Neurological diseases of the elbow joints. Neuropathy of the ulnar nerve. Features of medical care

Joint problems worry about every fourth person. Some develop problems with the hands or feet, while others develop problems with the knee and hip joints. Much less common lesions elbow joint, however, given its importance for daily activities, one should understand its anatomy and possible problems with him.

Joint anatomy

What is the elbow joint?

It is formed by three main bones upper limb- brachial, ulnar and radial. The joint is combined (i.e., several joints are involved in its formation - the connection between the humerus and ulna, between the bones of the forearm, as well as mobile joint between the head of the shoulder and the beam). All of them are closed in one capsule, which eventually forms the elbow joint.

Movement in it is carried out along several axes - flexion / extension (movement in the frontal plane), pronation / supination (right / left rotation). Thanks to such mechanics, complex movements are possible.

Flexion of the elbow joint is carried out by sliding the olecranon along the block of the shoulder. Rotation occurs due to the displacement of the bones of the forearm in the proximal (closest to the central axis of the body) joint.

The actions themselves are due to the muscles attached to the bones of the upper limb. These include biceps, triceps, deep shoulder muscle. All of the above formations, including ligaments, form a complete elbow joint.

Pain syndrome

Elbow pain can appear for many reasons. First of all, it is typical for long-term work in forced position(printing of text, at manicurists in beauty salons, drivers). The pain syndrome is characterized, in this case, by low intensity, a feeling of heaviness at the end of the working day, swelling of the joint. Usually, swelling is preceded by pain in the elbow joint. The reasons for its development lie in the stagnation of blood and lymph in the vessels, ischemia of the components of the articular bag and cartilage. After doing warm-up exercises, it usually disappears.

Everything becomes worse when there is any disease or inflammatory process. In this case, pain is a harbinger of a more serious condition. An exception is traumatic injury, when it occurs after the injury. What processes underlie the fact that there is pain in the elbow joint? The causes of pain syndrome will be listed below.

Classification of diseases

Due to its complex structure, the joint is prone to various types diseases. These can include both traumatic (bone fractures, dislocations, muscle ruptures, sprains, bruises) and non-traumatic etiology (inflammatory diseases of bone muscles, articular bags).

Injuries develop much more often than infectious lesions. Inflammatory processes are rare, however, with their progression. contribute to the dysfunction of the limb and temporarily withdraw it from circulation.

Direct joint damage usually occurs after excessive load on the axis of the limb. Their treatment takes quite a long period. Rehabilitation after an injury takes no less time.

Inflammation in the elbow joint, with a timely diagnosis, passes quite quickly. The function of the limb after the disease either does not suffer, or its ability to move is slightly impaired. What diseases are most common?

Epicondylitis

The disease is a consequence of muscle overload. There are two forms of the process - lateral and medial.

The medial form develops in people who are predominantly engaged in light, but prolonged physical labor(seamstresses, shoe repairmen, and professional golfers).

Lateral epicondylitis is usually associated with limb overload during exercise. sudden movements. Tennis players usually suffer.

Most often, the disease is characterized by pain in the epicondyle humerus. The pain is intense, aching. It gets worse when you try to bend or straighten your arm. If there are similar symptoms, and the disease was preceded by a tendon injury in the elbow area, then there is epicondylitis of the elbow joint. Treatment in this case should begin immediately, so as not to worsen the condition and not provoke further rupture of the tendons and muscles. With the development of complications ( prolonged pain, obstruction of joint flexion) may require surgery.

Dislocations in the elbow joint

They develop quite often. Given that the joint is formed by three smaller joints, dislocation of the elbow joint can occur in any of them.

Dislocation in the shoulder joint is the most severe, as it is always accompanied by a fracture of the part ulna. It usually develops when falling on an outstretched hand. The treatment is relatively long, as it requires the fusion of the bone fragment of the elbow with the bone.

Dislocations in the elbow joint are often accompanied by rupture of the interosseous membrane. The reason is a sharp rotation of the forearm relative to its axis. Heals much faster than a dislocated elbow.

