joint;
paresthesia in the palmar surface of the ring finger and little finger, wrist joint and ulnar edge of the hand;
movement disorders, expressed in weak flexion of the ring finger and little finger and difficulty in bringing and spreading the fingers, the thumb is not brought to the palm;
muscle atrophy and a change in its appearance (“clawed” or “bird” brush).

Diagnostics

In most cases, the diagnosis of neuropathies is not difficult. After questioning and examining the patient, the doctor conducts a tapping test. To do this, he lightly taps with a hammer on the places of possible compression of the nerve. If symptoms of compression - pain, paresthesia - are detected, the presence of neuropathy of the ulnar nerve is confirmed.

Electroneuromyography can be used to determine the area of damage to nerve fibers. The same method allows for differential diagnosis between neuropathy and damage to the nerve roots that emerge from the vertebral foramina and form its trunk.

If it is necessary to identify bone defects, the patient is prescribed X-ray or MRI. And to visualize the structural changes that occur in the nerve trunk at the entrance to the pinching canal, ultrasound is used.

Treatment

The choice of treatment for neuropathies of the ulnar nerve is largely determined by the causes of their development. When the nerve is torn as a result of fractures, an operation is performed to stitch it together. After that, the patient needs rehabilitation, which can take about six months. If the compression of the nerve is caused by other reasons, then the patient is prescribed conservative therapy, and surgical intervention is recommended only if medical and physiotherapeutic treatment is ineffective.

Conservative therapy

With compression of the ulnar nerve, it is recommended to wear fixing devices to limit compression during movement. For this, special orthoses, bandages or splints can be used. Some of them can only be used at night.

If the compression of nerve fibers is provoked by habits or movements that must be performed due to their professional activities, then the patient should completely abandon them. In addition, during treatment, it is necessary to avoid movements that cause increased pain or other symptoms.

To eliminate pain and signs of inflammation at the beginning of the disease are prescribed:

Indomethacin;
Diclofenac;
Nimesulide;
ibuprofen;
Meloxicam etc.

For local anesthesia, a Versatis medicinal patch containing Lidocaine can be used.

With severe edema, diuretic drugs (Furosemide), anti-edematous and anti-inflammatory agents (L-lysine aescinate) and capillary-stabilizing agents (Cyclo-3-fort) are used to reduce compression.

To improve the nutrition of the nerve, B vitamins are used:

Combilipen;
Neurorubin;
Milgamma;
Neurovitan etc.

In the absence of signs of elimination of the inflammatory reaction, instead of non-steroidal anti-inflammatory drugs, an injection into the cubital canal or Guyon's canal of a mixture of a solution of Hydrocortisone and a local anesthetic (Lidocaine or Novocaine) is prescribed. In most cases, this procedure eliminates the symptoms of neuropathy and has a lasting therapeutic effect.

Medical treatment of neuropathies is supplemented by physiotherapy procedures:

acupuncture;
electrophoresis with drugs;
ultrasound;
massage;
physiotherapy;
electromyostimulation.

Surgery

With the ineffectiveness of conservative therapy and severe cicatricial changes in the area where the nerve passes through the canals, surgical intervention is recommended. The purpose of such operations is to eliminate (cut and remove) structures that compress the ulnar nerve.

During compression in the cubital canal, its plasticity is performed, part of the epicondyle is removed and a new canal is created to move the nerve. In cases of Guyon's canal syndrome, a transection of the palmar carpal ligament is performed above the canal.

Performing a surgical operation allows you to release the nerve from compression, but additional treatment is prescribed to fully restore all its lost functions:

drugs - analgesics, drugs to improve the nutrition of the nerve and its conductivity, vitamins, diuretics;
physiotherapy procedures;
physiotherapy.

After the operation is completed, the patient's hand is immobilized with a splint or splint for 7-10 days. After its removal, the patient is allowed to perform passive movements. After 3-4 weeks, active movements are allowed, and only after 2 months can exercises with a load and throws be performed.

