Ulnar neuropathy is caused by nerve damage. The nature of the nerve damage is varied, and can result from inflammation or compression. Nerve damage at the elbow can result from compression of the nerve when sensation is obliterated during general anesthesia. As well, a blow to the elbow or even too much leaning on the elbow can be damaging, as can diseases (rheumatoid arthritis) and metabolic disturbances (diabetes). Even malnutrition can be a factor, as protective fatty deposits and muscle mass waste away. Damage to the nerve at the wrist can be caused by a blow, tumors, and impinging of an artery.
The nerve damage that results in ulnar neuropathy can involve the main body of the nerve, the branching region at the end of the nerve known as the axon (which is involved in the movement of the nerve impulse to the adjacent nerve), and the protective myelin coating around the nerve. When the main body of the nerve is involved, the problem is usually a block in the passage of the impulse down the nerve. Axon damage typically decreases the movement of the nerve impulse away from the nerve or the wavelength of the impulse. As a result, the impulse may not reach the adjacent nerve, or may not be recognized by the receptors of that adjacent nerve. Finally, damage to the myelin sheath (demyelination) also impedes the movement of signal down the body of the nerve.
Depending on the site of the neuropathy and whether the neuropathy arises suddenly (acute) or has been present for a long time (chronic), various symptoms can arise. Acute and chronic ulnar neuropathy of the elbow is always associated with numbness and weakness. Pain is present almost 40% of the time in the acute form of the disorder and almost 80% of the time in the chronic disorder. When the ulnar neuropathy involves the wrist, weakness is ever-present in a main muscle controlling wrist movement, generalized weakness in the absence of pain in 50% of those afflicted, and finger numbness occurs in about 25% of cases.
Other physical signs include the adoption of a clawed shape by the hand and the inability of the entire thumb to move to the forefinger in a single motion.
Diagnosis
Typically, the development of weakness in the elbow or wrist is the sign that alerts aclinician to the possibility of ulnar neuropathy. Follow-up tests can include ultrasound ormagnetic resonance imaging to visualize cysts or structural abnormalities. The functioning of the nerve can be assessed in a nerve conduction EMG/NCS test. Laboratory analyses of blood can be done to detect the presence of diabetes or infections that can damage nerves (such as Lyme disease, human immunodeficiencyvirus, or hepatitis viruses).