The displacement of the radius relative to the head of the shoulder usually occurs when the interosseous membrane is ruptured. At the same time, movements are preserved due to sliding relative to the shoulder block. Dislocation of the elbow joint in this case will be accompanied by pain and the appearance of a bone formation (which is the radius) under the skin inner surface elbow.

fracture

Most frequent traumatic injury. It can proceed relatively easily (which is observed with dislocation), but in some cases its treatment becomes extremely difficult (if both bones of the forearm break or the integrity of the articular surface of the shoulder is violated).

An elbow fracture can develop for a variety of reasons. First of all, it appears when a heavy object strikes a limb. A prerequisite is a strict fixation of the limb (as, for example, when grabbing a horizontal bar or a barbell). Another reason, as already mentioned, is a fall from a height onto an outstretched arm.

With a fracture, a shortening of the absolute length of the limb is often observed (if the fracture is oblique and with a displacement). The relative length also decreases.

Treatment in the event that a fracture of the elbow joint has developed takes a long time and requires fixation in a plaster cast or splint in a physiological position (bent at an angle of 90 degrees).

Ruptures of muscles and ligaments

These types of injuries usually accompany fractures. Muscle rupture can occur due to damage to bone fragments. However, the most common cause of rupture is excessive stress muscles when doing any kind of work. Loaders, weightlifters and wrestlers are most susceptible to breaks.

The ligaments of the elbow joint are damaged more often than the muscles. Usually, their stretching is observed (when trying to increase the amplitude of the movement performed - for example, when rotating the forearm).

Typically, these injuries are characterized by the development of pain. With ruptures, the pain is severe, accompanied by the development of a hematoma at the site of the rupture. Active movements, with a strong gap, are impossible. For stretching, it is typical It's a dull pain low intensity, aggravated by movement.

Treatment of the elbow joint, with such injuries, includes immobilization (gypsum for rupture or bandage for stretching), taking painkillers. As the main symptoms subside, physiotherapy exercises and some physiotherapy are necessary.

Inflammation of articular cartilage and capsule

Young people usually have rheumatoid arthritis. It is characterized by damage to both elbow joints. A characteristic lesion for the disease is the formation of subcutaneous nodules on the extensor surface of the elbow.

Most often, arthritis of the elbow joint develops in older and older people. This is due to their work, as well as physiological aging. It is mainly people who are physically active who suffer.

The disease is manifested by stiffness in the elbow, non-intense pain. During movement, a specific crunch and friction of the articular surfaces one on one can be felt. Over time, there is muscle atrophy (usually in the elderly) with the development of muscle contractures. Arthritis of the elbow joint is one of the main causes of disability.

Treatment involves the use of analgesics, non-steroidal anti-inflammatory drugs, as well as agents to restore normal processes in the joint cavity.

Arthrosis of the elbow joint

The disease is similar to the clinic of arthritis, but there are significant differences in its pathogenesis.

The process is based on the depletion of articular cartilage. There is a decrease in the joint space and joint cavity. Since the only shock-absorbing structure disappears, friction between the articular surfaces begins to develop. Over time, due to this movement, the erasure of bone tissue occurs. New bone begins to form at the site of injury. The process can be aggravated by the development of bone deformities, which will ultimately lead to the impossibility of performing active movements.

Arthrosis of the elbow joint is characterized by pain long work, external changes joint (for late stages). Develops with long work at the computer (movements are made with a load on the elbows). Often leads to the development of bone ankylosis, which can only be eliminated surgically.

Therapeutic measures

What to do if any of the above diseases has developed or symptoms of one of them have appeared? First of all, it is necessary to consult a traumatologist or neurologist, who can put reliable diagnosis. You should also conduct some research to determine the condition of the joint. Only if the results of the studies are available, appropriate treatment can be started.

The complex of therapeutic measures includes non-drug methods, drug therapy and surgical operations.

Non-drug methods include therapeutic exercises, warm-up exercises, diet, and treatment of elbow joints with folk remedies.

Diet involves avoiding spicy food, alcohol. The diet should be varied with foods containing calcium and omega-3 fatty acids. These substances contribute to the regeneration processes in the affected joints.

Exercises help reduce the load on the elbows, as well as prepare them for doing any work. Thus, injury prevention is also carried out.

Drug therapy

Medicines are used mainly for intense pain or inflammatory processes in the joints.

