anatomy ulnar nerve

Anatomy of Ulnar Nerve

Cubital Tunnel Syndrome

• Symptoms & Signs:- sensory changes volar & dorsal ulnar 11/2 digits

- Pain or Tinel’s sign at elbow- Positive elbow flexion test- weakness/atrophy of intrinsic muscles (esp. key pinch)- Wartenberg’s sign- Froment’s sign- Claw hand

Cubital Tunnel Syndrome

• Sites of compression:- Arcade of Struthers- Medial head of triceps- Medial intermuscular septum- Arcuate lig. Of Osbourne- Aponeurosis of FCU

Cubital Tunnel Syndrome

• Non-surgical management- night splints to keep elbow extended (static)- Soft elbow pads to prevent direct compression- Rest & activity modification- Anti-inflammatories

Cubital Tunnel Syndrome

• Surgery- Principles:

- Release of compression- Prevention of subluxation

Cubital Tunnel Syndrome

• Surgery:- Simple decompression in situ- Medial epicondylectomy- Anterior transposition:

- subcutaneous- intramuscular- submuscular- transmuscular

Ulnar Tunnel Syndrome (Guyon’s canal)

• Symptoms & signs:- numbness volar surface ulnar 1.5digits- Intrinsic weakness- Can be pure motor, pure sensory or combination

Ulnar Tunnel Syndrome (Guyon’s canal)

• Aetiology:- carpal ganglion- Repetitive trauma- Fracture of hook of hamate- Hypertrophied palmaris brevis- Thrombosis or aneurysm of ulnar artery

Ulnar Tunnel Syndrome (Guyon’s canal)

• Surgery:- Release of Guyon’s canal- Ensure visualization of deep motor branch- Check for ganglion