Do you have a strange sensation when you bend your pinkie finger? Are your fourth and third fingers also sometimes involved? Do your hands get numb when you rest on your elbows? Does Flexing your little finger cause a not so funny pain in your funny bone, or maybe in the groove of your elbow? Does this pain sometimes radiate up your arm to your neck?
If your answer to most of these questions is "yes," you may have a condition known as ulnar neuropathy, damage to your ulnar nerve. The ulnar nerve runs down your arm along your ulna bone, the inside bone of the two in your forearm. It powers sensation in your pinkie and in part of your fourth (ring) finger, as well as the parts of the palm nearest to them. At your "funny" bone it is close enough to the surface that striking the surface of your arm may cause intense pain for a short time.
There are four places on your arm where injury can cause the ulnar nerve to become "entrapped." If you experience an injury in one of these locations, you probably want notice any problems right away. You are more likely to have what medicine calls a "tardy" reaction, months, years, or even decades after the original injury. Because the motor neurons (the nerves that regulate motion) are deep inside your arm and the sensory neurons (the nerves that transmit pain signals) are closer to the surface, if you have any entrapment of the ulnar nerve you are more likely to suffer pain than you are to lose motion in your fingers.
Ulnar neuropathy is more common in men and women, because women have protective fat pads in their arms. The condition is more common after the age of 35, when the protective tunnel through which the nerve flows begins to shrink.
What are the symptoms of ulnar neuropathy?
- Usually the condition interferes with both adduction and abduction of the pinky finger, that is, it is hard or impossible to hold the finger away from the hand, but it is also hard or impossible to hold it close to the fourth finger.
- Usually there is no pain in the fingers, but often there is pain at the elbow or even higher up.
- Sometimes there is claw hand, caused by the excessive bending of the metacarpophalangeal joints in the fifth and fourth fingers. Claw hand occurs at rest.
- Sometimes there is weakness that makes it harder to open jars or turn door knobs.
- Sometimes the pinky finger gets caught in a pocket when placing the hand in a pocket.
- Sometimes the hands just "look older."
Many of the treatments that work for carpal tunnel syndrome also work for ulnar neuropathy. Vitamin B-6 supplements (120 mg a day), acetyl-L-carnitine supplements (500 to 2000 mg a day), and biotin (500 micrograms a day) help nourish the nerve. Splints worn at night relieve stress on the capsule that carries the nerve to the hand. Like there are for carpal tunnel syndrome, there are sliding and gliding exercises that a physical therapist can teach you that help strengthen muscles in ways that reduce injury to the ulnar nerve.
Ulnar neuropathy can also be treated with surgery, but there are complications about 5 to 10 percent of the time, depending on the surgeon. There can be a real problem with damaging the nerve in the surgery itself. Sometimes the surgery removes one "entrapment" only to create a new one. New scar tissue can replace old scar tissue. And there are complications of this kind of surgery such as blood clots and infection that there are for any other kind of surgery. Diabetics need to keep blood sugar levels under good control.
However, the more you are able to use your fingers, the less likely you are to have a recurrence of problems after surgery. Patients who are able to follow instructions to the letter get a good result about 85 percent of the time.
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