Elbowing Injury Out Of The Way

Ulnar neuropathy at the elbow (UNE), or “Cubital Tunnel Syndrome”, is the second most prevalent form of peripheral nerve entrapment (after median neuropathy at the wrist) and occurs when the ulnar nerve becomes compromised at the elbow.

The ulnar nerve is one of the three main nerves in the arm. It begins underneath the collarbone and travels down the inside of the arm, wrapping around the elbow and entering the hand, where it divides into two branches – the superficial branch (providing sensation to the pinkie finger and medial half of the ring finger) and a deep branch (providing motor supply to the remainder of the hand).

There are several potential sites of entrapment along the ulnar nerve; however, it’s most vulnerable to compression at the elbow, where it travels through a narrow space with a lack of protective muscle. Enlargements, tears, deformity or trauma to the elbow can all increase the nerve’s susceptibility to an UNE and/or dislocation.

UNE symptoms may include elbow pain (commonly with trauma) and an impaired sense of touch (often after prolonged/awkward positioning, such as in a sling). Conversely, there may be no pain at all. If the UNE is severe, hand muscles can become weak and wasted. Numbness or tingling sensations of the fourth and fifth fingers also support a diagnosis of UNE.

Proper neurophysiology testing is important to confirm a UNE diagnosis, rule out other conditions and determine if co-existing neuropathies are present.

Nerve conduction studies (NCS) can provide an accurate overall impression of ulnar nerve function. Electromyography (EMG) can also be used to assess the functional effects of the injury.

Coastal Neurophysiology provides premium quality, bulk-billed NCS and EMG testing, with no long wait periods, servicing our local community for more than twenty years. Results are immediately explained to you by our Neurologist and are sent to your referring Doctor within 24 hours.

We recently tested a 71-year-old woman who presented with a fracture in eight places in her right shoulder, after a fall while gardening.

She presented with numbness in her fourth and fifth fingers – classic UNE symptoms – as well as a ‘trigger’ finger and general weakness in her hand, which was initially likely attributed to the fracture.

It was important to determine if a UNE was present (or if all of the symptoms were attributable to the fracture), whether the only site of injury was at the shoulder and whether surgery was likely to assist.

Our Neurologist suspected that a UNE co-existed with her fracture, as the symptoms in her fourth and fifth fingers emerged only after her elbow was kept flexed in a sling and not after the original injury.

NCS testing was then conducted on her neighbouring nerves to rule out similar conditions. These results were normal, rather than supporting a UNE diagnosis.

To determine if the UNE was in her shoulder or elbow, NCS was then conducted on her ulnar nerve, moving from the wrist up towards her shoulder. Results were normal from her wrist up to her mid-forearm, with poor responses at her elbow, returning to normal towards her shoulder. This indicated a clear UNE. Further EMG was not required.

Surgery was recommended, which would likely see the patient recover in full. It was important for these tests to be performed (assuming that all of the symptoms should be attributed to the original injury). The NCS findings in this patient were also critical to correct management and an optimal long-term outcome for the patient.

For more information on neurophysiology testing visit www.corbett.com.au or phone 07 5503 2499 and ask your GP for a referral today.

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