DIAGNOSIS AND

MANAGEMENT OF ULNAR
NERVE PALSY
By:
Amalia Farahtika Srikandi
1102014016

Lecture Adviser:
dr. Donny H Hamid Sp.S
 Definition

• Ulnar nerve palsy is a condition when you lose sensation and have
muscle weakness in your hand if you damage your ulnar nerve.
This condition can affect your ability to make fine movements
and perform many routine tasks, it can also result in paresthesia and
dysesthesia in the affected hand. In severe case, ulnar nerve palsy can
cause muscle wasting, or atrophy, that makes the hand look like claw.
Epidemiology
The second most common
peripheral nerve condition after
median nerve palsy

Ulnar nerve palsy are

disproportionately male in the
working age group (18 – 45 y.o)

a result of a high-energy injury

caused by traffic accidents, fall
from a height and sports injuries
Anatomy
 Etiology

Acute Trauma

Chronic Pressure

Entrapment

More vulnerable to traction and contusion

 Clinical Presentation

Tingling and Limited

numbness in May be dexterity and
the fourth and worsened by strength of
fifth digits of elbow flexion the grasp and
the hand pinch
Ulnar Nerve Entrapment at the Elbow

weakness of the adductor pollicis,

flexor pollicis brevis, and palmar
dorsal interosseous muscles

Lumbrical weakness
Ulnar Nerve Entrapment at the Wrist

Sensation in the proximal hypothenar

region and the dorsum of the little
and ring fingers is not impaired

The sensory loss, if present, is

confined to the palmar surface of the
ulnar-innervated fingers
 Diagnosis

History Taking
• Differentiate between neurapraxia and axonotmesis (which can
be treated without surgery) and neurotmesis, which requires
surgical intervention
• Ask about trauma and pressure

Complaints
• sensory changes in the fourth and fifth digits
• pain tend to be more common in the arm, up to and including
the elbow area.
• hands “look older.”
• Weakness
 Physical Examination

Froment’s sign Consider a shoulder internal

rotation test

Test abduction of the little finger Perform an elbow flexion test Check for clawing of the 4th and
against resistance
Check for the Tinel sign 5th fingers
Test abduction of the index finger
against resistance
Laboratory Studies
• Complete blood cell count
• Urinalysis
• Blood glucose
Radiography
• Radiograph of the elbow to reveal abnormal
anatomy, such as a valgus deformity, bone spurs
or bone fragments, a shallow olecranon groove,
osteochondromas, and destructive lesions
(tumors, infections, or abnormal calcification)
 Electromyography
• ELECTROMYOGRAPHY
• To confirm the area of entrapment.
• The ulnar nerve is stimulated at the wrist and above and below the elbow.
The inching technique, in which the nerve is stimulated over 1- to 2-cm
intervals, can increase the sensitivity of the procedure and may improve
localization by helping the examiner judge whether a blockage is
infracondylar (near the cubital tunnel) or higher (near the ulnar or
epicondylar groove).
 Differential Diagnosis

 Compression of the eight cervical root at (C7-T1) may mimic ulnar nerve
palsy.
 Elbow fracture/dislocation
Cervical radiculopathy
 Alcohol (Ethanol) related neuropathy
Primary bone tumors, peripheral polyneuropathy
 Treatment

Non-surgical Therapy
• Oral vitamin B-6, B-12 supplements for mild
symptoms
• Decrease repetitive activities that may
exacerbate symptoms
• Do not improve with splinting? daytime
immobilization for 3 weeks should be considered
• Improve? conservative treatment should be
continued for at least 6 weeks to prevent
recurrence
Surgical Therapy
• If nonsurgical methods fail and the patient has
severe or progressive weakness or atrophy,
stabilization of traumatic injuries, resection of
masses or cysts, and sectioning of fibrous bands
Kinds of surgery:
• Decompression in situ
• Decompression with anterior transposition
• Medial epicondylectomy
 Prognosis

• Functional recovery is determined by the time required for the motor end
plate to be reinnervated and by the number of regenerated motor axons
that can reach target muscle.
• Only about 60% of patients, with symptoms of less than 1 years duration,
benefit from surgery, some experience worsening of symptoms.
• However, the prognosis of ulnar nerve entrapment at the wrist is usually
good after surgical decompression with effective reinnervation.
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