First of all wide application for all types of pathology of the elbow joints, non-steroidal anti-inflammatory drugs (Nimesulide, Diclofenac, Meloxicam) were found. These drugs contribute to the subsidence of inflammatory processes in the joints, and also have an antianginal (pain) effect.

Treatment of the elbow joint with these drugs is best done under the control of the gastrointestinal tract. A mandatory appointment, if these drugs are prescribed for a long time, is Omeprazole. This tool helps protect the gastric mucosa from the development of NSAID gastropathy.

If epicondylitis of the elbow has developed, treatment is best started with the use of antibiotics, since tendon ruptures can be complicated by bursitis, tendovaginitis, or the development of an abscess.

Injectable drugs are prescribed mainly in the joint cavity for arthritis and arthrosis. Through the creation high concentration drug in the joint, the best analgesic effect is achieved.

Surgical treatment and prevention

It is usually carried out with the development of traumatic injuries of the joints. Surgical intervention is mandatory if there is a comminuted fracture of any of the bones that form the elbow joint. In this case, the joint is opened, the exact comparison of the fragments and their fixation. Otherwise, with improper fusion of the bones, there may be a violation of movement in the joint, up to total loss its functions.

Also to surgical methods the reduction of complicated dislocations also applies. It must be done under anesthesia. After reduction, a splint is applied to the arm or gypsum bandage, allowing to immobilize the joint and accelerate the process of its recovery.

Prevention of the development of injuries includes compliance with safety regulations in sports and work, a thorough warm-up before work, as well as compliance with healthy lifestyle life and rejection bad habits. Also important is a conscious attitude to one's health and the state of the musculoskeletal system.

There are many reasons why the joint in the elbow hurts. This and degenerative changes in cartilage tissues, and inflammatory phenomena, and joint injuries. Many seek to quickly relieve the symptoms of the disease with pills or folk remedies. But the treatment of the elbow joint should be long and complex. In some cases, to avoid severe complications, specific therapy is necessary.

Doctors with complaints of discomfort in the area of ​​​​the joints and examination of the patient most often diagnose arthritis. The disease usually affects the right and left elbow at the same time. Pathology occurs suddenly, swelling is formed, soreness and redness of the skin in the joint area appear. Discomfort intensifies at night. Possible violation general condition: the patient feels weakness, nausea, his temperature rises, there is an ache in the muscles of the shoulder and forearm.

At the beginning of the disease, a certain type joint inflammation difficult to diagnose. In the later stages, this is much easier to do.

There are the following forms of arthritis:

1. Juvenile. Develops in children. The danger of the disease lies in slowing down the growth of bones connected by the affected joint, and the normal development of intraarticular ones is also disrupted. Therefore, one hand may lag behind the other in growth.
2. Tuberculous. The disease leads to the destruction of cartilage tissue. It is characterized by fever, profuse sweating at night, redness and swelling of the skin over the joint.
3. Infectious. May occur at any age. Manifested high temperature, severe swelling and elbow pain. Children often experience nausea and vomiting.
4. Purulent. Characterized by an acute onset of the disease. The skin around the affected joint turns red. Appears great weakness, fever, headache, nausea, tachycardia. The pain in the arm is intense, constant, often acquiring a shooting character.
5. Gonococcal. Pathology is dangerous with rapidly developing atrophy of the muscles of the hand.
6. Rheumatoid. For him, subcutaneous seals are typical in the region of the joint and adjacent areas of the shoulder and forearm.

Hyaluronic acid preparations are prescribed in the form of injections. They are injected directly into the joint cavity. The best medicines- Ostenil, Synvisc, Synocrom.

Part complex therapy for pain in the elbow joint, ointments, creams, gels that have anti-inflammatory, warming, analgesic and regenerating effects are included without fail. They are dispensed without a doctor's prescription. For arthritis, the following ointments are recommended: Emulgel, Apizartron, Chondroitin, Diclofenac, Kapsikam.

Physiotherapy

To restore the mobility of the joints, massage, therapeutic exercises and a number of other procedures are prescribed:

• laser therapy;
• cryotherapy;
• electrophoresis;
• magnetotherapy;
• impulse currents.

Massage and exercise therapy can be done at home. The rest of the procedures are carried out in the hospital.

