The ulnar neuritis is an inflammation of the ulnar nerve that is caused by pressure on it along its path behind the elbow. Normally the ulnar nerve passes through a specially formed area along the inner side of the elbow.
The path of the ulnar nerve along the inner side of the elbow, behind the median epicondyle
Kinematics of the elbow joint and its relation to the ulnar nerve
The descending path of the nerve ends in the hand where it provides sensation to the little finger and half of the ring finger.
Ulnar Neuritis – Symptoms
Patients suffering from ulnar neuritis often report numbness in the ring and little finger of the hand as well as pain in the inner side of the forearm.
They may also report severe nighttime symptoms.
Athletes involved in throws, such as javelin throwers and hammer throwers suffer from the syndrome due to chronic traction of the ulnar nerve.
Conservative therapy
The conservative therapy for the treatment of ulnar neuritis is very effective. Prolonged maintenance of flexion in the elbow joint often causes ulnar nerve irritation.
Getting a detailed history from the patient usually highlights activities and habits that cause nerve irritation.
Patients are advised not to keep their elbows bent for a long time and to avoid prolonged contact of the joint on hard surfaces (office).
Patients suffering from nocturnal symptoms are usually relieved by applying elongated elastic bandages.
Anti-inflammatory drugs usually help, because they improve local nerve edema and effectively soothe pain.
Injections with cortisone usually are not recommended in the treatment plan of the disease.
A splint may keep the elbow extended.
Surgical treatment
The surgical treatment of ulnar neuritis is also the definitive solution to the problem.
Conservative treatment should be applied for 4-6 months and includes rest, change of habits and activities that affect the ulnar nerve in the elbow, medication.
If symptoms persist or deteriorate during this period of time, then the orthopedist will recommend surgical treatment.
The indications are:
Severe and non-recurrent forearm and hand pain (little finger and ring finger).
Muscle atrophy in the inner half of the forearm and palm muscles.
Electromyographic findings indicating moderate to severe damage to the ulnar nerve.
The orthopedist, using a microscope and microsurgical techniques, decompresses the nerve, releases it from its anatomical region and transposes it in front of the joint.
The nerve in its new position is covered by subcutaneous fat (subcutaneous transposition), or placed between the muscle groups of the forearm (intramuscular transposition).
The method that will be used will be decided by the orthopedist, who shall estimate the best possible outcome for the patient.
The procedure lasts approximately 60 minutes and is performed with general or nerve block anesthesia.
The patient remains in the clinic for 24 hours to receive full medical and nursing care.
The nerve in its new position is under no pressure, a fact that results in the gradual elimination of the patient’s symptoms.
