Ulnar Never Injury

INTRODUCTION:

Ulnar nerve is the branch of the medial cord of brachial plexus with root value C8 and T1. it supplies flexor carpi ulnaris and the medial half of flexor digitorium profundus in forearm. In the hand through its superficial branch it supplies palmaris brevis and digital branches to the volar side of the little finger and medial half of ring finger. The deep branch supplies the hypothenar, the dorsal and palmar interossei, two medial lumbricals and the adductor pollicis muscles of the hand.

CAUSES:

CAUSES IN THA AXILLA:

  • Crutch pressure
  • Aneurysm of the axillary vessels

CAUSES IN THE ARM:

  • Fracture shaft of humerus
  • Gunshot or penetrating wounds

CAUSES IN THE ELBOW:

  • Compression by the accessory muscle
  • Fracture of lateral epicondyle of humerus
  • Repeated occupational strain
  • Recurrent subluxation of the nerve
  • Compression by the osteophytes as in rheumatoid or osteoarthritis
  • Cubitus valgus deformity due to various causes results in repeated friction of the nerve giving rise to tardy ulnar nerve palsy.

CAUSES IN THE FOREARM:

  • Fracture of radius and ulna
  • Incised wounds, gunshot wounds and penetrating injuries of forearm.

CAUSES AT THE WRIST:

  • Compression by osteophytes
  • Fracture hook of hamate
  • Compression by ganglion
  • Wrist injuries

CAUSES IN THE HAND:

  • Blunt trauma
  • Penetrating injuries
  • Associated ulnar artery aneurysm
  • Occupational-people operating high speed drills in rock mining.

SYMPTOMS:

The list of signs and symptoms mentioned in various sources for Ulnar nerve injury includes the 4 symptoms listed below:

  • Hand pain
  • Finger pain
  • Pain in 4th and 5th fingers
  • Tingling in 4th and 5th fingers

Note that Ulnar nerve injury symptoms usually refers to various symptoms known to a patient, but the phrase Ulnar nerve injury signs may refer to those signs only noticable by a doctor.

 

ULNAR NERVE INJURY GIVE RISE TO CLAW HAND DEFORMITY EITHER TRUE TYPE OR ULNAR CLAW HAND.

CLAW HAND DEFORMITY:

It’s the deformity with hyperextension of the metacarpophalangeal joints and flexion of the interphalangeal joints of the fingers.

TYPES AND CAUSES:

  • True claw hand involving both ulnar and median nerve
  • Ulnar claw hand or claw like hand due to ulnar nerve injury.

CLINICAL FEATURES:

  • Classical deformity
  • Loss of sensation along the distribution of ulnar nerve
  • Wasting of the hypothenar muscles, intrinsic muscle of hand leading to hollow intermetacarpal spaces at the dorsum of the hand.

LEVEL OF LESIONS:

HIGH:

  • above the level of elbow

LOW:

  • below the elbow at the junction of middle and lower third of the forearm
  • Proximal to guyon’s canal
  • Distal to guyon’s canal

DIAGNOSIS:

CLINICAL TEST:

FROMENT’S SIGN: three muscles first palmar interossei adductor pollicis and flexor pollicis longus require holding a book between the thumb and the other fingers. In ulnar nerve injury the first two muscles are paralyzed and now to hold the book, the patient has to depend only on flexor pollicis longus which flexes the thumb prominently this is the positive froment’s sign.

CARD TEST: inability to hold a card or paper in between fingers due to loss of adduction by the palmar interossei.

EGAWA TEST: with palm flat on the table the patient is asked to move the middle finger sideways this is the test for the dorsal interossei of the middle finger.

TREATMENT:

For Claw Hand deformity

Principles of treatment: All the treatment measures aim at blocking the hyperextension at the metacarpophalangeal joint. Once this joint is stabilized the long extensors will bring about the extension of IP joints. The long finger flexors will help in flexion of the MP joints along with their action of finger and wrist flexion.

Methods of Stabilization of MP Joints:

This can be done by active method which involves tendon transfer or by passive method which involves arthrodesis, capsulodesis or tenodesis.

Active method: This is by tendon transfers. A neighboring healthy tendon is brought to replace the action of the lost intrinsics. The choice of the tendon is dictated by the available normal tendons and the existing local situations

Kindly contact PHYSIOLINE for further consultation and rehabilitation