hi everyone this lesson is on ulnar neuropathy so we're going to talk about why this condition occurs the signs and symptoms how it's diagnosed and how it's treated so all in neuropathy may also be known as cubital tunnel syndrome it is a monomeropathy condition involving the ulnar nerve so modern neuropathy mono meaning one so one nerve is involved and that is the ulnar nerve so the ulnar nerve is located in the upper extremity so the arm and as you'll see later there's going to be numbness and tingling Sensations in the pinky or the fifth digit the ulnar aspect of the hand and half of the ring finger that is closest to the fifth digit so that is going to be some of the Hallmark findings we'll talk about those clinical findings in more detail later on in this lesson so almond neuropathy is a relatively common condition it is the second most common nerve entrapment condition of the forearm and it is second to the most common entrapment condition and that is entrapment of the median nerve which is carpal tunnel syndrome males are more affected than females with regards to this condition so the ray ratio is three to eight males for every one female and there is an increasing prevalence of this condition over the age of 35. now let's talk about the anatomy and pathophysiology of this condition so the ulnar nerve actually originates from the neck and it runs all the way down the arm and ends at the medial aspect of the hand it is responsible for sensation of the medial half of the fourth digit so if we were to look at this diagram here it's the medial half so it would be the half of the fourth digit closer to the pinky finger or the fifth digit it is responsible for sensation of the fifth digit entirely and it's also responsible for the sensation of the ulnar aspect of the posterior hand so the Sensation that this nerve is responsible for includes this whole area here and this is in contrast to carpal tunnel syndrome which involves the sensation of the thumb index finger middle finger and half of the ring finger or half of the fourth digit now the reason why this condition occurs is due to nerve entrapment as we mentioned earlier and the most common places of entrapment include the following the elbow so it actually occurs in what is called the cubital tunnel this is why this condition can be referred to as cubital tunnel syndrome or in the epicondylar ulnar Groove so there's a small area here where the nerve can become entrapped so it's the medial aspect of the elbow is where we're going to have entrapment occurring most commonly now the risk can also be a location where entrapment can occur as well so as we see in this diagram here the ulnar nerve does extend through the wrist through what is called the canal of gion and that allows it to enter into the hand to supply the hand for nerve sensation and then the forearm is also the other location where we can see entrapment occurring between the elbow and the wrist so again we're going to see the elbow the medial aspect of the elbow most commonly being the place where we're going to have entrapment but we can have these other areas being the places where entrapment can occur as well which can lead to this condition now let's talk about the causes of ulnar neuropathy we know that it is due to entrapment but why would that be the case so we can actually break down the causes into multiple categories one category can be direct pressure so there can be direct pressure on some of those areas we talked about before like the ulnar groove or on the forearm or in the wrist in the canal of Geon and the direct pressure can come from sleeping position so just happening to lay on a particular spot in the arm can increase the risk of having this condition and lead to some numbness and tingling sensation in the hand sitting position and resting on your elbow can be other important causes so if you're sitting and you are resting on your elbow the position that you're resting on can cause all neuropathy and then compression during a medical procedure including during general anesthesia so during general anesthesia the patient is under anesthesia and the way their arms are positioned they may have pressure on their medial aspect of their elbow for instance other causes can include anatomical causes these can include rheumatoid arthritis osteoarthritis blunt trauma or injuries ganglion exists and tumors so anything that is altering the structure of the anatomy in those important areas of entrapment are going to be causes of ulnar neuropathy metabolic causes can also be important with regards to causing all neuropathies can include diabetes and malnutrition so if there's issues with diabetes there can be diabetic neuropathy so neuropathy again is a disease of the nerves so diabetes can cause nerve issues in multiple parts of the body and the ulnar nerve can be one of them and some other conditions that we can include in the metabolic category can include hypothyroidism or a low thyroid function and anemia as well and some other causes of this condition include cigarette smoking chronic alcoholism occlusion of the brachial artery so if there is occlusion of the brachial artery we're not going to get enough blood supply to the nerves so we're going to have issues with nerve functioning venipuncture so if there's issues with of any puncture in the area of the ulnar groove or the cubital tunnel for instance that can lead to issues with ulnar nerve functioning hemophilia-induced hematomas so there can be a large collection of blood that can impinge on the nerve as well and then idiopathic causes causes that are not entirely understood so those are the causes of this condition let's talk about the signs and symptoms of ulnaropathy so we're going to have paresthesias and paresthesias are going to be numbs and tingling Sensations on the medial aspect