A renowned personality in the field of hand and upper extremity Dr. Vikas Gupta seems unperturbed while putting forth his observed train of thoughts regarding ulnar nerve injuries, “Ulnar nerve is one of the three main nerves in the forearm region responsible for the sensations and mobility in the hand and fingers. It runs down from the shoulder to the little finger passing through the inside of the arm. It is essential to understand here that the nerve carries messages between the brain and the hand and if they sustain an injury and left untreated they might result in severe complications. There are many who do not realize the underlined importance of this nerve and its potential damage to the motion functionality in the hand.”
Years of perseverance and diligence are tools that aided the stupendous success of Dr. Gupta from a hand to shoulder surgeon to one of the best specialists in the field leaving his mark on patients and delivering passionate service at AIIMS, Medanta and at present Max Healthcare. Effusively explaining the importance of ulnar nerve Dr. Gupta says, “presence of ulnar nerve injuries are ascertained by the loss of feeling in the little finger and the ring finger and intense pain along with numbness in the arm and hand and are more conclusively diagnosed after x-ray and nerve conduction studies.”
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Having completed his MBBS and MS in orthopedics from All India Institute of Medical Sciences, New Delhi and his fellowship from Germany and USA Dr. Gupta has been intrinsically involved in various research projects in his 25 years long career of professional service and after having performed more than 18000 surgeries, he stresses on the requirement of deft impartation in the surgical release of ulnar nerve injuries, “The most common cause of ulnar nerve injuries are its compression and entrapment in the cubital tunnel and guyon’s canal besides other causes and it becomes essential that the pressure on the nerve gets released by surgical intervention. Ulnar nerve being delicately complex requires skill and expertise, for any careless move can result in severe complications.”
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Summing up his views on ulnar nerve injuries he nonchalantly nods his head, “the patient should strictly follow the instructions and recommendations regarding therapy and resuming activities given by the surgeon as they are important prerequisites that help the patient to gain back their motion. I would yet again stress on the fact that these injuries should not be taken lightly or they might result in paralyzing the joint.”
FAQ – Ulnar Nerve Injuries
When any trauma, pressure or illness sustained by the ulnar nerve, one of the three main nerves of the forearm, damages its functioning, they are referred to as ulnar nerve injuries.
There are three nerves in the forearm, the median nerve, the radial nerve and the ulnar nerve that govern the functioning of the forearm and the hand. The ulnar nerve starts from the shoulders and passing down the inside of the arm to the hand it runs right to the little finger. Not covered by muscles or bones throughout its course the nerve is susceptible to common injuries.
The ulnar nerve carries messages between the hand and the brain. It not only empowers the sensations and mobility in the hand and the forearm but also manages the muscles that control the finger movements. When the ulnar nerve suffers an injury the muscles that govern the functioning of the fingers and forearm become weak and the hand loses mobility and feeling.
Intense pain and loss of muscular strength in the arm, hand and the little as well as the ring finger are indicative of an ulnar nerve injury. The other symptoms that usually mark the presence of the injury are-
Burning sensation and soreness in the arm and hand Numbness in the arm and hand which increases with application of fingers i.e. while typing or writing
Prickling and unusual tingling sensations in the arm hand or fingers The symptoms may vary in their mildness or severity and may be experienced by the patient daily or occasionally.
Ulnar nerve injuries may arise out of traumatic accident, undue pressure on the nerve or a critical illness and sometimes they may perpetuate without any possible cause.
During its course from shoulder to hand, the nerve passes through two tunnels, cubital tunnel behind the elbow and the Guyon’s canal at the wrist. It is in these tunnels of tissue that the ulnar nerve may get compressed or injured due to pressure and result in ulnar nerve entrapment.
Sometimes arthritis, elbow dislocations, elbow or wrist fractures, and bone spurs may cause damage to the bones thereby resulting in an injury to the ulnar nerve.
Excessive use of arm and hand, repetitive bending of elbow may also cause ulnar nerve injury.
Direct trauma or any nerve disease such as diabetes or hypothyroidism may also become the reason for ulnar nerve to get damaged.
There are a number of factors besides common causes which increase the possibility of an ulnar nerve injury. The factors may not necessarily result in the injury but may induce its probability. They are-
- Positions during sleep that might create pressure on the ulnar nerve
- Any abnormalities in the elbow or wrist
- Brachial plexus injury
- Activities which may compel the elbow or wrist to be twisted or bent for long time periods
- Excessive habit or use of alcohol
After discussing the prevalent symptoms the concerned doctor examines the arm and hand to look for other visible signs and after conducting some physical tests to ascertain the damage in the nerve. Imaging tests like x-ray and nerve conduction studies are undertaken to clinically conclude the presence of nerve injury.
Treatment of the ulnar nerve injury depends significantly on the severity and the underlined factors that have caused the injury.
The initial course of treatment begins with corticosteroid injections, therapy, medications and splinting of the elbow or wrist and furthered with surgical interventions if non surgical techniques fail to provide any relief.
Techniques such as removal of cysts, surgery in the cubital tunnel or guyon’s canal, relocation of the ulnar nerve or removal of pressure from the nerve are some methods which are performed to provide relief to the patient.
If ulnar nerve injuries are not properly treated they might result in severe unforeseen complications such as-
- Pain that becomes persistent and permanent
- The nerve may get permanently damaged such that it may result in aralysis
- Sensations might be permanently lost
- Nerves may become problematic with tingling and numbness
Recovery in the nerves is a slow process and they take time to heal up after the surgical procedure. The success ratio is generally good and almost all surgical methods produce similar outcomes. It is only in cases where the nerve is severely injured or compressed that it does not return to its normal functioning ever.
The patient has to be extremely precautious after the surgery. Splint that is an essential tool for proper healing after the operations should not be taken off for a period of few weeks and all instructions given by the surgeon should be diligently followed.
Carelessness regarding the recommended therapy exercises should be avoided as they are important aids to regain strength and motion ability in the fingers.
Returning back to normal activities is usually dependent on the severity and the nature of the work that has to be returned to. After an in depth discussion with the patient the surgeon gradually lets the patient resume normal activities within days and advices the patient to stay away from strenuous activities for a period of few months to avoid re-injury.
- Frozen Shoulder
- Shoulder Dislocation / Shoulder Instability
- Rotator Cuff Tears / Injuries
- Scapula Fractures
- Shoulder Replacement
- Impingement Syndrome
- Proximal Humeral Fractures
- Clavicle Fractures
- Loose Body Removal
- Synovial Biopsy / Synovectomy
- Slap Injury and Repair
- AC Joint Injury
- PASTA Lesion and Repair
- Hand and Wrist Fractures
- Carpal Tunnel Syndrome
- Basal Joint Thumb Arthritis
- Distal Radius Fracture
- Scaphoid Fractures
- Radial Club Hand
- Rheumatoid Arthritis
- Metacarpal Fractures
- Giant Cell Tumors (GCT) Tendon Sheath
- Phalangeal Fractures
- Congenital Trigger Thumb
- Radial Nerve Injury
- Median Nerve Injury
- Extensor Tendon Injuries
- Flexor Tendon Injuries
- Ulnar Nerve Injuries
- Nerve Injuries Finger
- Mallet Finger
- Thumb Extensor Tendon (EPL) Rupture
- Dupuytren’s Contracture /Disease