Specialists in the Field of Cubital Tunnel Syndrome
Information About the Field of Cubital Tunnel Syndrome
Are you looking for information on sulcus ulnaris syndrome and specialists for treatment or surgery? Then, you will find exclusively experienced specialists and clinics in Germany, Switzerland, and Austria for the diagnosis and treatment of cubital tunnel syndrome. Find out about symptoms, signs, diagnosis, and surgery, and contact our specialists.
What is Sulcus Ulnaris Syndrome
Sulcus Ulnaris Syndrome (also called cubital tunnel syndrome) is basically a nerve bottleneck of the ulnar nerve, the elbow nerve. It proceeds on the inner surface of the little finger side of the forearm and is palpable in a groove-like depression in the elbow area when suffering from sulcus ulnaris syndrome.
The nerve runs extremely close to the surface and is therefore very sensitive. For example, probably everyone has hit their elbow on the edge of a table or something similar and felt a pain that sometimes spreads into the hand. This is the so-called funny bone, a narrow nerve plexus that proceeds close to the skin in this area, where, among others, the ulnar nerve is localized, which triggers this pain.
The ulnar nerve performs two very important tasks: On the one hand, it supplies the last two fingers sensitively (sensation supply), and on the other hand, it supplies essential parts of the forearm, the ball of the thumb, the ball of the little finger, and the short muscles of the hand (extension and flexion of the fingers) with motor function (movement). At the wrist level, the ulnar nerve then enters the hand through what is called the Loge de Guyon.
What Are the Causes of a Sulcus Ulnaris Syndrome?
Probably the most common cause of this syndrome is overuse in the form of pressure or traction in the ulnar nerve area. However, dislocations, contusions, strains, and fractures can also cause sulcus ulnaris syndrome. Rather rarely pronounced but occurring are tumors, anatomical shape variants of the muscles or ganglia (ganglions), which can trigger this syndrome.
What Are the Symptoms?
Patients with sulcus ulnaris syndrome often report fingers getting numb, often in the area of the last two fingers. However, these "numb" fingers are also associated with paresthesia in the region of the hand and forearm edges. In parallel with this paranesthesia, a very severe constriction syndrome may also cause pain that may radiate from the edge of the forearm to the last two fingers. If the sulcus ulnaris syndrome remains untreated, paralysis or reduced strength may also occur in the late stages, affecting the supply area of the ulnar nerve. The consequence of these paralysis symptoms is also muscle atrophies. This means that the muscle shrinks due to insufficient movement resulting from the paralysis.
How Does the Physician Make a Diagnosis?
The differential diagnosis between sulcus ulnaris syndrome and Loge de Guyon syndrome can sometimes present complex because the latter syndrome is also described with numbness in the last two fingers. Still, muscle weaknesses of the forearm are also found in both syndromes. Therefore, only a neurophysiological examination can distinguish between sulcus ulnaris syndrome and Loge de Guyon syndrome. Generally, during clinical examination, patients report numbness in the area of the fifth finger and on the inside of the fourth finger.
If this disease progresses further, patients also find it challenging to hold a sheet of paper between their fingers when stretched. The final stage of this disease then results in a loss of strength in the fingers and muscle weakness in the thumb.
Which Therapeutic Options Are Available?
Generally speaking, conservative therapies can be used in the early stages, while surgery must be considered for advanced diseases. Conservative therapy, in this case, includes avoiding extreme bending and stretching movements and pressure and tension loads, which can trigger the pain.
In many cases, the condition improves in the course of this treatment. There are also orthoses for the sulcus ulnaris syndrome, so-called wrist splints worn at night. They hold the forearm or hand in a particular position to minimize the pain, which is very often unbearable at night. If there are still complaints, these can also be controlled with cortisone therapy combined with certain local anesthetics.
Sulcus Ulnaris Surgery
If the sulcus ulnaris syndrome is already in an advanced stage, or if conservative therapy has not improved, surgery should definitely be considered. If left untreated, this syndrome will continue to worsen. Two types of surgery are available: endoscopic surgery using small cameras and tubes or traditional open surgery through incisions in the skin.
In many clinics, the open procedure is highly valued. First, after general anesthesia is given, an approximately five-centimeter-long skin incision is made in the area of the elbow groove, and the ulnar nerve is widely exposed to relieve the pressure. In doing so, it is only necessary to relocate the nerve in small exceptional cases. The skin is then sutured, and the stitches can be removed as usual after about two weeks. Immobilization of the arm by a splint is not necessary. However, heavy work with the operated hand should not be started immediately after the operation, but rather it should be spared for two to four weeks.
In some cases, postoperative physiotherapy may also be necessary, although this measure may differ from patient to patient. Strength and sensation may also not be fully restored until several months postoperatively, so the patient should not do any strenuous work but should also have been informed of this fact.
Are There Any Risks or Complications to Be Aware Of?
The general risks or complications include postoperative bleeding, inflammation, infection, hematoma, wound healing problems, and nerve and vascular injuries. There may also be temporary or permanent paralysis and numbness. Visible scars may also occur.
Generally speaking, this surgery can be carried out under local or general anesthesia and, if performed by a specialist, is a routine procedure and relatively low risk.
Which Doctors and Clinics are Specialized in Sulcus Ulnar Syndrome Surgery?
Every patient who needs a doctor wants the best medical care. Therefore, the patient is wondering where to find the best clinic. As this question cannot be answered objectively, and a reliable doctor would never claim to be the best one, we can only rely on a doctor's experience.
We will help you find an expert for your condition. All listed doctors and clinics have been reviewed by us for their outstanding specialization in Sulcus Ulnar Syndrome and are awaiting your inquiry or treatment request.
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