ULNAR NERVE

NEUROPATHY

By :
Mellati Zastia Putri
1102011160

Lecturer Adviser :
Dr. Donny H. Hamid, Sp.S
Department of Neurology Pasar Rebo Province General Hospital

The ulnar nerve is an

extension of the medial cord
of the brachial plexus.

supplies innervation to
muscles in the forearm and
hand and provides
sensation over the medial
half of the fourth digit and
the entire fifth digit and the
ulnar portion of the
posterior aspect of the hand

Entrapment of the ulnar

nerve is the second most
common entrapment
neuropathy in the upper
extremity

The most common site of

ulnar nerve entrapment is in
the region of the cubital
tunnel; the second most
likely site is in the area of
the anatomic structure
called the canal of Guyon.

Pressure on or injury to the

ulnar nerve may cause
denervation and paralysis of
the muscles supplied by the
nerve.

numbness and tingling

along the little finger and
the ulnar half of the ring
finger.

anatomy

The ulnar nerve is the

terminal branch of the medial
cord of the brachial plexus
and contains fibers from C8,
T1, and, occasionally, C7.

The ulnar nerve innervates

muscles in the forearm and
hand

Its sensory territory includes

the
hypotenar
eminence,
medial dorsum of the hand,
and
dorsal
and
palmar
surfaces of the 5th finger and
half of the 4th finger.

Motor function of the ulnar nerve

action

muscle

Wrist flexion, ulnar side

Flexor carpi ulnaris

Flexion at distal IP joint

Flexor digitorum profundus, digits

4&5

Touching 2nd digit to 4th digit;

spreading fingers

Interossei

Extension of finger at proximal IP

joint with the MCP joint fixed

Lumbricals to digit 4 & 5

Adduction of thumb at right angle

to palm

Adductor pollicis

Flexion at MCP joint

Flexor digiti minimi

Abduction of 5th digit

Abductor digiti minimi

Pinch between thumb and 5th digit Opponens digiti minimi

Sites of The Entrapment

Location

Elbow

Mechanism of entrapment

Wrist
(Guyon canal)

Clinical findings

Ulnar groove (compression or

stretch)
Cubital
tubbek
syndrome
(anatomic)

Extrinsic
compressive
neuropathy
Anatomic entrapment
Wrist fracture

Palm

palmar
branch
(blunt
Deep
trauma to palm)
Superficial palmar branch (blunt
trauma to palm)

Numbness in medial hand, worsened

by elbow flexion
Weakness of grasp or pinch
Claw hand in severe, chronic
compression
Poor motor (deep palmar branch),
hypothenar weakness
Poor sensory (superficial palmar
branch), palm numbness
Mixed motor and sensory (both)

Poor motor (deep palmar branch),

hypotenar weakness
Poor sensory (superficial palmar
branch), palm numbness

Nerve injuries classification

Diagnose
Tinel sign (+)
EMG & nerve conduction studies important to
evaluate th eulnar mononeuropathy
Blood studies & imaging can be informative in
some cases

treatment
Conservative
therapy

Immobilization
Avoid hard activities
Patients may wear simple elastic elbow bandages
during sleep to prevent sustained elbow flexion
ineffective
Short course of oral corticosteroids,
followed by long-term nonsteroidal
therapy
Ineffective
within 4-8 weeks

Ulnar decompression or
transposition

Prognosis
The duration of entrapment and the severity of
numbness and muscle weakness are key factors
influencing the prognosis.
Unfavorable or poor surgical
associated with the following:

outcome

is

o Age older than 50 years

o Coexisting
diabetes
or
other
causes
of
peripheral
polyneuropathy
o Atrophy and ongoing denervation of ulnar-derived muscles
o Absent ulnar sensory responses