Pressure damage to the ulnar nerve (nervus ulnaris) is referred to as ulnaris gut syndrome or sulcus-ulnaris syndrome. The nerve runs relatively exposed at the elbow in a narrow groove, the ulnar groove – also known as the musical bone – and can be damaged by constant incorrect strain or other irritations. The ulnar nerve groove syndrome manifests itself symptomatically by tingling on the little finger, the inside of the ring finger and on the corresponding parts of the back of the hand.
What is Ulnar Gutter Syndrome?
The ulnar nerve runs at the elbow in a narrow groove in the ulnar bone directly under the skin and is only slightly protected from pressure or tensile injuries by the surrounding connective tissue. It supplies nerves to the little finger, the inside of the ring finger and the corresponding part of the palm up to the wrist. For what does the abbreviation dm2 stand for, please visit usvsukenglish.com.
Damage to the nerve has a direct effect on the regions of the hand mentioned and ranges from slight tingling or burning to numbness to loss of strength or even restricted movement and claw-like positions of the little and ring finger.
Brief pressure loads on the ulnar nerve, for example when the elbow accidentally hits a hard object, cause the typical pain in the “musician’s bone”, which usually subsides after a few seconds.
There are several causes that can trigger ulnar nerve syndrome. In individuals with normal range of motion and mobility, the nerve can be damaged by repetitive mis-straining of the forearm ( golfer ‘s elbow) or by leaning on the elbow, which is repetitive.
In professional drivers, the habit of frequently resting the left elbow on the window frame of the door or on an existing projection of the door while driving can gradually lead to damage to the ulnar nerve and trigger the typical symptoms. In immobile bedridden individuals, repeated improper positioning that constantly puts pressure on the ulnar nerve groove area leads to ulnar nerve lesion and thereby can cause ulnar nerve groove syndrome.
Injuries to the forearm tissue in the area of the ulnar nerve can also obstruct and damage the nerve through constant tension or pressure, with severe scarring and formation of tissue hardening, so that the typical symptoms can occur.
Symptoms, Ailments & Signs
Ulinaris gut syndrome leads to sensory disturbances and pain in the hand. If a treatment is refused, you can only move your hand to a limited extent in everyday life. A distinction must be made between initial symptoms and signs that appear after some time and are of a permanent nature. In the early stages, those affected usually describe a tingling sensation on the ring and little fingers.
It gives the impression that an ant colony is walking over the corresponding areas. Other patients report that both fingers are numb. The unfamiliar sensation sometimes extends to the inside of the elbow. A stressful situation – such as lifting heavy objects – often favors the symptoms mentioned. These disappear by themselves after a few seconds or minutes.
In the further course, the ulinaris syndrome occurs permanently. The gripping side of the hand constantly feels numb in everyday situations. Some patients also interpret the signs as a burning sensation. This limits motor skills. The so-called clawed hand is characteristic.
The ring and little finger are permanently in a bent position. Spreading the fingers is only possible with pain. If no treatment is started, muscle atrophy (muscular dystrophy) sets in due to the avoidance of painful movements. Persistent motor weakness then makes everyday life more difficult.
Diagnosis & History
An initial diagnosis of the presence of an ulnar nerve syndrome can be made based on the symptoms of tingling, burning or numbness in the little finger and ring finger.
By checking the so-called Froment sign (paper strip test), the diagnosis of damage or complete paralysis of the ulnar nerve can be confirmed or disproved with a simple exercise. If the suspicion of damage or total failure of the ulnar nerve is confirmed, it is essential to determine in a differential diagnosis whether the nerve has already been damaged from the ulnar groove or from the wrist ( Loge-de-Guyon syndrome ). Further electrophysiological diagnostic methods allow conclusions to be drawn about the conductivity of the ulnar nerve and the transmission speed of impulses.
If the causes for the triggering of the ulnar nerve gut syndrome are not eliminated, numbness, motor weakness and gradual muscle atrophy occur as the disease progresses. The consequences are a restricted mobility of the hand up to the typical clawed hand.
Ulnar nerve syndrome leads to a number of different symptoms, all of which have a negative impact on the patient’s everyday life and quality of life. Most of those affected suffer from various sensory disturbances in the area of the little finger. This feels numb and can tingle or hurt.
It is not uncommon for these sensory disturbances to spread to the neighboring regions and can therefore also lead to complaints on the other fingers or on the wrist. The position of the little finger is claw-like, so that there are considerable restrictions in the everyday life of the person concerned. The muscles are also significantly weakened, so that the ulnar nerve syndrome can cause problems when working. The entire mobility of the hand is restricted due to illness.
