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Ulnar Neuropathy

Ulnar nerve is a nerve that originates in the brachial plexus and travels downwards to the arm. It extends from shoulder to the wrist and branches into little finger and ring finger. It is responsible for sending sensation to the inner forearm, a portion of the palm near the little finger and half of the ring finger. Any damage caused to this nerve leads to a condition called ulnar neuropathy.


One of the most common causes of repeated neuropathy is compression. This is the only nerve in the entire body that is not well protected by bones and muscles and hence more prone to damage. The ulnar nerve can be constricted and get entrapped as it passes through the elbow and wrist. It can even be entrapped under the collarbone or at the point of origination near spinal cord. However, the ulnar nerve is commonly entrapped at the elbow and the condition is known as Cubital Tunnel Syndrome. It is also referred to as ulnar nerve compression, Ulnar nerve palsy or ulnar nerve entrapment. The other names for ulnar nerve condition are Bicycler's neuropathy and Guyon's canal syndrome.


Patients with ulnar nerve compression at any level have altered sensation in the little and ring fingers. Indeed, in most patients, sensory loss is the first symptom to be reported. As the condition progresses, they may also notice clumsiness in the hand, as the ulnar nerve is the principal motor supply to the intrinsic muscles of the hand. In well‐established cases, there may be marked wasting of the small muscles of the hand and the ulnar‐sided muscles of the forearm. Typical symptoms of this condition involve numbness and reduced sensation in the fingers. Clumsiness or weakness of the hands might be noticed. There is loss of grip and reduced coordination between fingers.


Direct injury to the nerve or pressure are primary causes for this condition. In severe cases of ulnar nerve compression, wasting of the muscles of the hand and forearm may be detected. Any injury such as fracture, dislocation or severe twisting of elbow can affect the the ulnar nerve. Pressure on the nerve caused by swelling or injury of adjacent tissue can also lead to ulnar nerve compression.


A through physical examination is conducted and history and symptoms of the patient are noted. Doctor may ask the patient to perform certain tasks with the hands to understand if the pain is arising due to ulnar nerve entrapment. Ultrasonography and/or MRI of the ulnar nerve in conjunction with nerve conduction study to assess the functioning of the ulnar nerve, can help identify the location at which it is being compressed.


Treatment of Ulnar Nerve Compression

Ulnar neuropathy is most often treatable through a conservative approach. Pain relievers and anti-inflammatory drugs are prescribed to address the pain. Steroid injections, though highly effective, are avoided as they can damage the nerve when injected in that region.


  • Giving some rest to the elbow and keeping it straight relieves the pain. Doctor may prescribe a padded brace or splint to wear at night to keep the elbow straight while sleeping.
  • Occupational therapy is also found to be highly effective in treating ulnar neuropathy as it strengthens the ligaments and tendons surrounding the elbow region and wrist.
  • Nerve gliding exercises are also taught to release the trapped ulnar nerve through cubital tunnel at the elbow or the Guyon's canal at the wrist.
  • When physical therapy and other forms of non-surgical treatment fail to address the pain and when the arm muscle is getting wasted, nerve entrapment surgery is the only option to treat ulnar neuropathy.

Sedatives

Antihistamines

Antihistamines are widely used for allergies and motion sickness. As they exhibit properties that can indirectly induce drowsiness, there is a class of antihistamines, sold as OTC sleeping pills. However, the American Academy of Sleep Medicine warns that such pills should be used only occasionally. Beware that there is a price to pay for buying OTC antihistamines. Some OTC sedatives combine antihistamines with pain relievers and some combine it with alcohol.


They can induce abnormal muscle spasms. Other side effects are blurred vision, constipation, diarrhea, nausea and vomiting, dry mouth and general dehydration. Therefore she needs to consume plenty of water if she is taking any antihistamine. In elders and children, antihistamines can cause nervousness and insomnia. Similarly, asthmatics should steer clear of antihistamines as these can aggravate their condition. They can affect the behavior of the fetus in the womb. Antihistamines also interfere with lactation. Be warned that OTC antihistamines should never be clubbed with alcohol or other sedatives.


