ulnar nerve injury By Chaman Lal Karotia (CK)

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ulnar nerve injury, pathology and nerve conduction study

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Ulnar Nerve Course & Injuries:

Ulnar Nerve Course & Injuries Chaman Lal Karotia (CK) CNPT (AKUH), R.EEGT, BS.PT,MPPS(PAK) Member of AANEM & ASET (USA) Aga Khan University Hospital , Karachi.

INTRODUCTION:

INTRODUCTION Ulnar nerve is the continuation of medial cord of brachial plexus. the ulnar nerve is a nerve which runs near the ulna bone. It derives from C8 and T1 roots.

Carpals:

Carpals Mnemonic for carpal bones (Lateral to medial) S he L ooks T oo P retty , T ry T o C atch H ere OR S ophia L aren T indy P akaey , T indy T ou C akchy H ai OR Sc Lu Tri Pis, Tram Trpz Cap Ham S caphoid , L unate, T riquetrum , P isiform, T rapezium , T rapezoid, C apitate, H amate . Starts at the proximal row closest to thumb, and goes across and same the distal row.

PowerPoint Presentation:

Anatomy Guyon’s canal Triangular Roof Superficial volar carpal ligament Medial Pisiform Lateral Hook of the hamate

PowerPoint Presentation:

1.Abductor pollicis brevis 2.Flexor pollicis brevis 3.Oblique head of adductor pollicis 4.Transverse head of adductor pollicis 5.Flexor digiti minimi brevis 6.Abductor digiti minimi 7.Superficial palmar arch 8.Common palmar digital branches

PowerPoint Presentation:

Abductor digiti minimi : abducts MCP joint of 5 th digit ulnar nerve Opponens digiti minimi : opposes 5 th digit with thumb ulnar nerve Dorsal Interossei : abduct fingers at MCP joint ulnar nerve Palmar Interossei : adduct fingers at MCP joint ulnar nerve Lumbricals: flexes MCP while extending IP joints 1 st /2 nd median nerve, 3 rd /4 th ulnar nerve

Sensory Distribution:

Sensory Distribution Cutaneous Innervations of the Ulnar Nerve : The ulnar nerve also provide sensory innervation to the skin over medial aspect of the hand from the wrist distally including, Hypothenar eminence The fifth digit and half of the fourth digit. It gives a sensory branch before entering into the ulnar canal “the dorsal ulnar cutaneous nerve”. Which supplies to the skin of the fourth web-space and lateral surface of the hand.

Ulnar Nerve Pathologies:

Ulnar Nerve Pathologies Ulnar tunnel syndrome Presentation: Rare Entrapment of ulnar nerve in Guyon’s canal Numbness in ulnar two digits Sensation in dorsal sensory branch spared Pure motor, sensory or mixed Etiologic factors Use of “heel of hand” Space occupying lesions Ganglia, bony, pseudoaneurysms

Ulnar Nerve Pathologies Cont’d:

Ulnar Nerve Pathologies Cont’d Ulnar tunnel syndrome Presentation: Pain in wrist Numbness Tingling Burning Provocative tests Sustained hyperextension or flexion of wrist

Ulnar Nerve Pathologies Cont’d:

Ulnar Nerve Pathologies Cont’d Ulnar tunnel syndrome Physical Intrinsic weakness Sensory testing Allen test Dopplers Fractures of hook of hamate Electrodiagnostic studies Establish diagnosis

Ulnar Nerve Pathologies Cont’d:

Ulnar Nerve Pathologies Cont’d Ulnar tunnel syndrome Treatment Conservative Splint NSAIDs Surgical Refractory to conservative care Documented anatomic lesions Release Guyon’s canal

Ulnar Nerve Pathologies Cont’d:

Ulnar Nerve Pathologies Cont’d Cubital tunnel syndrome “Tardy ulnar palsy” Presentation: 2 nd most common site Repetitive elbow flexion-extension Elbow pain Sensory disturbance in ulnar nerve distribution Weakness of ulnar intrinsics 1 st dorsal interosseus Adductor pollicis Key pinch strength Interosseus wasting

Ulnar Nerve Pathologies Cont’d:

Ulnar Nerve Pathologies Cont’d Cubital tunnel syndrome Physical Tinel’s at medial epicondyle Subluxation of nerve Snapping of triceps Decreased pinch strength Intrinsic atrophy Weakness in small FDP and FCU

Never Hesitate to dive for experience & knowledge:

Never Hesitate to dive for experience & knowledge

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