The duration of rehabilitation of the patient after such surgical interventions is about 3-6 months. The completeness of the restoration of nerve functions largely depends on the timeliness of the treatment started. In advanced cases, even surgical intervention does not allow for complete rehabilitation, and some violations of sensitivity and movement will accompany the patient throughout his life.

What is carpal tunnel syndrome?

Thank you

Tunnel syndrome as compression-ischemic neuropathy

Under definition tunnel syndrome combine a fairly large group of diseases of the peripheral nerve trunks caused by pinching of the nerves in one or another natural canal ( tunnels) formed by the bones, muscles and tendons of the human body.

Several dozen tunnel syndromes have been described. Some are very common for example, carpal tunnel syndrome in one form or another is found in 1% of the world's population), and some are extremely rare and known only to narrow specialists.

However, the reason for the development of all diseases, united under the name of tunnel syndrome, is the same - pathological seizure and a kind of strangulation of the nerve in its natural receptacle. Hence, another name for tunnel syndromes, born in English-speaking scientific medicine, is trapped neuropathy ( Entrapment neuropathy).

In addition to microtraumatization of the nerve during seizure, malnutrition of the nerve trunk plays an important role in the development of pathology. Hence another name - compression-ischemic neuropathy ( ischemia is a medical term for insufficient blood supply to an organ or tissue).

Tunnel syndromes of the hands are the most common, tunnel syndromes of the legs are much less common, tunnel syndromes of the trunk are a rather rare pathology. The disease most often develops at the age of 30 - 40 years. Women get sick several times more often than men.

Most carpal tunnel syndromes have a chronic course with gradual onset of symptoms that typically include pain and sensory and motor disturbances.

The detailed clinical picture consists of an intense pain syndrome, paresthesias ( crawling sensations on the skin, tingling, etc.), decreased sensitivity in the zone of innervation of the affected nerve trunk. Movement disorders in the form of flaccid paralysis and muscle hypotrophy join later. The exception is muscle bed syndromes, when damage to the motor part of the nerve manifests itself from the very beginning.

On palpation, most patients have severe pain in the area corresponding to the area of damage to the nerve trunk. Tinel's symptom has a high diagnostic value: with percussion ( tapping) of the affected area of the nerve, paresthesia and pain occur in the corresponding zone of innervation.

In controversial cases, to clarify the diagnosis, a test is performed with an injection of novocaine hydrocortisone, which is injected paraneurally into the area of \u200b\u200bthe alleged damage. A decrease in pain syndrome indicates that the affected area is defined correctly.

The root causes of tunnel syndromes

The leading role in the development of tunnel syndromes is played by chronic microtraumatization of the nerve trunk - professional, sports or household. That is why tunnel syndromes occur near the joints, where there is constant movement, and, therefore, there is a high probability of chronic traumatization.
In addition, the joints themselves are more often subjected to various types of pathological changes ( inflammatory, traumatic, degenerative), after which narrowing of the channels is possible.

A certain role is played by the fact that, as a rule, bone protrusions, tendon arches and other similar formations are located near the joints, contributing to nerve trauma in the tunnel.

Injuries to the nerve trunks can be caused by medical intervention. So, for example, with prolonged intravenous infusions, trauma to the ulnar nerve, sandwiched between the hard surface on which the hand rests, and the elbow joint is possible. Fixation of the hands in the area of the wrist joints in excited patients can lead to traumatic damage to the ulnar and median nerves.

Separately, it is necessary to highlight tunnel syndromes that occur when the rules for long-term administration of intramuscular injections are violated ( constantly in the same muscle). In such cases, nerve compression often occurs due to fibrosis and swelling of nearby tissues.

Some familiar postures also contribute to the capture and infringement of the nerve in the tunnel. So, when sitting in a pose, the leg, thrown over the knee, in the popliteal fossa, the peroneal nerve of the leg lying on top is clamped.

