anatomy ulnar-nerve
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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