Ulnar Nerve Contusion – 3 Important causes, symptoms, risk factors, prognosis, treatment, rehabilitation

What is an Ulnar Nerve Contusion

  • Ulnar nerve contusion is a bruise of the ulnar nerve.
  • An ulnar nerve contusion can cause a loss of feeling or movement in your hand.
  • Ulnar Nerve Contusion can also affect your ability to use the muscles that you use to grip objects.
  • Your ulnar nerve extends from your shoulder to the “pinkie side” of your hand.
  • This nerve provides feeling to the pinkie and half of the ring finger.
  • It also controls many hand and forearm muscles that let you grip objects.
  • The ulnar nerve has several potential compression sites along its course.
  • Although the elbow is the most common site of compression, the ulnar nerve is also susceptible to injury at the wrist, forearm, and upper arm.
  • Prevention of compression and early diagnosis/treatment is important for its prognosis because the treatment outcome is usually disappointing once the nerve has axonal damage.

What are the causes?

Ulnar Nerve Contusion may be caused by:

  1. A hit to the elbow.
  2. Falling on your elbow.
  3. Shoving your elbow against a hard surface.

Most commonly this condition occurs due to a direct blow to the ulnar nerve at the elbow or an injury like falling on the elbow.

What increases the risk?

Ulnar Nerve Contusion is more likely to develop in people who:

  • Play contact sports, like soccer, football and rugby
  • Certain disorders which increases the risk of bleeding
  • Metabolic Disorders such as Diabetes mellitus
  • Take blood thinning medicine, such as warfarin, aspirin, coumadin and nonsteroidal anti-inflammatory medications
  • Hypothyroidism (underactive thyroid gland)

What are the symptoms of Ulnar Nerve Contusion?

Symptoms of Ulnar Nerve Contusion condition include:

  • Tingling or numbness in the hand, especially in the pinkie or ring finger.
  • Weakness while moving the hand from side to side in a waving motion, or while moving your fingers together.
  • Abnormal claw-like hand position.

How is this diagnosed?

Ulnar Nerve Contusion may be diagnosed based on your symptoms, a medical history, and a physical exam. You may have tests for the Ulnar Nerve Contusion, such as:

  • An X-ray. This may be done to check for broken bones.
  • An electromyogram (EMG). This is done to see how well your nerves are working.
  • A nerve conduction study. This is done to see how electrical signals pass through your nerves.
  • An MRI. This is done to find the source of any nerve problems.

How is Ulnar Nerve Contusion treated?

Ulnar Nerve Contusion usually heals on its own within 6 weeks.

Treatment can help to reduce symptoms and it may include:

  • Wearing a brace or splint at night keep your elbow straight while you sleep.
  • Taking anti-inflammatory medicine, such as ibuprofen, to reduce pain and swelling around the nerve.
  • Working with a physical therapist to ease stiffness in your arm and wrist.

Is Surgery required or mandatory for Ulnar Nerve Contusion?

Surgery is usually reserved for the small number of patients.

If the non-surgical treatment is not successful, surgery may be necessary to free the pinched nerve, but this is rare.

Follow these instructions at home:

If you have a brace or splint:

  • Wear it as told by your health care provider. Remove it only as told by your health care provider.
  • Loosen the brace or splint if your fingers tingle, become numb, or turn cold and blue.
  • Keep the brace or splint clean.
  • If your brace or splint is not waterproof:
    • Do not let it get wet.
    • Protect it with a watertight covering when you take a bath or a shower.

Managing pain, stiffness, and swelling

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • If directed, apply ice to the injured area.
    • Put ice in a plastic bag.
    • Place a towel between your skin and the bag.
    • Leave the ice on for 20 minutes, 2–3 times a day.

When can I return to my sports or physical activities?

  • Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
  • Avoid activities that take a lot of effort (are strenuous) for as long as told by your health care provider.
  • Do exercises as told by your health care provider.

General instructions

  • Do not use the injured limb to support your body weight until your health care provider says that you can.
  • Do not use any tobacco products, including cigarettes, chewing tobacco, or e-cigarettes. Tobacco can delay bone healing. If you need help quitting, ask your health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important.

What research says about the Ulnar Nerve Contusion?

Is there any newer approach in the treatment?

A study introduced a novel technical approach to the ulnar nerve injuries. The ulnar nerve was divided into 4 distinct surgical zones, each mandating a unique management strategy.

This is a prospective observational study was conducted to verify the hypothesized algorithm.

The study included 110 patients diagnosed with ulnar nerve injury (Sunderland grade 5).

The patients were divided into 4 groups depending on the site of injury.

Each group of patients was managed in accordance with a particular strategy, exploiting nerve transfer techniques along with the updated knowledge of the internal topography of the ulnar nerve.

The motor recovery of the small muscles of the hand was assessed after 2 years of follow-up, using the disabilities of the arm, shoulder, and hand score, and other parameters including key pinch strength, hand grip strength, and the motor power of the first dorsal interosseous muscle on the Medical Research Council scale.

How is Ulnar Nerve Contusion prevented?

  • Warm up and stretch before being active.
  • Cool down and stretch after being active.
  • Give your body time to rest between periods of activity.
  • Make sure to use equipment that fits you.
  • Be safe and responsible while being active to avoid falls.
  • Do at least 150 minutes of moderate-intensity exercise each week, such as brisk walking or water aerobics.
  • Maintain physical fitness, including:
    • Strength.
    • Flexibility.
    • Cardiovascular fitness.
    • Endurance.

