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.

Myelography

Myelography or Myelogram is used to make a diagnosis of spinal canal and spinal cord disorders like nerve compression that in turn causes pain and weakness. A special dye is introduced into the spinal sac that in turn shows up in the x-ray to signify any deformities. The dye acts as an exclusive agent to outline the nerve roots and the spinal cord thus helping the doctor determine if there are any abnormal shapes in the spinal cord. Before CT scans and MRI scans were introduced, it was myelography that was used to study any abnormalities in the spinal cord. Current medical world uses myelography only for complicated revision spine surgeries and for patients who have metal plates or screws in their spine. Myelography is primarily used to identify slipped disk by exactly locating the disk or disks concerned. Spinal arthritis can develop bone spurs that may press against the nerves and cause pain, myelography can help identify if surgery is required and can also help spot if the spinal canal is narrowed. Tumors can be accurately located. A patient preparing for myelogram must stop a solid diet for a day and drink plenty of clear fluids.

Coccydynia

The coccyx also called the tailbone is located at the bottom of the vertebral column. The pain associated with this area - Coccydyniais is usually a localized form of inflammation. The pain occurring in the coccyx region can be very painful as it is connected to many muscle innervations in the gluteal region. The surrounding muscles that arise and enervate at this junction are gluteal, rectus femoris and the muscles governing the sphincters of the anus.

Coccydynia is caused by trauma to the lower spine. This condition is common in the emergency room as it is associated with falls and accidents. Many athletes complain of the tailbone, which may include other reasons such as nerve compression, ligament tear and fractures. Some studies indicate the involvement of the inter-vertebral discs, which in conditions such as cystic fibrosis can cause inflammatory response leading to coccydynia. This particular condition is characterized by degeneration of intercoccygeal and sacrococcygeal discs. Based on etiological conclusions, coccydyniais is defined as a condition which can be idiopathic or traumatic in origin.

In some cases coccydyina can be caused by the anatomical deformities in which bony spicules and coccygeal retroversion are found. These are termed as type II, III and IV forms of coccyx. Other causes include inflammation of the pelvic bone floor muscles and the soft tissues surrounding the coccyx and also compression of sacral nerve roots. Infections also play a major role in the onset of this condition. The most predominant forms of infections associated with coccydynia are tuberculosis, meningitis (bacterial and viral), arthritis and clostridium related infections. Sometimes, trauma to the coccyx results from an accident, poor posture or even during childbirth.

Symptoms

Although coccydynia is often mild in origin with respect to its occurrence, the progression of the condition can worsen and affect the lifestyle of a person - making the person slower as the pain radiates causing restricted movements and abstinence from prolonged physical activity, which may sometimes include daily routines. Coccydynia is more prominent in women than men due to the associated osteoporotic condition in which the calcium and phosphate imbalance is noticed to a larger extent in the deterioration of the bones. Elevated pain during sexual intercourse, premenstrual period and also in defecation are noticed. The pain is usually worse when sitting down or moving from sitting to standing position. Other symptoms include painful buttocks and hips and shooting pain down the legs.

Diagnosis

Radiological diagnosis is more significant in coccydynia as CT, MRI and PET scans reveal the gross anatomy of the coccyx. Sagittal rotation, hard stools, angle of pelvic rotation and angle of mobility can pave the way for definitive diagnosis of this condition.

Patients with coccydynia are advised to avoid long hours of sitting as this elevates the pressure on the tailbone. In most cases anti-inflammatory drugs are given and patients with persistent coccydynia are treated with cortisone injections. Physiotherapy can provide short-term relief from pain. Surgical interventions such as coccygectomy are done to remove any bony prominence in the coccyx region.