Monday, May 28, 2018

Ulnar Tunnel Syndrome

Ulnar tunnel syndrome occurs when the ulnar nerve in the wrist becomes compressed by a cyst or repeated strain. The nerve compression can cause numbness or tingling in the hands or fingers, burning pain, muscle weakness in the hand, difficulty gripping with the fingers and thumb, and fingers bending into a claw shape.

The ulnar nerve runs from the neck down to the hand. At the wrist, the lunar nerve enters the hand though Guyon’s canal. If the nerve becomes compressed here, it causes ulnar tunnel syndrome. Compression of this nerve at the elbow is called cubital tunnel syndrome. Ulnar tunnel syndrome is less common than cubital tunnel syndrome and carpal tunnel syndrome.

Development of a ganglion cyst in the wrist is a common cause of ulnar tunnel syndrome but anything which places pressure on the ulnar nerve in the wrist can be a cause. The risk of developing ulnar tunnel syndrome is greater if a person has had a previous injury to the wrist, performs repetitive tasks with the hands, does activities or sports that put the wrist under strain or uses vibrating tools.

Diagnosis is typically made by medical history and physical exam. However, a physician may also suggest imaging studies (x-ray, CT scan, and/or MRI), electromyography, and/or nerve conduction study.

Surgery is performed if the condition is caused by a ganglion cyst or fractured hamate. Sometimes a surgeon will cut a ligament to relieve the pressure in the wrist.

When caused by repetitive strain a wrist brace, reduction of repetitive movements, and physical therapy, called neural mobilization, may be useful.

My Take:
Diagnosis of ulnar tunnel syndrome is relatively easy if the condition is acute. However, most patients suffer intermittent symptoms for months or even years before seeking treatment. Once the ulnar nerve becomes inflamed nerve compression can occur at multiple locations. I often tell my patients that the safest diagnosis is a “neck-shoulder-arm-hand syndrome” as impingement must be addressed each potential location.

Clinically, ulnar tunnel syndrome responds extremely well to extremity manipulation. Often patients will note an immediate improvement in hand strength after manipulation of the wrist. However, inflammation must also be addressed along with eliminating or minimizing the activity that irritates the ulnar nerve.

Chronic cases often involve neuropathy (nerve damage). The prognosis is then guarded as healing of the ulnar nerve must be facilitated after the impingement is reduced. Inositol and St. John’s Wort are my preferred nutritional support for neuropathy. Grape seed extract can also be beneficial if there is a circulatory component.

The Bottom Line:
If you suffer symptoms of ulnar tunnel syndrome I highly recommend you consult with a chiropractic physician that performs extremity manipulation and also has a degree in nutrition. The combined approach of manipulation and nutrition is the most effective, least invasive form of treatment.

Source: May 21, 2018 National Institutes of Health

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