of the fourth digit so again the fourth digit is going to include the ring finger so it's going to be the medial aspect or medial half of the fourth digit and again the medial aspect is going to be the half of the ring finger closest to the fifth digit or the pinky and we're also going to have numbness and tingling sensations of the entire fifth digit or the entire pinky finger and we're also going to have numbness and tingling sensation over the medial or ulnar aspect of the hand as well we can also have issues with shooting pain so shooting pain can actually run down the arm so if you're actually to strike the ulnar nerve in and around the cubital tunnel for instance in your elbow you can have a shooting pain that can run down your arm and into these areas of the hand and this shooting pain is often going to be transient so it's going to occur and then it's going to subside you can have numbs and tingling sensation from this as well in some cases we can have a weakened grip so there may be issues with muscle use in that particular part of the hand and there can be muscle wasting in very rare cases so there can be muscle atrophy in the area of the ulnar nerve distribution in the hand and interestingly the left side is more commonly affected than the right side so we're going to have issues with shooting pain numbness and tingling Sensations in the left hand more commonly than in the right hand now let's talk about how clinicians diagnose this condition oftentimes it's going to be a clinical diagnosis so a clinician is going to see that characteristic issue with paresthesis or numbness and Ting sensation in the nerve distribution of the ulnar nerve and that's going to be enough to make the diagnosis in some cases there can be blood work done to assess for potential underlying causes some of the potential underlying causes that can be looked for in blood work include hypothyroidism as mentioned before hypothyroidism is a potential cause of ulnar neuropathy and we can look for TSH or thyroid stimulating hormone along with T3 and T4 anemia so that would be looked out for using a complete blood count or CBC in diabetes using hemoglobin A1c some other potential blood work that can be used in certain cases if there's some other reason to think about another potential systemic cause includes Ana this can be used to look for or to rule out any autoimmune conditions as I mentioned before rheumatoid arthritis can be a cause of ulnuropathy ESR so erythrocyte sedimentation rate can be used as well renal function tests Lyme serology vitamin B12 levels vitamin B6 levels folate levels and MMA levels can all be important as well we did mention this before but some vitamin deficiencies can also exacerbate some of the findings of ulnular neuropathy as well including a deficiency of vitamin B12 radiographic Imaging can also be important so we can look at the elbow and the wrist so we can look for valgus deformity bone spurs shallow electron on Groove tumors and Bone lesions so if there's any issue with the anatomy in some of those areas we talked about before this can lead to impingement or entrapment of the ulnar nerve and some other methodologies we can use for diet diagnosis includes ultrasonography to look at the diameter of the nerve so if there is impingement we can see the change in diameter of the nerve MRI in some cases so magnetic resonance imaging and electromyography can be used in certain cases as well once a clinician has made the diagnosis how do they treat it so we'll first start with non-surgical or conservative treatments these are going to include changes of position so if the signs and symptoms are elicited simply by or simply during sleep or certain positions we can change our position so change of sleep position for instance or resting on the elbow trying to change how you actually position yourself when sleeping or when sitting non-steroidal anti-inflammatory drugs or NSAIDs like ibuprofen or Motrin can be used in certain cases may help with some of the procedures if there is some pain some of that shooting pain that's consistent and problematic for the patient this may help as well in some cases tricyclic antidepressants may be used tricyclic antidepressants can be used to treat neuropathic pain in other conditions as well interesting vitamin B6 supplementation can help reduce some of the signs and symptoms of this condition and then occupational therapy as well and then some other modifications that can be utilized includes elbow pads night splinting and other splints as well and if these non-surgical or conservative methods don't work even some more severe cases surgery may be required so surgery is going to be used if again the conservative management is ineffective or if there is severe atrophy or weakness so some of the surgeries can include ulnar decompression so it can be inside you or with anterior transposition anterior transposition means that the nerve itself is actually moved to a slightly different location in the elbow and then medial epicondylectomy can be used in certain cases as well to allow a larger area for the nerve in case there is some structural deformity that is leading to impingement of the nerve and another more experimental type of surgery that is used in this condition is endoscopic cubital tunnel release and this type of procedures actually analogous to what is used in carpal tunnel syndrome so I also want to mention that here but most of the time we're going to use these other types of surgical methods and most of the time the non-surgical conservative methods are going to be enough to treat this condition if you want to learn more about carpal tunnel syndrome please check my lesson on the topic and if you haven't already please like And subscribe for more lessons like this one thanks so much for watching and hope see you next time