Although it is construed that some antihistamines are non prescription sleep aids, and they are more sedating than prescription hypnotics, beware that their effectiveness may decrease over time. More importantly, OTC sedative is only meant for short-term insomnia and by and large the long term effectiveness and safety of the OTC drugs is questionable. However, for transient insomnia or insomnia based on illness or depression, antihistamines can be an effective OTC tool.


Sedative antihistamine list includes (the following list also contains suggested dosage for an adult. Always take the medications e.m.p (ex modo prescripto as directed by the physician):

  • Chlorpheniramine (Chlor-Trimeton) 4 mg every 4 to 6 hrs; maximum dose: 24 mg/day

  • Cyproheptadine (Periactin) , 4 mg at bedtime

  • Clemastine (Tavist), 50-100 mg every 4-6 hours, not to exceed 400 mg/day and it is supplied in table form chewable

  • Diphenhydramine (Benadryl), as a night sleep aid to be taken 30 minutes before bedtime, and the dosage is 50 mg for adults

  • Promethazine (Phenergan) Sedation: 25-50 mg orally or 50 mg rectally

  • Hydroxyzine (Atarax, Vistaril), oral sedation dosage 50-100 mg, IM 25-100 mg. Intravenous (IV), subcutaneous and intra-arterial administrations are not recommended as these can cause thrombosis and digital gangrene.


These come in various brand and trade names and they can be taken as tablets, syrups or nasal sprays. Droplet form for use in the eyes is also available. The effects of these antihistamines including drowsiness, dizziness, headache, loss of appetite, vision changes, irritability, dry mouth, stomach upset should subside, when the body begins to adjust with the medication. If these side effects continue, it is better to contact the medical practitioner. Sedative antihistamines may be taken with food and milk. Sustained release low acting tablets can be swallowed whole as chewing the sustained release long acting tablets may destroy the action and increase the side effects. Chewable tablets can be chewed thoroughly and swallowed. Suspensions should be shaken before food consumption.


Melatonin

This is a hormone produced by human body – by the pineal gland, a pea-sized structure at the center of the brain. This regulates sleep and wakefulness. Taken as a supplement, melatonin helps to reduce delayed sleep syndrome. This also improves sleep quality and lengthens the period of sleep. Day time alertness also seems to improve when this is taken. Melatonin can treat insomnia without altering the sleep pattern of the individual. It also does not impair any performance related skills.


This may help elders with insomnia as the amount of melatonin produced in the body seems to decrease as one gets older, although it is not recommended for chronic insomnia. Melatonin works on the circadian rhythm – the biological clock that regulates our sleep and wake cycles. Many become melatonin deficient due to age, work schedules and stress. Melatonin supplements are a quick way to adjust the lack of melatonin in the body and rebalance the sleep cycle. These are available OTC and when used in conjunction with herbs like chamomile and lemon balm, help lull the body to sleep acting as a true sedative.

Although Melatonin shows good effects for the treatment of insomnia, if used in excess, this sedative can produce side effects including sexual irregularities, mood swings and depression. Although by and large safe when used in moderation, it is unsafe for small children and pregnant women to use melatonin supplements. It is also not recommended for those with lymphoma, extreme allergies, depression, rheumatoid arthritis, auto immune diseases and for cancer patients. Some melatonin sedatives include:

  • clonazepam (Klonopin)

  • lorazepam (Ativan)

  • phenobarbital (Donnatal)

  • zolpidem (Ambien)


As such Melatonin can cause sleepiness and drowsiness, and if taken with sedatives that cause sleepiness, then too much of sleepiness can result. Research indicates that quick release Melatonin can be more effective than sustained-release formulations, especially when used as sedatives. Intramuscular injections of 20 mg of Melatonin are also available.


SAMe

This is also found naturally in the body. This OTC aid can not only help to sleep but also treats depression and chronic fatigue by promoting serotonin production in the body. Unless consumed in large quantities, SAMe has no known side effects.


