As Ulnar Channel Syndrome or. Sulcus Ulnaris Syndrome Pressure damage to the ulnar nerve is called. The nerve runs relatively exposed at the elbow in a narrow groove, the ulnar groove - also called Funny bones known - and can be damaged by constant incorrect loads or other irritations. The ulnar channel syndrome manifests itself symptomatically by tingling on the little finger, the inside of the ring finger and on the corresponding parts of the back of the hand.
Schematic representation of the anatomy of the elbow in the sulcus-ulnaris syndrome. Click to enlarge.
The elbow nerve runs on the elbow in a narrow groove in the elbow bone directly under the skin and is only slightly protected from pressure or tension injuries by the surrounding connective tissue. He nervously cares for the little finger, the inside of the ring finger and the corresponding part of the palm up to the wrist.
Damage to the nerve has a direct effect on the mentioned regions of the hand and ranges from a slight tingling sensation or burning sensation to numbness to loss of strength or even restricted movement and claw-like positions of the little and ring fingers.
Brief pressure loads on the elbow nerve, for example through unintentional knocking of the elbow against a hard object, cause the typical pain in the "musician's bones", which usually subsides after several seconds.
There are several causes that can trigger ulnar channel syndrome. In people with normal mobility and mobility, the nerve can be damaged by repetitive stress on the forearm (golfer's elbow) or by leaning on the elbow, which is constantly repeated.
In professional drivers, the habit of frequently resting the left elbow on the window frame of the door or on an existing protrusion of the door while driving can gradually lead to damage to the ulnar nerve and trigger the typical symptoms. In immobile, bedridden people, repeated incorrect positioning, which constantly exerts pressure on the area of the ulnar groove, leads to a lesion of the ulnar nerve and can thus cause ulnar groove syndrome.
Injuries to the forearm tissue in the area of the ulnar nerve can also hinder and damage the nerve through constant tension or pressure in the case of severe scarring and hardening of the tissue, so that the typical symptoms can occur.
Ulinar groove syndrome leads to sensory disorders and pain in the hand. If a treatment is rejected, you can only move your hand to a limited extent in everyday life. A distinction must be made between initial symptoms and signs that appear after a while and are of a permanent nature. In the early stages, those affected usually describe a tingling sensation on their ring and little fingers.
The impression is created that an ant colony is running over the relevant areas. Other patients report that both fingers are numb. The unfamiliar sensation sometimes extends to the inside of the elbow. A stressful situation - such as lifting heavy objects - often promotes the symptoms mentioned. These disappear on their own after a few seconds or minutes.
As the disease progresses, the ulinar groove syndrome appears permanently. The gripping side of the hand constantly feels numb in everyday situations. Some patients also interpret the signs as a burning sensation. This limits the motor skills. The so-called claw hand is characteristic.
The ring and little fingers are permanently in a flexed position. Spreading the fingers is only possible with pain. If no treatment is started, muscle wasting (muscular dystrophy) sets in by avoiding painful movements. Persistent motor weakness then makes everyday life difficult.
An initial diagnosis of the presence of an ulnar channel syndrome can be made based on the symptoms of tingling, burning or numbness in the little finger and ring finger.
By checking the so-called Froment sign (paper strip test), the diagnosis of damage or complete paralysis of the ulnar nerve can be confirmed or refuted with a simple exercise. If the suspicion of damage or total failure of the ulnar nerve is confirmed, a differential diagnosis must be carried out to determine whether the nerve is already damaged from the ulnar groove or from the wrist (Loge de Guyon syndrome). Further electrophysiological diagnostic methods allow conclusions to be drawn about the conductivity of the ulnar nerve and the transmission speed of impulses.
If the causes of the triggering of the ulnar channel syndrome are not eliminated, in the further course of the disease, in addition to numbness, motor weakness and gradual muscle wasting set in. The consequences are limited mobility of the hand up to the typical claw hand.
The ulnar channel syndrome leads to a number of different complaints, all of which have a negative effect on the everyday life and quality of life of the patient. Most of those affected suffer from various sensory disorders in the area of the little finger. This feels numb and can tingle or hurt.
It is not uncommon for these sensory disturbances to spread to neighboring regions and can therefore also lead to discomfort in the other fingers or the wrist. The position of the little finger is claw-like, so that there are significant restrictions in the everyday life of the person concerned. The muscles are also significantly weakened, so that the ulnar channel syndrome can cause discomfort when working. The entire mobility of the hand is restricted due to illness.
