CUBITAL TUNNEL SYNDROME

Cubital tunnel syndrome is a condition where the ulnar nerve is exposed to a compression or pressure and causes some problems such as pain, swelling, numbness and loss of force. The nerve progresses between the two distinct starting point of the muscle (flexor carpi ulnaris) that bends our wrist. As nerve is very superficial in this area, it is open to the pressure and trauma.

When we bend our elbow, ulnar nerve stretches and compresses by being pushed to the bone projection that we call medical epicondyl. When a long time passes with this position, for example those who sleep by putting their hands under their heads (by bending the elbow) and those who has to lean the elbow; cubital tunnel syndrome formation is easy. The connective tissue that covers the nerve thicken by reacting against to the recurrent. When transmission quality of nerve fibers between the thickened connective tissue decreased, symptoms of the syndrome appear.

Symptoms of cubital tunnel syndrome include pain, weakness, numbness especially in 4th and 5th fingers and electric shock even after small crushes on the elbow level (Figure 2). In advanced phases, it is observed that it is difficult to move fingers to each other, and 4th and 5th fingers bend reversely while the person tries to hold the hand flat.

The disease is diagnosed by detection for the findings above and EMG (Electromyography) and nerve transmission test which will be performed by neurologists.

In early cases, less trauma is tried to be provided by describing positions that stretches the nerve and revealing these symptoms. In some cases, splinter which flattens the elbow helps to moderate symptoms. Surgery is required in long term and advanced patients. Only the arm is narcotized in the surgery (axillary block anesthesia). Ulnar nerve is carried to the front of the elbow by exiting from two projecting bones in the elbow. Numbness and electrification sense may disappear within several weeks-months. Physiotherapy is needed in some cases after the surgery.

Source: cubital tunnel syndrome

CARPAL TUNNEL SYNDROME

Nervus medianus develops, along with 9 tendons, in a cavity called carpal tunnel on the innards of carpus. Ailments due to nerve compression in here is called carpal tunnel syndrome.

Median nerve passes through the space called carpal tunnel in the inner side of the wrist among with 9 tendons. The diseases caused by compression of the nerve in this region or exposure to a pressure are called carpal tunnel syndrome.

Mostly exact reason can not be found. Carpal tunnel obstruction by any reason causes a pressure on the nerve and this causes symptoms appearing. Thickening of transverse carpal ligament which forms the roof of the tunnel, swelling of tendon sheathes in the tunnel, masses that causes obstruction, pregnancy and some hormonal changes are most frequent reasons of this syndrome.

Carpal tunnel syndrome causes pain, quick exhaustion when doing hand works, numbness and loss of sense in the thumb, index finger and ring finger. Lysis may be seen in the muscle stigma on the bottom of the thumb. Existence or increase of symptoms especially in the night is typical. In advanced cases symptoms diffuse to whole day.

The disease is generally diagnosed by EMG (electromyography) test by neurologists. In suspicious cases, additional radiological examination may be required to reveal old bone fractures or possible masses.

In some cases, wrist splinter may moderate or abolish symptoms. Steroid injections may decrease swellings around the nerve and help regressing the symptoms.

Surgery is required for carpal tunnel syndrome which progresses against conservative preventions and lasts for a couple of months. Carpal tunnel Access is performed with a cut between the palm and the wrist and transverse carpal ligament which forms the roof of the tunnel is liberalized. In advanced cases, neurolysis (nerve liberalization) to the thickened nerve sheath of the median nerve under the microscope. Therefore, the pressure around the nerve is put away. Endoscopic carpal tunnel surgery (closed method) may be applied in selected cases. But, all of the symptoms may not be removed in some severe and delayed cases.

Source : hand surgery