Ulnar Nerve

by Carlo Raj, MD

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    00:01 We move on to the ulnar nerve.

    00:03 Take a moment here and identify the ulnar nerve.

    00:05 Once again, a common site of injury.

    00:07 Most frequently at the elbow, from leaning on it or trauma.

    00:14 Clinical features: Weak hand.

    00:16 By that, we mean once again dropping objects.

    00:19 Difficulty turning keys, ignition and doorknobs.

    00:22 Turning, okay? Turning.

    00:26 Numbness and tingling of fourth and fifth fingers.

    00:31 Anatomical position, which was my fourth and fifth.

    00:34 It is the ring finger and the pinky, right? Fourth and fifth.

    00:39 Where are you? Ulnar.

    00:42 Medial aspect of the arm.

    00:45 Wasting of the interosseous muscle.

    00:49 What I wish to bring to your attention with the radial nerve, is the fact that you could have this pseudo type of interosseous issue as well and just be careful not to get the two confused, Here, it’s strictly wasting of the interossei.

    01:04 The onset is usually slow, insidious.

    01:08 Risk factors: More in men, diabetes, alcoholism, HIV, leaning on the elbow.

    01:14 So up until the point the risk factors are pretty much across the board quite common.

    01:19 Except now, specifically, leaning on the elbow.

    01:23 Occupational.

    01:24 For example, telephone operators or receptionists.

    01:26 They don’t even realize that this is happening.

    01:29 So if you’re working with too much of the hand, you’re thinking median nerve.

    01:32 If you’re once again are working behind the desk, there’s every possibility that you might be spending quite a bit of time while you’re talking on the phone, leaning on the elbow.

    01:42 Trauma.

    01:43 For example if there’s a hitting of the elbow.

    01:46 Physical examination: Look for the first dorsal wasting of the interosseous atrophy.

    01:52 Test the interosseous strength.

    01:53 Ask the patient to spread the fingers against resistance.

    01:59 Decreased sensation to touch and pinprick over what? Fourth and fifth fingers.

    02:06 Positive Tinel sign.

    02:07 What does that mean to you? Tingling upon tapping the nerve at the elbow.

    02:15 Spend a little bit of time with these physical exams, please, on these various mononeuropathies.

    02:20 Management: Stop or once again look for lifestyle modification.

    02:25 Surgery: Ulnar nerve what’s known as transportation for severe cases and atrophy with active denervation in interosseous, not always successful.

    02:35 But that’s the problem with surgery, it’s the fact that there is no guarantee that it worked, but in severe cases, oftentimes, you’ve ran out of options.

    02:46 Differential diagnosis: Here, once again, C8-T1 possibly root lesion, but usually accompanied by neck and arm pain.

    02:54 ALS, amyotrophic lateral sclerosis.

    02:56 Here, once again, if symptom are in more areas than just the ulnar nerve or if accompanied by speech and swallowing problems and fasciculation, all of this of course referring to ALS.

    03:08 Thoracic outlet syndrome, rare but nonetheless, a differential.

    About the Lecture

    The lecture Ulnar Nerve by Carlo Raj, MD is from the course Mononeuropathy.

    Included Quiz Questions

    1. Tapping the nerve on the wrist causes a tingling sensation.
    2. Tapping the nerve on the elbow causes a tingling sensation.
    3. Look for dorsal interossei atrophy.
    4. Ask fingers to spread apart against resistance.
    5. The decrease in sensation to touch and pinprick over the 4th and 5th fingers.
    1. Difficulty in turning knobs
    2. Dropping of objects
    3. Positive Tinel sign
    4. Thumb pointing to the ceiling to flex the forearm.
    5. Extension of elbow

    Author of lecture Ulnar Nerve

     Carlo Raj, MD

    Carlo Raj, MD

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