A causal relationship with various kinds of endocrine disorders is well traced. Tunnel syndromes often occur in women during pregnancy, lactation, and menopause. As contributing factors can be called acromegaly ( increased production of "growth hormone"), hypothyroidism ( decreased thyroid function), as well as long-term use of hormonal oral contraceptives.

Sometimes carpal tunnel syndrome occurs after prolonged fasting ( including medical) due to a sharp decrease in fatty tissue, which performs a shock-absorbing function.

Cases of "family" tunnel syndromes are described. Here there is a hereditary narrowness of the channels or a genetically determined increased vulnerability of the nervous tissue.
Many systemic diseases contribute to the occurrence of tunnel syndromes ( diabetes mellitus, rheumatoid arthritis), diseases of the corresponding joints, blood diseases ( myeloma), kidney failure, alcoholism.

muscle bed syndrome

Muscles in the human body are surrounded by fascial membranes that form a bed in which the vessels and nerves are located.
Muscle bed syndrome is a type of tunnel syndrome that occurs when a nerve is compressed due to a sharp increase in pressure inside the fascial sheath.
This pathology occurs infrequently, but requires emergency medical intervention, since extremely severe complications are possible, up to the death of the patient.

Muscle bed syndrome was first described as a complication of cast fracture treatment. Cases of the occurrence of this type of tunnel syndrome are described when splints, splints, and too tight bandages are applied. Other causes include thrombosis of internal veins, severe bruising, hemorrhage, edema, etc. Also, muscle bed syndrome can occur in diseases accompanied by convulsions or muscle hypertonicity: epilepsy, tetanus, eclampsia.

The mechanism of the development of pathology is based on a gross violation of blood circulation in tissues squeezed into the muscle bed. A detailed clinical picture develops, as a rule, 3-4 days after the action of a traumatic factor and includes: severe pain, fever, swelling, redness and soreness of the skin over the affected muscle bed, sensory disturbances in the area of the damaged nerve. In severe cases, necrosis of muscle tissue is possible with the development of acute renal failure ( roughly speaking, the kidney filter is clogged with decay products of muscle fibers that enter the blood), which is often fatal.

Urgent care includes removal of a splint or cast, fasciotomy ( surgical opening of the case), and in the presence of muscle necrosis - necrectomy ( excision of dead tissue). The limbs should be given an elevated position.

The anterior muscle bed of the lower leg is most often affected. This pathology is called anterior tibial syndrome. In this case, the musculoskeletal sheath contains three muscles of the anterior surface of the lower leg, which are responsible for the extension of the foot in the ankle joint, as well as for the extension of the toes. In addition, an artery, two veins and a deep peroneal nerve pass here. The high frequency of lesions is associated with the absence of collateral ( bypass) circulation. Therefore, in some cases, even increased physical activity can cause anterior tibial syndrome ( prolonged dancing, running or walking), which provoked edema with vascular compression. Often, acute ischemia is caused by thrombosis of the main vessels of the legs.

Clinically, anterior tibial syndrome is manifested by severe pain. At the same time, the anterior part of the lower leg is hyperimposed ( there is redness), edematous, dense and painful to the touch. Damage to the deep peroneal nerve is evidenced by gradually developing paralysis of the muscles that extensor the foot and toes, as well as a decrease or complete absence of sensitivity on the dorsum of the first interdigital space of the foot.

Carpal syndrome (wrist syndrome)

Overview of Carpal Tunnel Syndrome

Carpal syndrome accounts for about 50% of cases of all tunnel neuropathies. Its prevalence has recently been increasing annually, which is partly due to the increase in the number of people employed, predisposing to the development of this pathology ( work with computer mouse and keyboard). In about 40% of cases, both hands are affected. Most often women aged 50 - 60 years are ill.

