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Ulnar Nerve

Introduction
Ulnar nerve is on of the major
terminal branches of Brachial Plexus.
It is the continuation of medial cord
of brachial plexus which arises from
the anterior Division of the lower
Trunk.
Root Value: C8 and T1

Course From Cord to Axilla.


The Ulnar nerve runs between the
Axillary artery and vein in the axilla.
Course from Axilla to Arm
From the axilla it enters in the arm and
stays between the brachial artery and
vein.

Course from Arm to Elbow


The nerve runs inferior and posterior
medial aspect of humerus bone till it
enters the cubital tunnel.

Course from Elbow to Forearm


At the elbow the ulnar nerve lies in a
groove (Retrocondylar groove) which
is formed by medial epicondyle
humerus and olecranon process of
ulna
It enters the forearm through the
aponeurotic arcade (Cubital Tunnel).

Dorsal cutaneous branch

Palmar cutaneous branch

Ulnar Innervated Muscles

Forearm:
Flexor Carpi Ulnaris (C7, C8, T1)
Flexor Digitorum Profundus III & IV (C7, C8)
Thenar:
Hypothenar Muscles (C8, T1)
Adductor Pollicis (C8, T1)
Flexor Pollicis Brevis (C8, T1)
Fingers:
Palmer Interosseous (C8, T1)
Dorsal Interosseous (C8, T1)
Lumbricles (C8, T1)
Digiti Minimi:
Abductor Digiti Minimi (Quinti) (C8, T1)
Opponens Dgiti Minimi (C8-T1)
Flexor Digiti Minimi. : ( C8-T1)

ULNAR NERVE INJURY

Injuries of the ulnar nerve are usually


either near the wrist or near the
elbow ( medial epicondyle )
Open wounds may damage it at any
level.

Clinical features
Low lesions are often caused by cuts on
shattered glass.
There is numbness of the ulnar one and a
half fingers.
The hand assumes a typical posture claw
hand deformity with hyperextension
of the metacarpophalangeal joints of
the ring and little fingers, due to
weakness of the intrinsic muscles.

Hypothenar and interosseous


wasting.
Finger abduction is weak with the
loss of thumb adduction

Froments Sign
The patient is asked to grip a sheet of
paper forcefully between thumbs and
index fingers while the examiner tries
to pull it away; powerful flexion of the
thumb interphalangeal joint signals
weakness of adductor pollicis and first
dorsal
interosseous
with
overcompensation by the flexor pollicis
longus (Froments sign).

High ulnar paradox


High lesions occur with elbow
fractures or dislocations.
The hand is not markedly deformed
because the ulnar half of flexor
digitorum profundus is paralysed and
the fingers are therefore less clawed
Otherwise, motor and sensory loss
are the same as in low lesions.

Treatment
Exploration and suture of a divided nerve and anterior transposition
at the elbow permits closure of gaps up to 5 cm.
While recovery is awaited, the skin should be protected from burns.
Hand physiotherapy
Grip strength is diminished primary metacarpophalangea lflexors
are lost, and pinch is poor because of the weakened thumb adduction
and index finger abduction.
Fine, coordinated finger movements are also affected.
Metacarpophalangeal flexion can be improved by extensor carpi
radialis longus to intrinsic tendon transfers (Brand), or by looping a
slip of flexor digitorum superficialis around the opening of the flexor
sheath (Zancolli procedure).
Index abduction is improved by transferring extensor pollicis brevis or
extensor indicis to the interosseous insertion on the radial side of the
finger.