Ulnar nerve entrapment of elbow
Ulnar nerve entrapment of elbow is also called cubital tunnel syndrome. The ulnar nerve begins at the spinal cord in the neck and runs down the arm into the hand. This very long nerve can become compressed, or entrapped, by other structures at certain points along the way. Entrapment often happens in the cubital tunnel, which is the narrow passage at the inside of the elbow.
The exact cause for entrapment may not be known. Fluid buildup and swelling inside the elbow; previous elbow fracture or dislocation; or leaning on the elbow for long periods of time can put pressure on the ulnar nerve inside the cubital tunnel.
Symptoms include numbness and tingling of the hand and fingers, sometimes leading to weakness and even muscle wasting in the hand.
Diagnosis is made through physical examination, x-ray, and nerve conduction studies.
Treatment begins with wearing a supportive brace and adjusting activities to avoid further irritating the nerve. Surgery is usually not needed unless the nerve compression is causing weakness and loss of use in the hand.
Top Symptoms: hand weakness, weakness in one hand, numbness in one hand, pain in one elbow, pain in one forearm
Urgency: Primary care doctor
Thoracic outlet syndrome
The “thoracic outlet” is the space on either side of the base of the neck where nerves, arteries, and veins travel beneath the collarbone. If these become compressed or damaged, the condition is called thoracic outlet syndrome or TOS.
The most common causes are trauma, such as a car accident or fall; and repetition or overuse, such as a sports injury.
Symptoms vary depending on the structures being compressed:
- Neurogenic TOS affects the nerves. It is the most common form and creates numbness, tingling, pain, and weakness in the arms, hand, and fingers.
- Vascular TOS affects the arteries and veins. It creates the same symptoms as neurogenic TOS as well as cold, pale hands and arms with weak pulse.
It is important to see a medical provider about these symptoms so that the damage does not become permanent.
Diagnosis is made through patient history, physical examination, imaging such as x-ray or ultrasound, and sometimes nerve conduction and blood flow studies.
Treatment involves physical therapy, pain relievers, and sometimes surgery.
Raynaud phenomenon, also called Secondary Raynaud syndrome, is a condition that causes small arteries in the skin to abnormally constrict on exposure to cold water or air. This limits blood flow to the hands, fingers, feet, toes, nose, and ears.
Secondary Raynaud syndrome is rare and is caused by another underlying medical condition, often a connective tissue disorder such as rheumatoid arthritis, scleroderma, or lupus.
Women are more likely than men to be affected, especially if living in cold climates. Family history and smoking are also risk factors.
Symptoms include the hands and feet becoming numb and cold. The skin color changes from pale to bluish, and then to red as the skin warms again.
If not treated, patients may get ulcerated sores or deformities of the fingers and toes, or even gangrene, due to the lack of circulation.
Diagnosis is made through patient history, physical examination, and blood tests.
Treatment includes medications to help increase circulation; treatment of any underlying conditions; and lifestyle changes to gain better protection for the extremities in cold conditions.
Pinched nerve in the neck
A pinched nerve in the neck is also called cervical radiculopathy. It means that a nerve in the neck, at a point where it branches off from the spinal cord, is being compressed by the surrounding bones, muscles, or other tissues.
It can be caused by a traumatic injury, such as from sports or an automobile accident, especially if the injury results in a herniated disk. It may also arise from the normal wear and tear of aging.
Symptoms include sharp, burning pain with numbness and tingling from the neck to the shoulder, as well as weakness and numbness into the arm and hand.
Diagnosis is made through patient history, physical examination, and simple neurological tests to check the reflexes. Imaging such as x-ray, CT scan, or MRI may be done, as well as electromyography to measure nerve impulses in the muscles.
A pinched nerve in the neck often improves with simply a few days or weeks of rest. Physical therapy, nonsteroidal anti-inflammatory drugs, and steroid injections into the spine can all be very helpful.
Top Symptoms: pain in one shoulder, spontaneous shoulder pain, pain that radiates down arm, pain in the back of the neck, severe shoulder pain
Urgency: Primary care doctor
Panic or anxiety attack(s)
Panic disorder means a generalized set of symptoms involving sudden, unexplained feelings of anxiety and overwhelming fear. The physical symptoms are very real and consist of sweating, pounding heart, and shortness of breath.
The cause is not known. It may involve changes in brain chemistry that cause a person to perceive danger where there actually is none. Severe and ongoing stress, as well as post-traumatic stress disorder (PTSD) may be factors.
Panic disorder is most common among women. It can affect anyone, however, especially with a family history.
This condition does not improve on its own. If left untreated, the patient may become isolated and even suicidal.
A doctor will do a complete workup, including blood tests, to rule out any physical causes for the symptoms. A psychological workup will also be done.
The first line of treatment is talking with a professional who can help with coping and stress management. Medication, including some antidepressants and calming drugs, may be used temporarily but can cause dependence and unpleasant side effects if used for too long.
De quervain’s tenosynovitis
De Quervain’s tenosynovitis is a painful condition affecting the tendons on the thumb side of the wrist. If you have de Quervain’s tenosynovitis, you will feel pain upon turning your wrist, grasping anything, or making a fist.
You should visit your primary care physician to confirm the diagnosis and discuss treatment options. You can also reduce pain and swelling with over-the-counter pain relievers, such as ibuprofen (Advil, Motrin), naproxen (Aleve).
Chronic idiopathic peripheral neuropathy
Peripheral neuropathy refers to the feeling of numbness, tingling, and pins-and-needles sensation in the feet. Idiopathic means the cause is not known, and chronic means the condition is ongoing without getting better or worse.
The condition is most often found in people over age 60. Idiopathic neuropathy has no known cause.
Symptoms include uncomfortable numbness and tingling in the feet; difficulty standing or walking due to pain and lack of normal sensitivity; and weakness and cramping in the muscles of the feet and ankles.
Peripheral neuropathy can greatly interfere with quality of life, so a medical provider should be seen in order to treat the symptoms and reduce the discomfort.
Diagnosis is made through physical examination; blood tests to rule out other conditions; and neurologic and muscle studies such as electromyography.
Treatment involves over-the-counter pain relievers; prescription pain relievers to manage more severe pain; physical therapy and safety measures to compensate for loss of sensation in the feet; and therapeutic footwear to help with balance and walking.
Top Symptoms: distal numbness, muscle aches, joint stiffness, numbness on both sides of body, loss of muscle mass
Urgency: Primary care doctor
Carpal tunnel syndrome
Carpal tunnel syndrome causes numbness and pain in the underside of the wrist and hand. It is caused by narrowing of the carpal tunnel passageway, which puts pressure on the nerve running through it.
Narrowing and deformity of the tunnel is most often from overuse, especially highly repetitive activities such as typing or working on an assembly line. Wrist fracture or arthritis can damage the carpal tunnel, and so can diabetes and obesity.
Symptoms include numbness and shocklike pain in the wrist, palm, and fingers. There may be weakness in the hand when trying to hold an object.
Carpal tunnel syndrome virtually always gets worse over time. Permanent damage may result, so it is important to be seen by a medical provider.
Diagnosis is made through patient history and physical examination. X-rays or electromyography testing may be used.
Rest and cold packs to the wrist will reduce swelling. Wrist splints and ergonomically correct keyboards and other devices during work are often helpful.
Corticosteroid injections and surgery may also be tried.