Compression syndromes of the Ulnar nerve
(Compression of the ulnar nerve)
1. Cubital tunnel syndrome (compression of the ulnar nerve at the elbow) (= Cubital tunnel syndrome)
2. Loge de Gyon syndrome (compression of the ulnar nerve at the wrist)
1. What does “cubital tunnel syndrome” mean?
The Cubital Tunnel Syndrome (cubitus = elbow) or “Ulnar sulcus syndrome“ is the second most common nerve compression syndrome in the arm, after carpal tunnel syndrome. It involves compression of the “ulnar nerve” (Ulnar nerve) in the so-called cubital tunnel. In this “tunnel,” the ulnar nerve is constricted by strands of connective tissue or by a bony protrusion of the humerus on the inner side of the elbow (medial epicondyle). When the arms are flexed, the ulnar nerve can repeatedly catch on this bony protrusion, thereby causing symptoms. If the nerve is compressed within this canal by a thickening of this connective tissue plate, you may notice a recurring “tingling” sensation in the fingers, particularly in the ring finger and the little finger on the ulnar side. In addition, you may experience pain and weakness in the hand; objects may suddenly “slip out of your hand”; the muscles on the back of the hand may atrophy; and sensation along the ulnar side of the hand’s edge and on the back of the hand may be diminished.
If you are experiencing these symptoms, it is essential to undergo an evaluation by a neurologist, including a measurement of motor and sensory nerve conduction velocities.
If you have previously had a broken bone in your elbow, an X-ray of the elbow should also be taken in two planes to rule out bony protrusions.
If you experience unexplained neck or arm pain accompanied by numbness on the inner side of the forearm, it is essential to have your spine and the brachial plexus examined by an orthopedist and a neurologist to rule out other conditions, such as “thoracic outlet syndrome” or similar conditions.
2. What is Loge de Gyon syndrome?
The ulnar nerve passes through a sheath in the wrist region, “Gyon Lodge.” This compartment is bounded laterally and inferiorly by the carpal bones on the ulnar side of the wrist. A sheet of connective tissue spans this area, which can compress the nerves within this compartment. It is also not uncommon for a so-called ganglion (a protrusion of the synovial membrane) or external pressure to be the cause of these symptoms (e.g., “cyclist’s paralysis” caused by pressure from the hand against the bicycle handlebars). Within this compartment, the ulnar nerve divides into a superficial and a deep branch. The superficial branch supplies sensation to the little finger and the ulnar half of the ring finger. The deep branch is responsible for the function (motor control) of the small muscles of the hand.
If the nerve in the Gyon Lodge restricted, you'll notice:
— weakness in gripping between the thumb and index finger, and
— weakness in bringing the extended fingers together and spreading them apart.
This is caused by progressive muscle atrophy of the small muscles of the hand—resulting in visible indentations on the back of the hand between the thumb and index finger and the other metacarpal bones (advanced stage of the disease, known as “claw hand”).
In addition, sensation in the little finger and ring finger (on the ulnar side) may be diminished, or there may be a “tingling sensation” in this area if the superficial branch of the ulnar nerve is affected.
If you are experiencing these symptoms, it is essential to undergo an evaluation by a neurologist, including a measurement of motor and sensory nerve conduction velocities.
It is essential to rule out “cubital tunnel syndrome” (reduced sensation along the ulnar side of the hand in cubital tunnel syndrome!). In rare cases, nerve compression can occur at both sites (at the elbow and at the wrist, known as the “double-crush phenomenon”).
If you have previously fallen and landed on your wrist, you should also have an X-ray of the wrist taken in two planes, and, if necessary, a targeted carpal tunnel X-ray, to rule out bone-related causes, such as a hook-shaped bone fracture.
Information on the operation
You should not have any open wounds or scratches on the hand in question before the operation, as this increases the risk of infection. If the skin is very rough and hard, the hand should be treated with a well-lubricating hand cream several days before the operation and, if necessary, a disinfectant hand bath should be carried out the evening before the operation.
In cases of mild symptoms and a slight slowing of nerve conduction velocity, an initial attempt can be made to alleviate the symptoms using anti-inflammatory medications, wearing a splint to relieve pressure, physical therapy, ultrasound treatment, or electrical stimulation (TENS therapy). If these measures do not result in improvement or if there are advanced neurological findings, surgery is indicated. Pressure-related damage often resolves spontaneously.
If the condition has been present for a long time, irreversible nerve damage caused by pressure may have already occurred. This means that hand strength and pain may not fully recover after surgery. In addition, the muscles inside the hand atrophy, so that the ring finger and little finger can no longer be fully extended (“claw hand”).
1. Cubital Tunnel Syndrome
During surgery for cubital tunnel syndrome, the constricting band of connective tissue over the nerve on the inner side of the elbow is cut, thereby relieving pressure on the nerve.
The surgery is performed using what is known as an “upper arm tourniquet,” which means that a blood pressure cuff is placed around your arm and inflated to minimize bleeding and allow for a clear view during the procedure, using magnifying glasses.
The incision is made along the course of the nerve, on the inner side of the elbow. After cutting through the skin and fatty tissue, the nerve is exposed and any constricting strands of connective tissue are cut. At the same time, the surgeon checks whether the nerve jumps over the palpable bony protrusion on the inner side of the elbow when the elbow is flexed and, if so, whether it needs to be repositioned forward into the fatty tissue. In rare cases, this bony spur, which presses on the nerve, must be removed as the cause of the symptoms. After the skin is sutured, a bandage is applied, and the arm may be wrapped with an elastic bandage.
If the nerve is repositioned or bone is removed, a plaster splint is applied to immobilize the elbow for about 1 week.
2. Loge de Gyon syndrome
During surgery on a “Gyon Syndrome“This relieves pressure on the ulnar nerve on the palm side of the wrist.”
The surgery is performed using what is known as an “upper arm tourniquet,” which means that a blood pressure cuff is placed around your arm and inflated to minimize bleeding and allow for clear visibility while operating with magnifying glasses. The ulnar nerve is located through an incision on the ulnar side of the wrist, and the superficial and deep nerve branches are exposed. The constricting band of connective tissue over the nerve is then cut, thereby freeing the nerve. If a ganglion is found to be the cause of the symptoms, it will be removed.
After the skin is sutured, a bandage is applied and the hand is wrapped with an elastic bandage.
Hospital stay and anesthesia
The surgery can be performed under General anesthesia or with a local anesthetic injected into the brachial plexus (Plexus anesthesia) be carried out.
A hospital stay is generally not necessary.