Tunnel neuropathy in women develops more often due to many circumstances ( loosening of connective tissue during pregnancy and lactation, the negative impact of hormonal changes during menopause or due to taking hormonal birth control pills, etc.). In the case of carpal syndrome, the situation is aggravated by the fact that in women it is naturally much narrower than in men.
Carpal ( carpal) the channel is quite narrow, its bottom and walls are formed by the bones of the wrist, covered with a fibrous sheath. The roof of the tunnel is the transverse carpal ligament. Inside the canal are the tendons of the flexors of the fingers in special sheaths. The median nerve runs between the tendons and the ligament.

The median nerve is mixed, that is, it carries motor and sensory fibers. Its sensory part innervates the palmar surface of the first three to five fingers ( starting with big), the back surface of the nail phalanges of the first three fingers and the interdigital spaces. Motor fibers ensure the normal activity of the muscles that form the tenar ( prominence under the thumb).

Clinic and diagnosis of carpal syndrome

With the development of carpal tunnel syndrome, neuropathy of the median nerve occurs. The disease has a chronic course with a pronounced staging. The disease begins with morning numbness of the hands, then attacks of night pains and paresthesias appear, subsequently pain and paresthesia disturb the patient day and night.
Then there is a decrease in sensitivity and, finally, movement disorders ( decreased opposition force of the thumb) and tenor muscle atrophy.

For pain in neuropathy of the median nerve, irradiation upwards is characteristic - in the forearm, in the shoulder and even in the neck, which requires differential diagnosis with vertebrogenic lesions ( diseases of the peripheral nervous system caused by pathological changes in the spine).

It should be noted that even with a detailed clinical picture of the carpal tunnel syndrome, night pains and paresthesias are always more pronounced than daytime ones. In the morning there is stiffness in the affected joint. Night awakenings from intense pain and numbness in the hand are very characteristic, while the little finger does not go numb ( important diagnostic sign). The pain is partially relieved by rubbing and shaking the brush ( blood circulation improves).

Complex treatment of neuropathy of the external nerve of the thigh includes intramuscular administration of vitamins B1 and B12 ( 20 - 25 injections per course), analgesics, massage and physiotherapy exercises, physiotherapy ( mud, hydrogen sulfide, radon baths), reflexology.

Roth-Bernhardt's disease, as a rule, does not cause much suffering to patients, however, there are cases of intense pain requiring surgical intervention. When crossing the nerve, neuromas occur, leading to prolonged unbearable pain.

Neuropathy of the femoral nerve

Clinic and diagnosis of neuropathy of the femoral nerve

A typical place of compression in compression-ischemic neuropathy of the femoral nerve is the place where the nerve exits the retroperitoneal space to the thigh behind the inguinal ligament near the capsule of the hip joint.

The femoral nerve carries fibers that provide sensitivity to the anterior and inner surfaces of the thigh, lower leg and foot, and motor fibers that innervate the iliopsoas and quadriceps femoris muscles.

The most common cause of femoral nerve neuropathy is trauma complicated by the formation of retroperitoneal hematoma. Since the nerve passes near the hip joint, the second most common cause is various pathologies of this joint ( dislocation of the femoral head, etc.).

Often there are iatrogenic ( medical origin) neuropathy of the femoral nerve - complications of puncture of the femoral artery, plastic surgery of the hip joint, kidney transplantation.

The most common complaints in neuropathy of the femoral nerve are pain and paresthesia of the anterointernal surface of the thigh, the inner surface of the lower leg and foot. Later, there is a decrease in sensitivity and weakness of the innervated muscles, a decrease in the knee jerk and, finally, atrophy of the quadriceps femoris muscle.
Weakness of the iliopsoas muscle causes impaired hip flexion, and weakness of the quadriceps causes impaired knee flexion.

Treatment of neuropathy of the femoral nerve

Neuropathy of the femoral nerve may indicate a pathological process in the retroperitoneal space ( tumor, abscess, hematoma), so further testing is needed.