What is the prognosis of Ulnar Nerve Contusion

This condition is usually curable with appropriate treatment and often heals spontaneously.

Complete healing may take up to six weeks, depending on the extent of injury.

Rarely, symptoms may be permanent.

Contact a health care provider if:

  • Your pain does not improve or it gets worse.
  • Your swelling does not improve or it gets worse.
  • Your grip becomes weaker.

Get help right away if:

  • You have severe pain.
  • You have severe swelling.
  • You cannot move your wrist, hand, or elbow.
  • You cannot feel parts of your hand, wrist, or arm.

Ulnar Nerve Contusion Rehabilitation

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your forearm. These exercises also help to relieve pain, numbness, and tingling.

Exercise A: Extensor stretch

  1. Stand over a tabletop with your right hand resting palm-up on the tabletop and your fingers pointing away from your body. Your arm should be extended and there should be a slight bend in your elbow.
  2. Gently press the back of your hand down onto the table by straightening your elbow. You should feel a stretch on the top of your forearm.
  3. Hold this position for a few seconds.
  4. Slowly return to the starting position.

Repeat for a few times. Complete this stretch for a few times a day.

Exercise B: Flexor stretch

  1. Stand over a tabletop with your right hand resting palm-down on the tabletop and your fingers pointing away from your body. Your arm should be extended and there should be a slight bend in your elbow.
  2. Gently press your fingers and palm down onto the table by straightening your elbow. You should feel a stretch on the inside of your forearm.
  3. Hold this position for a few seconds.
  4. Slowly return to the starting position.

Repeat for a few times. Complete this stretch for a few times a day.

Exercise C: Ulnar nerve glide, hand moving

  1. Stand or sit with your left / right elbow bent and your hand at the height of your shoulder.
  2. Move your elbow about 6 inches (15 cm) away from your body.
  3. Gently and slowly wave your hand back and forth.
  4. Repeat this motion for a few seconds.

Repeat for a few times. Complete this exercise for a few times a day.

Exercise D: Ulnar nerve glide, elbow moving

  1. Stand or sit with your left / right arm straight out to your side at shoulder height.
  2. Bring your fingers up toward the ceiling so your palm faces away from you.
  3. Bend your elbow and bring it to your side and bend your wrist so your palm now faces the floor.
  4. Slowly go back and forth between doing the step 2 position and the step 3 position.
  5. Repeat these motions for a few seconds.

Repeat for a few times. Complete this exercise for few times a day.

Strengthening exercises

These exercises build strength and endurance in your forearm. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise E: Grip

  1. Hold one of these items in your right or left hand: a dense sponge, a tennis ball, or a large, rolled sock.
  2. Slowly squeeze as hard as you can without increasing any pain.
  3. Hold this position for few seconds.
  4. Slowly release your grip.

Repeat few times. Complete this exercise for few times a day.

Summary

Ulnar nerve contusion, also known as ulnar nerve injury or ulnar nerve bruise, refers to a condition where the ulnar nerve is damaged or compressed due to trauma or direct impact. The ulnar nerve is one of the major nerves in the arm, responsible for providing sensory and motor function to the hand and forearm. It runs along the inner side of the arm, passing through the elbow region.

Causes: Ulnar nerve contusion can occur due to various reasons, including:

  1. Direct Trauma: A direct blow or impact to the inner side of the arm or elbow can result in ulnar nerve contusion.
  2. Repetitive Stress: Activities that involve repetitive bending or pressure on the elbow can lead to chronic irritation and compression of the ulnar nerve, leading to a contusion over time.

Symptoms: The symptoms of ulnar nerve contusion can vary depending on the severity of the injury. Common symptoms may include:

  1. Pain: Localized pain or aching sensation around the elbow region.
  2. Numbness and Tingling: Numbness and tingling sensations, commonly felt in the ring and little fingers, as well as the inner side of the forearm.
  3. Weakness: Weakness in the hand, particularly in the grip strength, and difficulty with fine motor movements.
  4. Tenderness: Tenderness and sensitivity to touch along the path of the ulnar nerve.
  5. Muscle Atrophy: In severe cases or if left untreated, ulnar nerve contusion can lead to muscle wasting or atrophy in the hand.

Treatment: Treatment for ulnar nerve contusion aims to reduce pain, inflammation, and promote healing. It may include:

  1. Rest: Avoiding activities that aggravate the symptoms and allow the nerve to heal.
  2. Immobilization: The use of a splint or brace to rest the elbow and limit movement.
  3. Ice Therapy: Applying ice to the affected area to reduce swelling and pain.
  4. Medications: Over-the-counter pain relievers and anti-inflammatory medications may help manage pain and inflammation.
  5. Physical Therapy: Stretching and strengthening exercises under the guidance of a physical therapist can help improve nerve function and prevent muscle atrophy.

In more severe or persistent cases, a healthcare professional may recommend additional treatments, such as corticosteroid injections or surgery to decompress the nerve.

It is essential to seek medical attention if you experience symptoms of ulnar nerve contusion, as proper evaluation and treatment can prevent complications and promote recovery.

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