If conservative therapy does not bring the expected results, the destruction of the articular joints gradually occurs, and surgical intervention is resorted to. During the operation, the joint is corrected or endoprosthesis is performed.

Folk recipes

Treat elbow inflammation with traditional medicine recommended in combination with medicines and physiotherapy. This speeds up recovery and enhances the effect of taking medications.

With rheumatoid arthritis, warm baths with a saturated solution help well. sea ​​salt. After them, it is recommended to rub the elbow with a tincture of propolis or elecampane and wrap it with a woolen cloth. Such procedures are best done at night.

Hot potato compresses and blue clay applications relieve pain and swelling very well. Inside, you can take decoctions of dandelion, cinquefoil, elecampane, St. John's wort.

Other diseases of the elbow joint

The most common injury to the elbow is inflammatory diseases. In addition to damage to cartilage and bone tissue, as in arthritis, muscle-tendon structures can suffer for various reasons. Various injuries joints lead to stretching and rupture of ligaments.

Epicondylitis

It is that which is formed after intense physical activity. The disease is diagnosed mainly in athletes. People over 40 are also susceptible to it, especially those who perform daily heavy monotonous work with their hands. Often, pathology occurs after an injury, often formed against the background of osteochondrosis. cervicothoracic. The process can be internal or external.

Symptoms of epicondylitis

The main symptom of joint inflammation is sharp pain in the elbow, which increases when performing exercise or at the time of lifting the load. Rotational movements are especially difficult. At rest, the hand does not hurt.

Patients complain of decreased muscle strength in hand. It becomes difficult to hold small objects. When pressing on the joint, pain is felt.

Often the disease progresses to chronic stage, cyclically aggravated after excessive physical exertion. The pain may radiate from the elbow to the forearm and hand.

Treatment of epicondylitis

Therapy of the disease is most often complex. The choice of drugs depends on the stage of the disease and the condition of the muscles and ligaments.

Purpose of treatment:

• restore blood circulation;
• stop pain syndrome;
• restore joint flexibility and mobility;
• prevent muscle atrophy.

Therapy consists in immobilizing the diseased limb by applying a plaster cast or. It is also necessary to take medications prescribed by a specialist. The patient is recommended physiotherapy with the use of phonophoresis, Bernard currents, paraffin applications.

Treatment includes blockades with the introduction of novocaine (or lidocaine) and hydrocortisone. They relieve pain and improve the nutrition of muscles and ligaments. Along with this, analgesic and warming ointments, rubbing and compresses from medicinal herbs are used.

tendovaginitis

Pathology is an inflammation of the inner lining of the muscle tendons attached to the joint. Pathology is formed as a result of excessive professional, sports loads or infection of the joint and periarticular tissues. Often the disease occurs against the background of rheumatism or rheumatoid arthritis.

Symptoms of tendovaginitis

With the development of an acute form of the disease, the elbow noticeably swells, deforms. Pain is felt in the area of ​​the inflamed tendons. Movements in the joint are limited and are accompanied by a clearly audible creak.

With a purulent form of the disease, the patient's body temperature rises, chills and fever develop. Symptoms of intoxication of the body increase, lymph nodes increase. Compression of the vessel that feeds the tendon with blood can lead to partial necrosis connective tissue.

With untimely access to a doctor, the pathology spreads to nearby tissues.

Therapy Methods

In any form of pathology, the treatment is accompanied by immobilization of the joint with the help of splinting. To relieve pain and inflammation, NSAIDs, antibiotics, ointments, and physiotherapy are prescribed.

In cases of acute purulent tendovaginitis, it is necessary to open the tendon bag in a hospital. Further treatment can be carried out at home under medical supervision.

You can reduce pain and inflammation in the joint and adjacent muscles with the help of folk remedies. But it is recommended to use them only as an addition to the main (drug) therapy prescribed by the doctor. cure tendovaginitis non-traditional methods impossible without the help of drugs.

cyst (neoplasm)

Beyond disease inflammatory nature, the elbow joint is prone to other ailments. After injuries, a cyst often forms. It manifests itself in the form of a tumor-like formation filled with liquid contents. This is most often a benign neoplasm that requires treatment.