Treatment of neuropathy of the femoral nerve is conservative symptomatic. To relieve pain, anti-inflammatory drugs are prescribed. Special medical gymnastics is shown. If there are no severe comorbidities, a significant improvement can be expected 6 to 18 months after the onset of the disease.

In severe movement disorders that cause instability in the knee joint, there may be complications in the form of hip fractures.

Sciatic nerve neuropathy (piriformis syndrome)

Clinic and diagnosis of piriformis syndrome

Compression-ischemic neuropathy of the sciatic nerve occurs due to spastic contraction of the piriformis muscle, pressing the nerve trunk to the cruciospinous ligament. Frequent muscle spasms are most characteristic of osteochondrosis of the spine.

The main symptoms of sciatic nerve neuropathy are burning pain and paresthesias in the lower leg and foot, mainly in the zone of innervation of the common peroneal nerve ( anterior and outer surface of the lower leg and rear of the foot). Quite early, a decrease in the Achilles reflex begins to be determined. Less common is a decrease in sensitivity and weakness in the muscles of the lower leg and foot.

Palpation can reveal pain in the region of the subpiriform opening. The occurrence of pain in the gluteal region during adduction and internal rotation of the limb in the hip joint is also of diagnostic importance.

Piriformis Syndrome Treatment

The tactics of treatment is largely determined by the severity of the disease that caused the syndrome. In some cases, surgical treatment of complications of osteochondrosis of the lumbar spine is necessary ( elimination of intervertebral hernia).

Conservative treatment of piriformis syndrome includes drug relief of pain syndrome, improvement of microcirculation. Of great importance are therapeutic exercises, massage and physiotherapy.

Neuropathy of the peroneal nerve

Clinic and diagnosis of neuropathy of the peroneal nerve

The most typical place of compression of the peroneal nerve in compression-ischemic neuropathies is between the fibula and the fibrous edge of the long peroneal muscle near the head of the fibula.

The causes of compression are very diverse. Often the nerve is injured during sharp plantar flexion of the foot with its simultaneous supination ( outward rotation). In acute sprains of the ankle joint, acute traumatization of the peroneal nerve occurs, and with repeated habitual - chronic.
Often, compression-ischemic neuropathy of the peroneal nerve occurs when performing professional work associated with squatting ( one of the names of the pathology "professional paralysis of tulip bulb diggers"), the habit of sitting cross-legged is also of some importance.

Sometimes peroneal neuropathy occurs from the pressure of a plaster cast.
The most striking manifestation of the disease is paralysis of the extensors of the foot and fingers ( sagging foot). A decrease in the sensitivity of the outer surface of the lower half of the lower leg, the dorsum of the foot and the first four fingers is characteristic. With a sufficiently long course, atrophy of the anterior and external muscles of the leg develops.

Often patients complain of pain in the area of the fibular head, palpation and percussion of the projection of the head of the fibula are painful and cause paresthesia in the area of innervation of the peroneal nerve.

A test with forced plantar flexion and supination of the foot, which causes or increases pain in the region of the head of the fibula, is of diagnostic value.

Treatment of neuropathy of the peroneal nerve

Conservative treatment is possible at the initial stages of the disease and includes non-steroidal anti-inflammatory drugs, drugs that improve microcirculation; vitamins (B1, B6, B12, PP), electrical stimulation of the affected muscles, massage, therapeutic exercises, physiotherapy.

Surgical treatment is indicated for gross changes in the canal ( move tendons), as well as in the late stages of the disease and in the absence of the effect of conservative treatment for 6-12 months ( in this case, decompression of the peroneal nerve and plasty of the canal are performed).

Tarsal syndrome

Tarsal ( tarsal) the canal is located behind and downward from the medial malleolus. Its anterior wall is formed by the medial malleolus, the outer wall by the calcaneus, and the inner wall by the fibrous plate of the flexor tendon retinaculum, which is stretched between the medial malleolus and the calcaneus.

