Neuropathy is any disease condition of the nervous system. The ulnar nerve is the longest unprotected nerve in the human body; it is not shielded by bones or muscles as most other nerves are. This nerve runs from the neck, all the way down the arm, and is responsible for sensation in the fourth and fifth fingers of the hand, the palm of the hand and the underside of the forearm.
This sensitive nerve can become damaged from repetitive jarring motions. Individuals who work with jackhammers or other hydraulic equipment, and even long-distance cyclists and baseball pitchers can be at risk for developing this condition. When the ulnar nerve becomes compressed or “pinched” near the elbow, it is said to be “entrapped.”
Patients with this condition report symptoms of weakness or tenderness in the hand, tingling in the palm and fourth and fifth fingers, sensitivity to cold and tenderness in the elbow joint. Sometimes these symptoms will resolve on their own, but often, if the damage is more severe or the activities causing it are ongoing, medical intervention may be required.
A thorough examination by a specialist trained to heal the hands, arms and upper extremities of the body is the best person to diagnose this condition. The orthopedic doctor will examine the arm and hand, possibly tapping lightly on the ulnar nerve to determine sensitivity. She will take a detailed account of when the condition began and how it has progressed. Other tests may be ordered such as X-Rays, MRI or Nerve Conduction Velocity tests.
Often, Ulnar Neuropathy or Ulnar Nerve Entrapment can be treated through minimally-invasive methods. Non-steroidal anti-inflammatory drugs may be prescribed, and corticosteroid injections may be considered. Bracing or splinting, especially at night, may be undertaken. Occupational therapy exercises, when done faithfully, will help to rebuild flexibility and strength.
Occasionally, the condition is more serious and Cubital Tunnel surgery is required. Surgery is typically done on an out-patient basis, and the patient can go home that same day. In this situation, the cubital tunnel is cut to allow more space for the ulnar nerve. Splinting of the arm will be required for several weeks, and occupational therapy with home follow-up exercises will be utilized.
If ulnar neuropathy goes untreated, complications can result:
Partial or complete loss of feeling in the hands or fingers
Partial or complete loss of hand or wrist movement
Chronic pain
Emotional depression stemming from the pain or lack of ability to engage in sports or other life activities
If you or someone you know is experiencing tingling, numbness or pain in the hand, arm, wrists or shoulder, contact Dr. Rehman . She is a specialist in treating disorders, conditions and injuries related to the upper extremities, and will conduct a thorough evaluation and design a comprehensive plan to return you to full functionality. Her team of experienced hand therapists will follow up with exercises and other treatment modalities for a return to full strength and range of motion. Don’t endure pain for even one more day – contact Dr. Rehman today! 586-532-0803
Olympian long-distance cyclists are at risk for this condition, as are professional baseball pitchers, but you could be too. Do you notice numbness, tingling or pain radiating into your arm and hand on the side of the little finger? “Handlebar Palsy” or Ulnar Neuropathy can be caused by the repeated jarring of the wrists and hands when cycling. The result is an inflammation of the ulnar nerve, a major nerve in your arm that runs down your hand. Inflammation of the ulnar nerve can occur in several areas as it travels from your neck to your hand. Resting your elbows on hard surfaces for a long period may cause a slight inflammation, but intense physical activity such as long-distance biking or repeatedly pitching a baseball are more likely to cause the serious cases of this condition.
Watch for numbness, tingling or pain in the forearm or hand on the side of the little finger. Pain and numbness in the elbow may also be present, with decreased hand grip and the inability to pinch together the thumb and the little finger. The ulnar nerve often becomes trapped in the elbow, as the space it has to travel through in this area is limited. This is called “Cubital Tunnel Syndrome.”
Although ice, rest and anti-inflammatory medications may help initially, if the pain and tingling persist, seek the advice of a specialist trained to evaluate and rehabilitate the hands and upper body. This doctor will review your symptoms and ask about your lifestyle and activities. He or she will examine your neck, shoulder, arm and wrist. The doctor may order tests such as a nerve conduction study (NCS) or an electromyogram (EMG). EMG is a procedure where electrodes are placed into the muscles and on the skin to measure the health of muscles and the nerves that control them, to help identify the area of nerve damage and determine the severity of the condition.
The exact cause of the condition must be determined, and behavioral changes must be made to reduce the pressure on the nerve. Wrist splints may be prescribed to reduce discomfort. If the cause is from bicycling, it may help to wear padded gloves and to change your hand position on the handlebars frequently. Oral anti-inflammatory medications and B vitamins may also be prescribed. Typically these minimally invasive measures will alleviate the condition, but if not, surgery may be required. The vast majority of patients respond favorably to some type of surgery to correct this condition.
If the nerve is trapped in the elbow, Cubital Tunnel Release surgery can be effective. This is typically done on an outpatient basis, and individuals can go home the same day. The area known as the cubital tunnel is cut to allow more room for the nerve to pass through. As healing occurs, new tissue is formed and fills in this area. The recovery period for this type of surgery includes wearing a splint for a few weeks and physical rehabilitation therapy to return full range of motion and strength to the arm and hand.