Therapy may be:

1. Conservative. The patient is assigned a puncture (piercing) of the cyst. Its contents are pumped out and anti-inflammatory drugs are injected into the vacated cavity, after which a pressure bandage is applied.
2. Surgical. In this case, the tumor is removed under local anesthesia. The operation is less traumatic and does not cause complications.

osteophytes

Often, bone growths, or spurs, form on the joints. In the medical literature they are called osteophytes. They occur quite often, although less often than. Elbow growths are manifested by pain, aggravated by movement. Outwardly, they are completely invisible.

Treatment is mostly conservative. Includes physiotherapy, hormonal and anti-inflammatory therapy, therapeutic ointments, creams. If it is not possible to get rid of the pathology with the help of medicines, they resort to surgical intervention.

Conclusion

Having found symptoms of diseases of the elbow joint, it is urgent to visit a doctor. Only he can establish the correct diagnosis and prescribe treatment. Do not self-medicate. Wrong actions can not only aggravate the pathology, but also cause considerable harm to the body.

A lesion of different etiology n. ulnaris, accompanied by a violation of its sensory and motor function. It is manifested by weakness when trying to clench the hand into a fist and hold objects with the brush, lack of sensitivity of the skin of the V and partially IV fingers, atrophy of the hypotenor and small muscles of the hand, and the appearance of the hand, similar to a clawed paw. In the diagnosis of ulnar neuropathy, they rely on the results of a neurological examination, electrophysiological testing, radiography of bones and joints. Therapeutic tactics are built taking into account the genesis of neuropathy and may include both medication and physiotherapy methods, as well as surgical treatment.

General information

Ulnar nerve neuropathy is a fairly common lesion of the peripheral nervous system. It often accompanies injuries to the elbow joint area, and therefore it occurs not only in the practice of neurologists, but also in the field of traumatology.

The anatomical location of the ulnar nerve is such that the most vulnerable place is its site, which is localized in the area of ​​the elbow joint in the so-called. cubital (ulnar) canal. The symptom complex of compression of the ulnar nerve in this canal is called cubital canal syndrome in neurology. Among all neuropathies of compression genesis, it ranks second (the first belongs to carpal tunnel syndrome, one of the variants of median nerve neuropathy).

Anatomy of the ulnar nerve

The nerve originates in the medial bundle (C7-C8, Th1) brachial plexus. Without giving up branches, passes through inside shoulder, then passes to its postero-medial surface. In the area of ​​the elbow joint, it runs along the posterior surface of the internal epicondyle of the shoulder, where it is actually located subcutaneously. Then it enters the cubital canal formed by the olecranon, internal epicondyle, ligament and tendons of the muscles of the forearm.

Elbow to wrist n. ulnaris runs along the medial edge of the inner surface of the forearm. Here it gives motor branches to the medial portion of the finger flexor muscle and the ulnar flexor of the wrist. At the head of the ulna, the nerve gives off a dorsal branch that innervates the skin of the ulnar side of the rear of the hand, the back surface of the V, IV, and partially III fingers. Passing to the palm, n. ulnaris is divided into superficial and deep branches. The first is responsible for the sensory perception of the skin of the little finger and the half of the ring finger facing it. The second - for the innervation of the muscles of the hypotenor and small muscles of the hand, as well as the joints, ligaments and bones of the hand. After departing from the ulnar nerve, the deep branch passes in Guyon's canal, located between the pisiform bone and the metacarpal palmar ligament.

Causes of neuropathy of the ulnar nerve

The most common mechanisms for the development of ulnar neuropathy are traumatic nerve injury and its compression in the cubital canal. Nerve injury may be accompanied by: bruised arm, dislocation of the forearm, supracondylar fracture of the shoulder, fracture of the medial condyle of the shoulder, fracture of the forearm, isolated fracture of the ulna or fracture of the olecranon, dislocation of the hand. Cubital tunnel syndrome often occurs in people who are used to relying on their elbow. For example, lean with your elbow on a desk, a machine tool, a side of a door in a car, etc.

