Ulnar Nerve Entrapment at the Elbow

THE CLINICAL SYNDROME

Ulnar nerve entrapment at the elbow is one of the most common entrapment neuropathies encountered in clinic practice. The causes include compression of the ulnar nerve by an aponeurotic band that runs from the medial epicondyle of the humerus to the medial border of the olecranon, direct trauma to the ulnar nerve at the elbow, and repetitive elbow motion. Ulnar nerve entrapment at the elbow is also called tardy ulnar palsy, cubital tunnel syndrome, and ulnar nerve neuritis. This entrapment neuropathy presents as pain and associated parathesias in the lateral forearm that radiates to the wrist and ring and little finger. Some patients suffering from ulnar nerve entrapment at the elbow may also notice pain referred to the medial aspect of the scapula on the affected side. Untreated, ulnar nerve entrapment at the elbow can result in a progressive motor deficit, and ultimately, flexion contracture of the affected fingers can result. The onset of symptoms usually occurs after repetitive elbow motions or from repeated pressure on the elbow, such as using the elbows to arise from bed. Direct trauma to the ulnar nerve as it enters the cubital tunnel may also result in a similar clinical presentation. Patients with vulnerable nerve syndrome, such as diabetics and alcoholics, are at greater risk for the development of ulnar nerve entrapment at the elbow.

The ulnar nerve is susceptible to compression at the elbow.

SIGNS AND SYMPTOMS

Physical findings include tenderness over the ulnar nerve at the elbow. A positive Tinel’s sign over the ulnar nerve as it passes beneath the aponeuroses is usually present. Weakness of the intrinsic muscles of the forearm and hand that are innervated by the ulnar nerve may be identified with careful manual muscle testing, although early in the course of the evolution of cubital tunnel syndrome, the only physical finding other than tenderness over the nerve may be the loss of sensation on the ulnar side of the little finger. Muscle wasting of the intrinsic muscle s of the hand can best be identified by viewing the hand from above with the palm down. Tinel’s sign at the elbow is often present when the ulnar nerve is stimulated.

TREATMENT

A short course of conservation therapy consisting of simple analgesics, nonsteroidal anti-inflammatory drugs, or cyclooxygenase-2 inhibitors, and splinting to avoid elbow flexion, is indicated in patients who present with ulnar nerve entrapment at the elbow. If the patient does not experience a marked improvement in symptoms within 1 week, careful injections of the ulnar nerve at the elbow using the following technique is a reasonable next step.

Ulnar nerve injection at the elbow is carried out by placing the patient in a supine position with the arm fully adducted at eh patient’s side and the elbow slightly flexed with the dorsum of the hand resting on a folded towel. A total of 5 to 7 mL local anesthetic is drawn up in a 12-mL sterile syringe. A total of 80 mg methylprednisolone acetate steroid is added to the local anesthetic with the first block, and 40 mg depot steroid is added with subsequent blocks.

Ulnar nerve entrapment at the elbow is often misdiagnosed as golfer’s elbow, and this fact accounts for the many patients whose “golfer’s elbow” fails to respond to conservative measures. Ulnar nerve entrapment at the elbow can be distinguished form golfer’s elbow in that in cubital tunnel syndrome, the maximal tenderness to palpation is over the ulnar nerve 1 inch below the medial epicondyle. If cubital tunnel syndrome suspected, injection of the ulnar nerve at the elbow with local anesthetic and steroid will provide almost instantaneous relief.

Ulnar nerve block at the elbow is a simple and safe technique in the evaluation and treatment of ulnar nerve entrapment at the elbow. Cubital tunnel syndrome should also be differentiated from cervical radiculopathy involving the C8 spinal root, which may mimic ulnar nerve compression. Furthermore, it should be remembered that cervical radiculopathy and ulnar nerve entrapment may coexist in the double crush syndrome. The double crush syndrome is seen most commonly with median nerve entrapment at the wrist or carpal tunnel syndrome.

Low intensity laser therapy as well as a coordinated wellness program is also effective in treating this disorder.

Low Intensity Laser Therapy (LILT)

The low intensity Laser (LILT) sends photons (light) into the injured tissues and can penetrate two to three inches to treat affected areas. It uses a natural enhancement of the cellular machinery that can and has been dynamically measured in published studies to promote healing without burning affected tissue .Once the photons find the injured tissues, they stimulate and energize the cells to repair and strengthen at a remarkable rate. The treatment does not hurt, takes about 30 minutes and is very cost advantageous.

Wellness Program

A wellness program whichindividualizes treatment for age, performance and function has been shown in pilot studies to improve the overall health and well being of the individuals evaluated. A well conceived dietary and supplementary regimen based on scientific age –related decline in certain necessary compounds can improve quality of life, correct the ravages of hormone imbalance, balance critical neurotransmitter function without resorting to powerful drugs for depression that often have unfavorable side-effect profiles and restore vitality and youth in daily exercise routines. Furthermore, when wellness products are utilized with success, individuals often seek less costly interventions including unnecessary surgeries and narcotic options to treat pain. For more information go to www.drpwellness.com.