ulnar canal syndrome
Introduction
Introduction to ulnar tube syndrome There are many factors that cause the ulnar side of the palm of your hand. When people fall, the wrist is overstretched and the palm of the hand is mainly on the side of the ruler, which can cause damage to the ulnar side of the palm. Workers using heavy hammers or pneumatic drills are prone to damage in the small fish area of the palm. These injuries can cause hook or pea bone fractures, pea bone, triangular bone dislocation, lumbar ligament tear, ulnar aneurysm and arterial thrombosis, and ulnar nerve injury, which are the main cause of ulnar nerve compression in the wrist. factor. In addition, space-occupying lesions, scar contractures, abnormal muscles and neuroma can also cause ulnar nerve compression. basic knowledge Sickness ratio: 0.0001% Susceptible people: no specific people Mode of infection: non-infectious complication:
Cause
Cause of ruler syndrome
(1) Causes of the disease
The most common cause of ulnar nerve compression is nodular compression. It has been reported in the literature that 29% to 34% of cases are caused by nodular compression. Among the cases without obvious trauma, 86% are caused by nodular compression. Most of the compression nerves are located at the joints of the triangular bone and the hook bone. Muscle variation, such as the accessory finger flexor muscle, the small finger muscle and the extension of the palm length muscle to the Gunyon tube, are also the main causes of the ruler syndrome. About 16% of the total number of patients, other factors, such as lipoma, giant cell tumor, ganglion cyst, ligament thickening, bean bone hook joint, etc., can also cause ulnar nerve compression.
The ulnar tube syndrome caused by fracture is the main compression factor, ulnar ulnar fracture, especially the hook bone fracture. About 14% of patients may have ulnar nerve compression, fracture piece compression, nerve traction or scar compression. Lead to neuropathy, ulnar artery embolization can directly cause sensory disturbances, such factors account for 7% of the ruler tube syndrome, repetitive trauma caused by the ulnar tube syndrome accounted for about 6% of the total number of patients, rheumatoid sacral bursitis, In particular, the ulnar wrist flexor and the superficial flexor tendon bursitis are also associated with the occurrence of the ruler syndrome.
(two) pathogenesis
The ulnar tube, also known as the Guyon tube, is triangular in shape and consists of the lateral surface of the pea ulnar side, the superficial ligament of the carp ligament and the posterior side of the transverse ligament of the wrist (Fig. 1A). At the bottom of the Guyon tube, the ligament is located in the center. The transverse ligament of the wrist is located on the temporal side, and the ligament of the bean is located on the ulnar side and the distal end. The top of the ligament is composed of the transverse ligament of the wrist, the fiber bundle at the proximal end of the palmar aponeurosis and the distal end of the palmar short muscle. The Guyon tube is divided at the exit by the hook bone. For the two pipes, the distal end of the hole is composed of a fiber arch composed of the small finger muscle and the small finger flexor. The pea bone is connected with the hook bone, and the ulnar nerve movement branch is pierced deep in the hole, and the sensory branch is shallow. Wear out (Figure 1B).
Shea and McClain divide the ruled tube into three zones. In zone 1, the nerve compression is located in the proximal or ulnar tube. Because the nerve movement and sensory branch are in this zone, the clinical manifestations are both the ulnar nerve dominating zone. The inner muscles weakened or atrophied, and there was a sensory change in the volar side of the palm and the ulnar side of the small fish. In the 2nd area, the motor nerve compression occurred, and the anatomical area was located at the exit of the ruler tube. Between the small finger muscle and the origin of the little finger flexor, the ulnar nerve is stuck when the movement branch passes through the little finger against the palm muscle, or when the trans-shoulder reaches the flexor tendon and the metacarpal metacarpal, the compression occurs in the 3rd area. The sensation position of the sensation is located at the distal end of the ulnar tube outlet or in the ulnar tube. The clinical manifestations are small fish and ring fingers, and the sensory dysfunction of the little finger.
Prevention
Ruler syndrome prevention
Life restraint pays attention to rest, work and rest, life is orderly, and maintaining an optimistic, positive and upward attitude towards life is of great help in preventing diseases.
Complication
Systolic syndrome complications Complication
There are generally no complications.
Symptom
Symptoms of ulnar tube syndrome Common symptoms Insufficient sensory disturbances The tenderness of the hand muscles near the hook bone
1. History and clinical manifestations are often referred to as ring finger, small finger numbness, intramuscular muscle weakness for patients, history of hand ulnar fall, long-term use of vibration tools, rheumatoid history, osteoarthritis and other medical history for diagnosis value.
2. Physical inspection
(1) tenderness or mass in the wrist hook area: The most common cause of compression in the 1st and 2nd areas is the hook fracture of the hook bone. Therefore, such patients often have tenderness near the hook bone.
(2) Tinel sign: Tinel sign positive in the ulnar tube area has certain value for diagnosis.
(3) Exercise and sensation examination: the small finger and the ring finger side of the ulnar side of the palm face sensory abnormalities and intramuscular muscle atrophy (Figure 2).
Examine
Examination of the ruler syndrome
X-ray, MRI and electromyography: it has certain reference value for clinical diagnosis.
Diagnosis
Diagnosis and differentiation of ruler syndrome
According to medical history, clinical manifestations, physical examination, electromyography examination of muscle strength and sensory disturbance, X-ray examination can exclude fractures, MRI examination can exclude local space-occupying lesions, and then establish a diagnosis.
Because the ulnar nerve back of the ulnar nerve is issued before entering the ulnar ulnar, the ulnar tube syndrome only shows a sensation of the palmar side of the ulnar side. If the sensation of the dorsal side of the finger is simultaneously decreased, the ulnar nerve is also affected. The compression site should be at the elbow rather than the wrist. If the patient has a feeling of skin on the inside of the forearm, indicating that the medial cutaneous nerve of the forearm is involved, the thoracic outlet syndrome may be larger.