In most cases, ulnar channel syndrome can be treated. Complications usually only arise if the disease is not treated. By immobilizing the finger or arm, recovery takes place. Those affected have to take care of their fingers, but there are no permanent restrictions. The life expectancy of the patient is also not negatively influenced by the ulnar channel syndrome.
In the case of ulnar channel syndrome, the person concerned is dependent on treatment by a doctor. Only with correct treatment and above all with a quick and early diagnosis can further complications or a further worsening of the symptoms be prevented. Therefore, at the first symptoms and signs of ulnar channel syndrome, a doctor should be contacted in order to properly treat the disease. A doctor should be consulted if the person concerned suffers from severe disorders of sensitivity. In most cases, the hands can hardly be moved, which can have a very negative effect on the patient's everyday life.
Furthermore, a permanent tingling sensation in the affected regions can indicate the ulnar channel syndrome and should also be examined by a doctor if it occurs over a longer period of time and does not go away on its own. These symptoms can also occur when lifting heavy objects and can indicate the disease. Usually the ulnar channel syndrome can be diagnosed by a general practitioner or an orthopedic surgeon. Further treatment depends on the exact complaints and their severity. As a rule, the patient's life expectancy is not reduced by this disease.
When diagnosing an ulnar gutter syndrome, it is sufficient in simple cases to eliminate the causative factors. Bad posture can be corrected or certain habits of constantly supporting the elbow in certain ways can be changed.
After eliminating the causative factors and using conservative treatment methods such as relieving pressure by elevating and cooling the inside of the elbow, it may be necessary to rest the affected elbow for a certain period of time. It may even be necessary to temporarily fix the arm in place with a plaster cast to allow regeneration of the ulnar nerve.
In chronic and advanced cases in which conservative therapy did not bring the desired success, conventional and minimally invasive surgical intervention are available. With the conventional surgical method, the nerve in the area of the ulnar groove is exposed and disruptive tissue is removed in order to achieve pressure relief. In individual cases it may be necessary to relocate the ulnar nerve.
A modern and gentler alternative to open surgery is the endoscopic minimally invasive method. The endoscope and cutting tool are placed on the ulnar nerve through a small incision and the interfering tissue that caused the lesion of the nerve can be removed. With the minimally invasive method, an area from the middle of the upper arm to the middle of the forearm can be covered.
The ulnar channel syndrome is usually triggered by mechanical stimuli and not by physiological or nutritional processes. The most important preventive measure is therefore the avoidance of incorrect loads and / or (bad) habits that can lead to a long-term lesion of the ulnar nerve.
The first signs of impairment of the ulnar nerve, e.g. B. by tingling or burning in the little finger or in the ring finger should be taken seriously and possible causes analyzed and then eliminated.
Follow-up treatment is required if ulnar channel syndrome is treated with surgery. Sometimes the wound may burn slightly after the operation. In such cases, the doctor will give pain relievers and decongestants. The painful symptoms usually disappear after a few days.
The sensitivity on the fingers also returns after a few weeks at the latest. In order to accelerate wound healing and counteract the swelling of the limbs, it is important to keep the arm still and take care of it. Complete immobilization with a cast is only required after an open operation. If, on the other hand, a minimally invasive procedure with an endoscope takes place, the patient is given a pressure bandage and is allowed to move the elbow gently.
After about ten to fourteen days, the doctor will remove the sutures or staples on the skin of the arm that has been operated on, if the wound has healed well. After just one to three days, the small drainage, which is used to drain blood and wound fluid, is removed again.
In the case of an outpatient operation, the doctor gives the patient precise instructions on how to behave before he is discharged. He also tells him when the first check-up should be carried out. Normally, the operating physician carries out the follow-up treatment himself.
Ulnar channel syndrome is treated by splinting or padding the elbow region. The movement behavior must be changed to support this. For example, avoid propping up the bent elbow. The physiotherapist or sports doctor can name measures with which the patient can adjust the movement sequences. The exercises should be carried out regularly so that the ulnar channel syndrome does not develop into a chronic disease.
Surgical decompression of the ulnar nerve is necessary in the event of severe pain or nerve disorders. After the procedure, the surgical wound must be carefully observed, as repeated flexion of the elbow can cause bleeding and other discomfort. Usually a rail is attached, which has to be adjusted regularly.
People who have been diagnosed with ulnar gutter syndrome must first refrain from any sporting activity that affects the affected arm or elbow. Physiotherapy and physiotherapy are alternatives. Massages, cool or warm pads and calming baths support the healing process. Which self-help measures are useful and necessary in detail always depends on the severity of the condition. It is best for patients to contact the responsible doctor, who can use the symptoms to name suitable measures.