In most cases, ulnar artery syndrome can be treated. Complications usually only occur if the disease is not treated. Recovery takes place by immobilising the finger or arm. Those affected have to rest their fingers, but there are no permanent restrictions. The life expectancy of the patient is also not negatively influenced by the ulnar nerve syndrome.
When should you go to the doctor?
In the case of ulnar nerve gut syndrome, the affected person is dependent on treatment by a doctor. Only with the right treatment and above all with a quick and early diagnosis can further complications or a further deterioration of the symptoms be prevented. Therefore, a doctor should be contacted at the very first symptoms and signs of ulnar nerve duct syndrome in order to treat the disease properly. A doctor should be consulted if the person concerned suffers from severe sensory disturbances. In most cases, the hands can hardly be moved, which can have a very negative effect on the patient’s everyday life.
Furthermore, permanent tingling in the affected regions can indicate ulnar nerve gut syndrome and should also be examined by a doctor if it occurs over a longer period of time and does not go away on its own. These symptoms can also occur when lifting heavy objects and indicate the disease. As a rule, the ulnar nerve gut syndrome can be diagnosed by a general practitioner or an orthopedist. Further treatment depends on the exact symptoms and their severity. As a rule, the patient’s life expectancy is not reduced by this disease.
Treatment & Therapy
When diagnosing an ulnar nerve gut syndrome, it is sufficient in simple cases to eliminate the causative circumstances. Poor posture can be corrected or certain habits of constantly supporting the elbow in a certain way can be changed.
After eliminating the causative factors and using conservative treatment methods such as relief by elevating and cooling the inside of the elbow, it may be necessary to immobilize the affected elbow for a period of time. It may even be necessary to temporarily fix the arm in a cast to allow the ulnar nerve to regenerate.
In chronic and advanced cases, where conservative therapy has not brought the desired success, conventional and minimally invasive surgical interventions are available. With the conventional surgical method, the nerve in the area of the ulnar nerve groove is exposed and interfering tissue is removed in order to relieve the pressure. In individual cases it may be necessary to relocate the ulnar nerve.
A modern and gentler alternative to open surgery is the endoscopic minimally invasive method. The endoscope and cutting tool are placed on the ulnar nerve through a small incision, and disruptive tissue that caused the nerve lesion can be removed. With the minimally invasive method, an area from the middle of the upper arm to the middle of the forearm can be covered.
The ulnar nerve syndrome is usually triggered by mechanical stimuli and not by physiological or nutritional processes. The most important preventive measure is therefore to avoid incorrect strain and/or (bad) habits that can lead to a lesion of the ulnar nerve in the long term.
First signs of an impairment of the ulnar nerve, which is e.g. B. by tingling or burning in the little finger or in the ring finger, should be taken seriously and possible causes for this should be analyzed and then turned off.
Follow-up treatment is required when ulnar nerve duct syndrome is treated with surgery. Sometimes there may be a slight burning sensation in the wound after the operation. In such cases, the doctor administers pain-relieving and decongestant drugs. The painful symptoms usually disappear after a few days.
The sensitivity of the fingers also returns after a few weeks at the latest. In order to accelerate wound healing and counteract swelling of the limb, it is important to rest and rest the arm. However, complete immobilization with a cast is only required after an open operation. If, on the other hand, a minimally invasive procedure with an endoscope takes place, the patient is given a pressure bandage and is allowed to move the elbow carefully.
After about ten to fourteen days, the threads or staples on the skin of the operated arm are removed by the doctor when the wound has healed well. The small drain, which is used to drain blood and wound fluid, is removed after just one to three days.
In the case of outpatient surgery, the doctor gives the patient precise instructions on how to behave before they are discharged. He also informs him when the first check-up has to be carried out. Normally, the operating doctor carries out the follow-up treatment himself.
You can do that yourself
Ulnar nerve syndrome is treated by splinting or padding the elbow region. The movement behavior must be changed to support this. For example, avoid supporting the bent elbow. The physiotherapist or sports doctor can name measures that the patient can use to adjust the movement sequences. The exercises should be carried out regularly so that the ulnar nerve syndrome does not develop into a chronic disease.
In the event of severe pain or nerve disorders, surgical decompression of the ulnar nerve is necessary. After the procedure, the surgical wound must be carefully observed, as repeated elbow flexion movements can cause bleeding and other discomfort. Usually a rail is attached, which has to be adjusted regularly.
Individuals who have been diagnosed with ulnar nerve gut syndrome must initially refrain from any sporting activity that affects the affected arm or elbow. Physiotherapy and physiotherapy are alternatives . Massages, cool or warm pads and soothing baths support the healing process. Which self-help measures are useful and necessary in detail always depends on the severity of the condition. It is best for patients to contact the responsible doctor, who can name suitable measures based on the symptoms.