Inside the canal is the tibial nerve with accompanying vessels. Nerve compression in the canal often occurs as a result of an ankle joint injury, accompanied by edema and hematoma. Often the cause of tarsal syndrome remains unknown.

The main symptom of tarsal tunnel syndrome is nighttime pain in the plantar part of the foot. Subsequently, the pain begins to disturb the patient during the day while walking ( intermittent claudication). Sometimes the pain radiates up along the sciatic nerve from the foot to the gluteal muscle, inclusive.

Movement disorders are weakness of the toes.
Palpation and percussion of the tarsal canal causes pain and paresthesias in the plantar part of the foot ( Tinel's symptom).

Diagnostic value in tarsal tunnel syndrome is the extension of the foot associated with pronation ( inward rotation) increasing pain and paresthesia due to tension of the ligament of the flexors of the fingers and flattening of the canal. When moving backwards ( foot flexion and outward rotation) the pain subsides.

Tarsal syndrome resembles carpal tunnel syndrome in many ways, but surgical methods are not as effective. Therefore, conservative treatment is preferred ( gentle regimen, non-steroidal anti-inflammatory drugs, massage, therapeutic exercises, physiotherapy). Properly selected orthopedic shoes are of great importance.

Before use, you should consult with a specialist.

Neuritis, including the ulnar nerve, is an inflammatory pathology, involving the peripheral parts of the NS. The disease affects both one nerve fiber and many nerves. The severity of the damaging effect is interconnected with the root causes of emerging pathological conditions.

There is a relationship between the location of the nerve and the negative conditions that cause neuritis, so they distinguish:

damage to the ulnar nerve;
tibial;
radiation;
femoral and many other nerves.

Regardless of which nerve is affected, there are basic symptoms that are characteristic of each neuritis. This:

pain symptoms in the area of the damaged nerve fiber;
altered sensory perception;
muscle weakness in certain areas.

Ulnar neuropathy affects a large part of the population. Among all inflammations of nervous tissues, this takes an honorable second place.

Different circumstances simultaneously predispose to inflammation localized in the ulnar nerve, so the cause is possible:

with general or local prolonged exposure to cold on a certain area or the entire body;
due to various kinds of infections: influenza, brucellosis, measles, herpes and many others;
from the traumatic effect of both the nerve fiber itself and the area of \u200b\u200bbone tissue where it is localized. As a result, the nerve is pinched, its inflammation develops. For example, if there is neuritis of the ulnar nerve fiber, joint damage, fractures of the internal condyle with the epicondyle of the shoulder are possible;
when the vessels are affected, local microcirculation is disturbed, which leads to a violation of the trophism of the nervous tissue;
due to hypovitaminosis conditions, if the body lacks vitamin and trace element components;
from intoxication effects, including alcohol, salt compounds of heavy metals;
with endocrine disorders: diabetes mellitus, thyroid dysfunction;
due to structural anomalies of the bone and muscle canal, in the cavity part of which there is a nerve fiber. There is congenital, or it can be acquired;
with the squeezing effect of nerve bundles during sleep, improper sitting on a chair, when a person abruptly changed the position of the body, or due to damage due to a surgical operation. Pathology often manifests itself from long work with an emphasis on the elbow;
due to osteochondrosis, hernial changes in the discs located between the vertebrae.

About symptoms

Neuritis of the ulnar nerve is characterized by the fact that the patient feels that the hand is numb, then convulsive manifestations are observed, which indicates inflammation of the ulnar nerve tissue. Carpal pathological processes are expressed, especially on the fingers. Between the zone of the little finger and the ring finger, tension is expressed, the fingers are not always divorced.

There is a direct relationship between neuritis and its symptoms, depending on the degree of functional overload affecting the ulnar nerve and its innervated zone.

