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A - MSRA Neuro and Stroke [12] > [7] Ulnar Nerve Disorders > Flashcards

[7] Ulnar Nerve Disorders Flashcards

1
Q

What cord of the brachial plexus does the ulnar nerve originate from?

A

Medial cord

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2
Q

How does the ulnar nerve run from the arm to the forearm?

A

Inferiorly to the posteromedial aspect of the humerus, then passes behind the medial epicondyle at the elbow

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3
Q

What is the relevance of the ulnar nerve passing behind the medial epicondyle?

A

It is exposed for several centimetres

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4
Q

How does the ulnar nerve run from the forearm to the hand?

A

Enters the anterior compartment of the forearm through the two heads of the flexor carpi ulnaris. It then runs alongside the ulna bone, continuing distally alongside the ulnar artery deep to the flexor carpi ulnaris.

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5
Q

How does the ulnar nerve enter the hand?

A

Passes with the ulnar artery superficial to the flexor retinaculum of the hand via the ulnar canal

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6
Q

What branches of the ulnar nerve innervate forearm muscles?

A

Muscular branches

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7
Q

What muscles of the forearm are innervated by the ulnar nerve?

A
  • Flexor carpi ulnaris

- Flexor digitorum profundus (medial half)

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8
Q

What branches of the ulnar nerve innervate muscles of the hand?

A
  • Deep branch

- Superficial branch

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9
Q

What muscles of the hand are innervated by the deep branch of the ulnar nerve?

A
  • Hypothenar muscles
  • Adductor pollicis
  • 3rd and 4th lumbricals
  • Dorsal interossei
  • Palmar interossei
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10
Q

What muscles of the hand are innervated by the superficial branch of the ulnar nerve?

A

Palmaris brevis

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11
Q

What parts of the hand receive sensory innervation from the ulnar nerve?

A

4th and 5th fingers with corresponding palmar and dorsal surfaces

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12
Q

What branch of the ulnar nerve innervates the anterior skin of the 4th and 5th digits?

A

Palmar branch

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13
Q

What branch of the ulnar nerve innervates the posterior skin of the 4th and 5th digits?

A

Dorsal branch

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14
Q

What can caused ulnar nerve dysfunction?

A
  • Dislocation or fracture of the elbow
  • Compression due to habitual elbow leaning
  • Medial epicondylitis
  • Entrapment in the cubital tunnel
  • Compression at the wrist
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15
Q

What is medial epicondylitis also known as?

A

Golfer’s elbow

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16
Q

What can cause entrapment of the ulnar nerve at the cubital tunnel?

A
  • Heavy manual work
  • Following previously poorly healed supracondylar fracture of the humerus
  • Osteophytic encroachment in osteoarthritis
17
Q

What can cause compression of the ulnar nerve at the wrist?

A
  • Aneurysm of ulnar artery
  • Thrombosis
  • Synovial inflammation and ganglia
  • Repeated trauma
18
Q

How can lesions of the ulnar nerve at the elbow present?

A
  • Total paralysis of the nerve
  • Wasting
  • Sensory loss of the dorsal and palmar aspects of medial side of the hand and medial 1 and 1/2 fingers
  • Palpably enlarged nerve in the ulnar groove when compression occurs
19
Q

Where can wasting occur with an ulnar nerve lesion at the wrist?

A
  • Medial side of the forearm

- Hypothenar, interossei, and medial part of the thenal eminance

20
Q

How can lesions of the ulnar nerve at the wrist present?

A

Usually motor loss with cutaneous sensation of hand and fingers often spared

21
Q

When is sensory loss in the ulnar nerve distribution more likely at the wrist?

A

Just proximal to the wrist

22
Q

How can an ulnar nerve lesion just proximal to the wrist cause present?

A
  • Impaired sensation over the palmar aspect of the hand and 4th and 5th fingers
  • Weakness over the hypothenar eminence
23
Q

What clinical tests can identify ulnar nerve lesions at the wrist?

A
  • Tinel’s sign

- Phalen’s test

24
Q

What is a positive Tinel’s sign?

A

Light percussion at the wrist causes ‘pins and needles’ in distribution of the nerve

25
Q

What is a positive Phalen’s test?

A

Paraesthesia in 4th and 5th fingers when wrist is held in flexion for 30-60 seconds

26
Q

What investigations may be useful in assessing ulnar nerve dysfunction?

A
  • USS of cubital tunnel
  • Electromyography tests and nerve conduction studies
  • MRI scan
  • Blood tests
  • X-rays
27
Q

Why may blood tests be appropriate to investigate ulnar nerve dysfunction?

A

To rule out disorders causing neuropathy e.g. anaemia, hypothyroidism and rheumatoid arthritis

28
Q

What are some differentials for ulnar nerve dysfunction?

A
  • Cervical disc disease
  • Brachial plexus abnormalities
  • Elbow abnormalities
  • Epicondylitis
  • Neuropathy
  • Wrist fractures
  • Ulnar artery aneurysm or thrombosis at wrist
29
Q

What can cause neuropathy?

A
  • DM
  • Hypothyroidism
  • Rheumatoid arthritis
  • Alcoholism
30
Q

When is conservative management of ulnar nerve dysfunction indicated?

A
  • Paraesthesia is transient
  • Caused by malposition of the elbow
  • Blunt trauma
31
Q

What does conservative management of ulnar nerve dysfunction involve?

A
  • Anterior elbow splinting
  • Correction of ergonomics at work
  • NSAIDs
32
Q

When is it common to perform surgery to correct ulnar nerve dysfunction?

A
  • No improvement
  • Progressive palsy or paralysis
  • Clinical evidence of long-standing disease
33
Q

What clinical signs suggest long standing ulnar nerve dysfunction?

A
  • Muscle wasting

- 4th and 5th digit clawing

34
Q

How can elbow lesions of the ulnar nerve be surgically managed?

A
  • Transposition
  • Epicondylectomy
  • Decompression
35
Q

How can wrist lesions of the ulnar nerve be surgically managed?

A

Exploration of the ganglia

A - MSRA Neuro and Stroke [12] (33 decks)

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