Ulnar Nerve Compression in the Elbow
The ulnar is most commonly trapped in the elbow due to the anatomical location of the nerve. There are 5 areas in the medial elbow where the ulnar nerve can get stuck. These include Struthers arcade, medial intermuscular septum, retroepicondylar groove, cubital tunnel (shoulder arcade) and flexor pronator aponeurosis. The compression is the most common retroepicondylar and occurs in the cubital tunnel.
Although all compressions in this region are called cubital tunnel syndrome, it is important to know the location of the compression in surgical treatment. The true cubital tunnel is the area between the two heads of the Osborne ligament and the flexor carpi ulnaris muscle.
With aging, the incidence of ulnar neuropathy-compression in the elbow increases. It is more common in men than in women. As a reason, it is shown that the fat tissue in the elbow area is higher in women than in men.
Facial bands, cubitus valgus, osteophytes, ulnar nerve subluxation, thickened Osborne ligament, elbow resting habits may be responsible for cubital tunnel syndrome, but may also be idiopathic. Repeated flexion and extension movements of the elbow are also responsible for the etiology.
The symptoms of compression of the ulnar nerve at different sites are very similar. The most common complaint is numbness and paresthesia in the fourth finger half and the entire fifth finger. These complaints may be accompanied by a decrease in shaking power and loss of hand skills. Elbow flexion causes an increase in symptoms. Complaints of a feeling of discomfort spreading from the elbow to the proximal (up) and distal (down). Night pain and discomfort are very symptomatic.
In advanced cases, the 4th and 5th fingers are slightly abducted and the 5th finger is abducted and clawed. Hyperextension occurs from the metacarpophalangeal joint in the thumb. These anomalies may be accompanied by hypothenar atrophy. The thumb cannot adduct due to adductor paralysis.
The diagnosis includes clinical findings, provocative tests, and electromyography. The aim of EMG is to determine the presence of damage to the ulnar nerve, to identify the severity and to make a differential diagnosis.
The treatment is conservative and surgical.
Structures of conservative treatment, patient education, and activity modification. Actions that increase symptoms should be avoided. Resting the elbow provides relief of symptoms. Local steroid injection is not used in treatment.
If there is no response to conservative treatment within 6-12 weeks, if muscle atrophy is present and paralysis is progressive, surgical treatment should be performed.
In surgical treatment, the nerve is loosened, relieved, and transported forward if necessary.