Antidepressants used as sedatives

Although the FDA has not approved the use of antidepressants as sedatives, there are those who believe that insomnia is related to depression. As with any other medication for depression, there is a significant risk of suicidal thoughts particularly in adolescents and children. Approximate dosage of antidepressants s.o.s (si opus sit only if there is a need) :

Citalopram 20 mg
Escitalopram 5-10 mg
Fluvoxamine 100 mg
Fluoxetine 20 mg
Paroxetine 20 mg
Sertraline 50-75 mg
Venlafaxine 75 mg
Donormyl sleeping pills are available without prescription and they are approved by the FDA for non-prescription. They are used in the treatment of insomnia. 25 mg of Donormyl is the strongest non-prescription sleeping pill. Possible common side effects of antidepressant sedatives include diarrhea, dizziness, headache, insomnia, rash, vomiting, blurred vision, decreased appetite, cold symptoms, nervousness, cramps, hallucinations, hair loss and decreased coordination.


OTC sedatives side effects

Although OTC sedatives can be effective for an occasional sleepless night, the longer you take them, the less they are likely to make you sleepy. OTC sleep aids can leave you feeling groggy and unwell the next day. This is like the 'hangover' effect. Much remains unknown about the safety and effectiveness of OTC sleep aids.

Dizziness and forgetfulness, clumsiness, feeling off balance, dry mouth and throat are some common side effects. Serious risks of OTC sedatives include severe allergic reaction, facial swelling, memory lapses, hallucinations, suicidal tendencies, sleep-related complexities such as sleep-walking, sleep-driving, and sleep-eating. If any unusual sleep-related behavior is exhibited, consult the doctor immediately.


Over-the-counter sedative tips


  • Consult the doctor before taking OTC sedative, although you do not need the doctor concurrence to buy an OTC drug. This is because your doctor can make sure that the sedative does not interfere with other underlying medications.
  • Certain OTC drugs are not recommended for those with glaucoma, asthma, chronic pulmonary disorders, liver diseases and urinary retention.
  • Remember that OTC sedatives are only a temporary solution for insomnia and they are not intended to be used for longer than about two weeks.
  • Persistent insomnia is a symptom of an underlying medical or psychological problem. These cannot be cured with OTC sedatives. It is better to learn about safer and effective way of end sleepless nights.
  • Never mix alcohol with sedatives and this can increase the sedative effects of the medication.
  • Combining medications such as OTC sedatives and pain relievers and allergy medicines is very dangerous.
  • Do not drive or attempt any other activity that may require alertness while taking a sedative.
  • Over a period of time, you may build up intolerance to sedatives and this can in turn lead to more side effects.
  • You may also come to rely on sedatives and will be unable to sleep without them.


Abscessed Tooth

A dental condition wherein the nerve or the dental pulp (inner part of tooth) gets infected is termed as abscessed tooth. The bacterial infection in the inner part of the tooth leads to collection of pus. Following a good oral hygiene regimen many help preventing dental abscess.

Tooth abscess types

Periodontal: occurs in the supporting bone and tissue structure of the teeth.

Periapical: found in the dental pulp.

Gingival: occurs in gum tissue, does not affect tooth or periodontal ligament.


Abscessed tooth causes


  • A dental cavity when left untreated leads to spread of infection deep within the tooth and this may cause abscessed tooth.

  • A broken tooth or cracked tooth can also cause abscessed tooth as the dental pulp is exposed to the environment.

  • An infection between the gum and root of the tooth can also cause tooth abscess.

  • Gum disease can also cause abscessed tooth.

  • Gingivitis can also cause abscessed tooth.

  • Trauma to tooth or mouth.

  • Weak immune system.

Abscessed tooth symptoms

Typical symptoms of an abscessed tooth include swelling, toothache, bad breath, inflammation of the gum tissue, sensitivity in tooth and swollen neck glands. A dentist will physically examine it and might order a tooth xray.

Abscessed tooth treatment

Abscess is drained through the procedure of root canal. A crown is placed on the tooth to protect it. Affected tooth may be extracted. Incision into the swollen gum may treat the condition. Antibiotics prescribed prevent infection and pain relievers help relieve pain.

Dental Abscess prevention

Brush teeth twice a day. Eat a balanced diet low in sugar. Use dental floss to clean in between teeth. Visit dentist for regular dental check. Use fluoridated drinking water.

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Bibliography / Reference

Collection of Pages - Last revised Date: December 13, 2019