What If You Had No Left Ring Finger
What If You Had No Left Ring Finger – The ulnar nerve is one of the three main nerves in the arm. It travels from the neck to the hand and can be forced in several places along the way, such as under the collarbone or on the wrist. The most common point for nerve compression is behind the inside of the elbow. Compression of the ulnar nerve at the elbow is called cubital tunnel syndrome.
Numbness and tingling in the hand and fingers are common symptoms of cubital tunnel syndrome. In most cases, symptoms can be managed with non-surgical treatments such as changes in activities and bracing. If nonsurgical methods do not improve symptoms or if nerve compression causes muscle weakness or damage to the hand, your doctor may recommend surgery.
What If You Had No Left Ring Finger
This illustration of the shoulder, arm and hand bones shows the path of the ulnar nerve.
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Reproduced from Mundanthanam GJ, Anderson RB, Day C: Ulnar nerve palsy. Online Orthopedic Knowledge 2009. Accessed August 2011.
At the elbow, the ulnar nerve travels through a tunnel of tissue (the ulnar tunnel) that runs under a bony prominence on the inside of the elbow. This bony prominence is called the medial epicondyle. The point where the nerve runs under the medial epicondyle is often referred to as the “funny bone”. With a funny bone, the nerve is close to your skin and hitting it causes a sensation of shock.
Beyond the elbow, the ulnar nerve travels under the muscles on the inside of the forearm and into your hand on the palm side of the little finger. When the nerve enters the hand, it travels through another tunnel (Guyon’s canal).
The ulnar nerve provides sensation to the little finger and the middle of the ring finger. It also controls most of the small muscles in the hand that help with fine movements and some of the larger muscles in the forearm that help you make a strong grip.
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The ulnar nerve provides sensation (sensation) to the little finger and the middle of the ring finger on both the palm and the back of the hand.
In many cases of cubital tunnel syndrome, the exact cause is not known. The ulnar nerve is particularly vulnerable to elbow compression because it must travel through a narrow space with very little soft tissue to protect it.
Elbow tunnel syndrome can cause excruciating pain on the inside of the elbow. Most symptoms, however, occur in your hand.
(Left) The photo shows the appearance of the normal muscle between the thumb and forefinger when the fingers are pinched. (Right) In this photo, muscle wasting has occurred due to long-term entrapment of the ulnar nerve.
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There are many things you can do at home to relieve symptoms. If your symptoms interfere with normal activities or last more than a few weeks, be sure to make an appointment with your doctor.
Loosely wrapping a towel around your arm with duct tape can help you remember not to bend your elbow at night.
Your doctor will discuss your medical history and general health. They may also ask about your work, activities and medications you take.
After discussing the symptoms and medical history, the doctor will examine the arm and hand to determine which nerve is compressed and where it is compressed. Some of the physical examination tests your doctor may perform include:
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To perform the Tinel test for nerve damage, the doctor lightly taps along the inside of the elbow joint, directly above the ulnar nerve.
X-rays. X-rays provide detailed images of dense structures, such as bones. Most causes of ulnar nerve compression cannot be seen on an x-ray. However, your doctor may take x-rays of the elbow or wrist to look for bone spurs, arthritis, or other places where a bone could be compressing the nerve.
Nerve conduction studies. These tests can determine how well the nerve is working and help identify where it is compressed.
Nerves are like electrical cables that run through your body carrying messages between the brain and muscles. When a nerve is not working well, it takes longer to conduct.
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During a nerve conduction test, the nerve is stimulated at one point and the time required for a response to be measured is measured. Several points along the nerve will be tested; the area where the response takes too long is likely to be where the nerve is compressed.
Nerve conduction studies can also determine if compression is also causing muscle damage. During the test, small needles are inserted into some of the muscles controlled by the ulnar nerve. Muscle damage is a sign of more severe nerve compression.
Unless nerve compression has caused a lot of muscle atrophy, your doctor will most likely recommend nonsurgical treatment first.
Non-steroidal anti-inflammatory drugs (NSAIDs). If symptoms have just started, your doctor may recommend an anti-inflammatory medication, such as ibuprofen or naproxen, to reduce swelling around the nerve.
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Although steroids, such as cortisone, are very effective anti-inflammatory drugs, steroid injections are generally not used to treat cubital tunnel syndrome because there is a risk of nerve damage.
Bracing or splint. Your doctor may prescribe a padded brace or splint to wear at night to keep the elbow in a straight position.
Exercises for gliding nerves. Some doctors believe that exercises to help the ulnar nerve flow through the cubital tunnel at the elbow and Guyon’s canal at the wrist can improve symptoms. These exercises can also help prevent arm and wrist stiffness.
Examples of nerve sliding exercises. With your arm in front of you and your elbow straight, bend your wrist and fingers toward your body, then stretch them away from you, then bend your elbow.
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There are some surgical procedures that relieve pressure on the ulnar nerve in the elbow. Your orthopedic surgeon will talk to you about the option that would be best for you.
These procedures are often performed on an outpatient basis, but some patients get better results with an overnight stay in the hospital.
Cubital tunnel release. In this operation the ligamentous roof of the cubital tunnel is cut and divided. This increases the size of the tunnel and decreases the pressure on the nerve.
This illustration shows the path of the ulnar nerve through the cubital tunnel. Structures that can compress the nerve, such as the medial epicondyle and ulnar collateral ligament, are also shown.
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After the procedure, the ligament begins to heal and new tissue grows through the division. The new growth heals the ligament and allows more space for the ulnar nerve to slide.
An ulnar tunnel release tends to work best when nerve compression is mild or moderate and the nerve does not slide out from behind the bony ridge of the medial epicondyle when the elbow is flexed.
In this surgical photograph, cubital tunnel release was performed to decompress or relieve pressure on the ulnar nerve. The arrow shows the part of the nerve that has shrunk over time due to compression.
Anterior transposition of the ulnar nerve. In many cases, the nerve is moved from its position behind the medial epicondyle to a new position in front of it. Moving the nerve to the front of the medial epicondyle prevents it from sticking on the bony ridge and straining when you bend your elbow. This procedure is called anterior transposition of the ulnar nerve.
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The nerve can be moved to lie under the skin and fat but above the muscle (subcutaneous transposition); within the muscle (intermuscular transposition); or under the muscle (submuscular transposition).
For anterior transposition of the ulnar nerve, an incision is made along the inside of the elbow (pictured) or along the back of the elbow.
Medial epicondylectomy. Another option to free the nerve is to remove part of the medial epicondyle. Like ulnar nerve transposition, this technique also prevents the nerve from getting tangled on the bony ridge and stretching when the elbow is bent.
Depending on the type of surgery, you may need to wear a splint for a few weeks after the operation. Submuscular transposition usually takes a longer time (3 to 6 weeks) in a splint.
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Your surgeon may recommend physical therapy exercises to help you regain strength and movement in your arm. They will also talk to you about when it will be safe to return to all your normal activities.
The results of the surgery are generally good. Each surgical method has a similar success rate for routine nerve compression cases. If the nerve is severely compressed or if there is muscle atrophy, the nerve may not be able to return to normal and some symptoms may persist even after surgery. Nerves heal slowly and it can take a long time to know how the nerve will function after surgery.
AAOS does not endorse any treatment, procedure, product, or medical referral contained in this document. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult their orthopedic surgeon,
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