| Do you remember what it felt like when you banged | | | | ligaments, blood vessels, cysts and scars. |
| your elbow on a hard surface and it sent shocks | | | | Sometimes, an ulnar neuropathy is the leading |
| through your forearm and into your little finger? Not | | | | symptom of a "polyneuropathy," meaning that all the |
| too pleasant, to be sure. But on the plus side, the | | | | peripheral nerves in the body are somewhat impaired, |
| unpleasantness was merely temporary and, for the | | | | but the ulnar nerve is the first one to cause |
| time being, you remembered not to do that again. | | | | symptoms noticeable to the affected individual. |
| The part of the nervous system responsible for this | | | | Polyneuropathy is not the result of injury, but can be |
| annoying symptom is the ulnar nerve, a peripheral | | | | seen in a variety of illnesses, including diabetes, |
| nerve-bundle whose individual nerve-fibers originate in | | | | alcoholism and also on an inherited basis. |
| the spinal cord where it passes through the neck. | | | | Diagnosing an ulnar neuropathy starts with the story |
| The nerve-fibers run most of the length of the arm, | | | | of the symptoms and a physician's examination. The |
| including through the "ulnar groove" which you may | | | | physician might subsequently order nerve conduction |
| know as the "funny bone" or "crazy bone." | | | | testing which looks at the nerve and muscle |
| Some people experience a more persisting | | | | electricity, and can determine the degree of |
| impairment of the ulnar nerve called ulnar neuropathy. | | | | impairment. Moreover, nerve conduction studies can |
| With "-pathy" as the medical suffix meaning illness or | | | | also evaluate other nerves to see if the ulnar nerve |
| impairment, an "ulnar neuropathy" means an illness or | | | | is the only one impaired, or merely one of many. |
| impairment of the ulnar nerve. The ulnar nerve is | | | | What if a simple injury to the ulnar nerve at the |
| vulnerable to injury or pinch in the ulnar groove for | | | | elbow is diagnosed? What can be expected? |
| more than one reason. First, instead of being | | | | Fortunately, the peripheral nerves have some |
| surrounded by soft, cushioning muscles and tendons, | | | | capacity to heal themselves. So if the degree of |
| it is sandwiched between a layer of skin on its | | | | nerve impairment is not too severe, conservative |
| exterior surface and nothing but hard bone on its | | | | treatment is called for. Unfortunately, there are no |
| interior surface. Second, when the elbow bends, the | | | | conservative treatments that have been studied by |
| ulnar nerve stretches because it has to take the long | | | | good, randomized, controlled trials, a form of |
| way around the elbow. | | | | evaluation in which the outcome of a treated group |
| Like a telephone cable containing numerous wires, the | | | | of patients is compared to that of an untreated |
| ulnar nerve-bundle contains many individual | | | | group. Randomized, controlled trials are the gold |
| nerve-fibers, some of which tell the muscles what to | | | | standard for deciding whether or not a treatment is |
| do and others of which carry messages back to the | | | | effective, so in this case all we have to go on is |
| spinal cord and brain about sensations experienced by | | | | "clinical judgment" and observation. |
| the skin and other tissues. So when the ulnar nerve is | | | | A typical conservative treatment consists of putting |
| injured, both motor and sensory symptoms are | | | | a sport-pad (not a medical brace) on the elbow with |
| possible. Most of the muscles of the hand receive | | | | the foam covering the ulnar groove. This |
| their marching orders via the ulnar nerve, so when | | | | accomplishes two things. First, if the elbow gets |
| the ulnar nerve is out of whack, there can be | | | | leaned on, then the nerve is still protected. Second, a |
| weakness in hand muscles. The muscles that spread | | | | well-fitting pad also prevents excessive |
| the fingers and those that straighten the middle | | | | elbow-bending (including during sleep) that |
| joints of the ring and little fingers are often affected. | | | | overstretches the nerve and re-injures it. In addition, |
| Damage to the ulnar nerve also causes changes in | | | | eating nutritious, well-rounded meals, together with |
| sensation. The ring and little fingers can become | | | | vitamins, gives the ulnar nerve the building-blocks it |
| numb, and so can the heel of the hand. | | | | needs in order to make the best possible recovery. |
| The ulnar nerve can come to harm in more than one | | | | If the nerve injury is severe, or fails to respond to |
| way. For some people the problem might result from | | | | conservative treatment, then surgery might be |
| leaning on their elbows too much. This can compress | | | | beneficial. When the nerve is tied up in scar tissue or |
| the ulnar nerve within the ulnar groove. Granted, | | | | compressed by nearby abnormal tissues, a simple |
| many people lean on their elbows without damaging | | | | release operation might suffice in which the nerve is |
| their ulnar nerves, but like most things in medicine, an | | | | freed up. Otherwise, in a procedure called "anterior |
| ulnar neuropathy is usually caused by a combination | | | | transposition" the nerve is transferred out of the |
| of factors, and it is likely that some people are more | | | | ulnar groove so it is out of harm's way from leaning |
| vulnerable than others based on their particular | | | | on the elbow, and also gets to take to the short |
| anatomies. Of course, rearranging one's anatomy, as | | | | way around when the elbow is flexed. |
| for example from a preceding elbow fracture, may | | | | Neurosurgical researchers at Radboud University |
| also put one at risk for an ulnar neuropathy. | | | | Nijmegen in The Netherlands conducted a |
| Another way to injure the ulnar nerve is by | | | | randomized, controlled trial of patients with ulnar |
| over-stretching it. In the author's clinical practice a | | | | neuropathy at the elbow in which half the patients |
| thin, young lady with loose elbow-joints who worked | | | | received simple release surgery and the other half |
| as an emergency medical technician injured her ulnar | | | | received anterior transposition. In this study there |
| nerves repeatedly while lifting heavy patients. For | | | | was no difference in outcomes between the two |
| her, it was a problem that wouldn't go away, and she | | | | surgeries. About two-thirds of the patients in each |
| eventually changed professions. | | | | group obtained an outcome that was considered |
| Although, as discussed, the ulnar nerve at the elbow | | | | either excellent or good. However, there were more |
| is especially vulnerable to injuries, it can also come to | | | | complications in the patients receiving the anterior |
| harm by getting compressed or pinched by nearby | | | | transposition procedure, so the results of this study |
| abnormal tissues. The usual culprits are tendons, | | | | favored the simple release approach. |