Nerve compression in the cubital canal and in the Guyon canal is possible with inflammatory or anatomical changes in the structures that form these canals. So, compression neuropathy of the ulnar nerve can be observed with osteoma, sprain, synovitis, tendovaginitis, deforming osteoarthritis, rheumatoid arthritis, osteodystrophy, elbow bursitis, post-traumatic arthrosis wrist joint and other diseases. provoke ulnar neuropathy at the level of the Guyon canal, work associated with prolonged pressure of tools (screwdrivers, hammers, scissors, tongs, etc.) on this area is capable.

Symptoms of neuropathy of the ulnar nerve

Defeat n. ulnaris at the level of the cubital canal is characterized by weakness in the hand, which manifests itself when you try to take something in your hand (for example, pick up a kettle from the stove), play the piano, type on the keyboard, etc. Sensory disturbances are manifested by a feeling of numbness of the little finger, partially the ring finger and ulnar edge of the palm. A typical feeling of discomfort in the area of ​​the elbow joint, often - pain in it, radiating to the hand along the ulnar edge of the forearm. Often, an increase in these symptoms is noted in the morning, which is associated with the habit of many patients to sleep with their hands under the pillow or under the head, which means bending them at the elbow joints.

On examination, attention is drawn to hypotrophy of the hypotenor and small muscles of the palm, the position of the fingers in the form of a clawed paw (the main phalanges are in the extension position, and the middle ones are bent).

Ulnar neuropathy in Guyon's canal has similar manifestations. The difference is the localization of the pain syndrome only in the area of ​​the base of the hand and the hypotenor, the presence of sensory disorders exclusively on the palmar surface of the little finger and half of the ring finger with full preservation of the sensitivity of the back of the hand.

Diagnosis of neuropathy of the ulnar nerve

AT acute period neuropathy of the ulnar nerve important point is the exclusion/limitation of static and dynamic load, reinforcing pathological manifestations diseases. Patients suffering from cubital tunnel syndrome are advised to bandage a rolled-up towel to the flexor surface of the elbow to limit bending of the arm at the elbow for the period of night sleep. Subsequently, when subsiding inflammatory process and a decrease in pain syndrome, a special complex of exercise therapy is prescribed.

13. Damage to the ulnar nerve

The defeat of the ulnar nerve is the second most common among the lesions of all nerves that make up the brachial plexus.

In most cases, the cause of neuropathy of the ulnar nerve is its compression in the area of ​​the elbow joint. This pathology can be observed in people when working with elbows on a machine, desk, etc. Most often this occurs in emaciated people. The nerve may be compressed at the level of the wrist.

In addition to compression, ulnar nerve neuropathy can be caused by a fracture of the internal condyle of the shoulder or supracondylar fractures. In more rare cases, ulnar neuritis occurs with a variety of infections, such as typhus, typhoid fever etc. According to the function performed, the ulnar nerve is mixed.

The motor fibers that make up the nerve innervate the ulnar flexor of the wrist, the deep flexor of the finger, and the adductor thumb muscle. The ulnar flexor of the wrist during contraction produces flexion of the hand, as well as its abduction in ulnar side. The deep flexor of the finger flexes the IV and V fingers of the hand.

In addition, this nerve innervates the muscles that adduct and spread the fingers. The ulnar nerve also innervates the vermiform muscles, which extend the middle and distal phalanges of the fingers. Thus, the ulnar nerve performs the following movements: flexion and extension of the middle and distal phalanges of the IV and V fingers, dilution and adduction of all fingers except for I, adduction of the thumb.

In addition to the above motor acts, the ulnar nerve, together with the median nerve, performs flexion of the hand at the radiocarpal joint, as well as flexion of all fingers of the hand, except for I, in the main phalanges.

The composition of the ulnar nerve includes sensory fibers that innervate the skin on the ulnar surface of the hand, as well as the skin of V and part IV of the fingers.

Damage to the ulnar nerve leads to the impossibility of palmar flexion of the hand. The possibility of bending the IV and V fingers is lost, the patient cannot reduce and spread the fingers of the hand, and also carry out the adduction of the first finger of the hand.

An objective examination shows atrophy of the small muscles of the hand, hyperextension of the fingers in the area of ​​their main phalanges due to the preservation of the function of the radial nerve. The middle and distal phalanges of the fingers are in the flexion position. Outwardly, the brush of the affected limb takes the form of a clawed paw. The patient is unable to flex