Nerve neuritis is characterized by the following symptoms:

altered sensory perception in the form of paresthesia manifestations (the patient feels as if his elbow is pricked) or numbness, pain, loss of touch is also possible;
movements of the affected upper limb are poorly expressed, its paralysis is possible. The patient can hardly bend his fingers, cannot move them. Such symptoms occur not only due to the fact that innervation is reduced, but also due to impaired tissue nutrition;
due to impaired trophism, the skin in the affected area is cyanotic, edematous, hair falls out locally, nail fragility is increased.

A characteristic sign in a patient with ulnar nerve neuritis is expressed in the fact that his hand hangs down, he cannot bend his fingers into a fist. Visually, the third and fourth fingers are in a bent position, the lateral abduction of the little finger is expressed.

When a patient's symptoms are based on pain with impaired motor activity, but no vegetative type of disorders is observed, then this is neuralgia of the ulnar nerve. Soreness with numbness is characteristic of the ring finger and little finger.

This is how this neuropathy manifests itself, before its treatment, diagnostic measures are necessary.

About diagnostics

There are different methods that reveal this ulnar nerve. For example, the patient is offered to put the upper limbs on a hard type of plane so that the palms are straightened downwards and one should try to scratch this plane a little with the help of the little finger. Naturally, he can't do it.

In the areas where the ulnar nerve goes, there is a high probability of a destructive process with development. This zone is localized under the collateral type of ligament.

About treatment

Before treatment, you need to find out the main root cause, due to which this neuropathy occurred. When it is an infectious pathology, an antibacterial, antiviral type of drug is prescribed.

If the cause is a violation of microcirculatory processes in the vessels with their narrowing, then the treatment of ulnar neuritis is carried out with vasodilators.

When neuritis occurs due to injury, the treatment is to fix the upper limb. In order to remove the inflammatory process, therapy in the form of non-steroidal anti-inflammatory drugs is prescribed. If you are in severe pain, the doctor will prescribe analgesics.

With neuropathy of the ulnar nerve, additional treatment is carried out with vitamin preparations of group B, and agents that relieve swelling are also used.

With this disease, the patient is not able to hold different things in his hand, carpal drooping occurs with the development of atrophy. Therefore, the doctor adjusts the splint bandage on a straightened hand with half-bent fingers and forearm. The fixation of the arm should be at an angle of 80 °. In this form, the upper limb is a couple of days, then the patient is prescribed a classic massage with therapeutic exercises.

the diseased upper limb should be lowered into the water and pressed with the other hand on the finger phalanges, trying to straighten them;
lift each finger;
make double-sided finger movements in a circle;
raise and lower straightened fingers (except for the thumb);
make carpal rotation;
raise and lower the brush;
the emphasis of the fingers on the bottom surface, when pressed, it is necessary to bend and unbend them;
something soft is placed on the bottom surface, it is necessary that the patient lifts this object. It is desirable to change objects in size and shape.

After 14 days, the doctor will add physiotherapy procedures in the form of:

hydrocortisone ultraphonophoresis;
electrophoretic introduction of novocaine, lidase;
impulse currents, UHF;
muscle electrical stimulation.

In order for the hand to recover faster, it is massaged with the study of all finger phalanges. The massage procedure will eliminate congestion. An excellent result will be given by circular movements and digital assignments.

When the inflammatory process develops due to a compression cause with the development of a tunnel type of syndrome, drugs are injected into the musculoskeletal region of the canal. To relieve swelling, pain, inflammation, a hormonal type of drug with painkillers is prescribed.

If the nerve fiber is compressed, then a surgical operation is possible, in which the nerve tissue is sutured, in some cases the plastic method is corrected.

About the forecast

If the pathology is detected in a timely manner, then the prognosis for the patient is favorable. The treatment course will be approximately 60 days.

After a person has recovered, one must beware of:

avoid hypothermia;
not get hurt;
If there is a concomitant pathology, then it must be treated.

Therapeutic measures of any inflammation should not be delayed, otherwise permanent remissions are possible.