Repetitious motions or constant jarring of the arm cause the inflammation of the ulnar nerve. Try to reduce activities that repeatedly stress this area, and take frequent breaks with arm stretching when you can. If you are a bicyclist, wear padded gloves and move your hand position on the handlebars frequently.
If you are experiencing pain, stiffness or tingling in your hands, arms or shoulder, contact Dr. Rehman for a comprehensive evaluation and treatment plan. Her team of hand therapists will help you return to your activity with full use of your arm or hand. Call 586-532-0803 for more information.
We’ve all heard of splinting, and have a general idea of what it is. But today’s advanced, custom-designed orthopedic splints are so much more than the basic splints of years ago.
Particularly for hand and wrist involvement, a specially-designed splint that is custom made for the individual’s particular situation can make a world of difference in the healing process and the return to full use of the affected area. Custom splints are often used to treat conditions like muscle strain, neuritis, tendonitis, and sometimes are used following hand or wrist surgery. The splint acts to provide rest for the injured or inflamed areas, as well as holding the affected appendage in the correct position.
Especially after surgery, custom splints can help the patient with the early motion protocols that are needed to help facilitate a full recovery. Custom splints also help following surgery by providing a barrier against common post-operative injuries.
With today’s technology and the advanced skill set of the hand therapists at Dr. Rehman’s office, custom splints can be made for many applications. The therapist designs and fabricates the custom splint, which is manufactured from low-temperature thermoplastic material; it can be designed specifically for the injury, as well as the size of the patient.
Injuries and conditions of the hand and wrist that are not healing properly deserve the attention of an experienced, knowledgeable, Board Certified orthopedic doctor who specializes in this area of the body. If you are having pain in the hand, wrist or shoulder, seek a consultation from Dr. Rehman today.
There are many types of corticosteroid injections, but in general, a corticosteroid injection is a formulation of two or more medications to reduce inflammation, relieve pain and improve function and mobility.
Corticosteroids are derived from cortisone, a steroid hormone released by the adrenal gland in response to stress. When combined with other pain-killing and anti-inflammatory medications in a corticosteroid injection, they work more effectively and efficiently to treat discomfort. Depending on the condition that is being treated, injections can providepain relief for several weeks up to several months.
At Midwest Hand Therapy, we sometimes administer corticosteroid injections as part of a comprehensive approach to hand and wrist rehabilitation. Depending upon the condition and the particular patient, a corticosteroid injection may accompany hand exercises, hot and cold modalities, and massage.
Many patients that have never had one of these injections express concern regarding the amount of pain they will experience. These injections are very similar to any other type of injection; the initial needle stick is similar to the pain caused by a quick bee sting. There is temporary discomfort while the medication is being injected, but nearly all corticosteroid injection patients agree that a short moment of discomfort is much better than ongoing pain of the wrist or hand!
Corticosteroid injections should only be administered by a licensed physician, and to ensure the best results, patients should visit a doctor that specializes in the specific area being treated. For example: a hand specialist for the hand, fingers, wrist or forearm, and a podiatrist for the foot, ankle or lower extremities.
For more information on corticosteroid injections, or if you are experiencing hand, wrist or finger pain, please contact us at Midwest Hand Therapy.
Ulnar nerve entrapment (or ulnar nerve neuropathy) is a painful condition that affects the outer side of the arm and hand near the little finger. This pain is caused by pressure on the ulnar nerve (located within the arm) and is often a sign that the ulnar nerve is trapped or pinched.
Because the ulnar nerve passes through many tunnels within the arm, many conditions or injuries could cause the nerve to become compressed or pinched. Causes include:
Elbow fractures
Growth plate injuries
Wrist fractures
Infections
Tumors
Diabetes
Alcoholism
Even problems originating at the neck
Bicycler’s neuropathy
Cubital tunnel syndrome
Guyon or Guyon’s canal syndrome
The ulnar nerve provides sensation to the flexor muscles of the hands, allowing for bending, which makes this condition all the more painful – many of us rely on our hands all day long!
What are the symptoms?
Hand, wrist and arm pain can be an indication of a number of conditions. However, symptoms of ulnar nerve entrapment may include:
Weakness
Tenderness
Tingling in the little finger (your pinky finger)
Elbow tenderness
How do I know if I have ulnar nerve entrapment?
The very best thing you can do if you are experiencing arm, wrist or hand pain is to see a hand specialist. Hand specialists, such as Dr. Rehman, can diagnose and treat your condition before it worsens.
Upon an extensive evaluation, your doctor can recommend a course of treatment. Ulnar nerve entrapment can often be treated through occupational therapy, anti-inflammatory drugs, or splinting. In some cases, surgery may be recommended, depending upon on the severity of the entrapment.
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