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.
02:24
Surgery is indicated for severe lesions
and for interossei atrophy
due to denervation. Most common surgical
option is in-situ decompression.
Ulnar nerve transposition is rarely used
nowadays. The success rate of in-situ
decompression is acceptable.
02:42
Differential diagnosis: Here, once
again, C8-T1 possibly root lesion,
but usually accompanied
by neck and arm pain.
02:50
ALS, amyotrophic
lateral sclerosis.
02:53
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.
03:03
Thoracic outlet syndrome, rare
but nonetheless, a differential.