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Ulnar Nerve Injury

  1. The ulnar nerve passes just behind the medical epicondyle So the fracture would lead to injury of ulnar nerve
  2. Ulnar Nerve (C8 T1)
  1. Sensory Supply
    1. Palm
      1. Anterior-Medial 1/3 of palm (Hypothenar area)
      2. Posterior — Medial ½ of palm
    2. Digits
      1. Anterior - Medial 1½ digits
      2. Posterior Proximal Phalanx - Medial 2½ digits
        Middle & Distal Phalanx - medial 1½ digits
    3. Clinical Presentation
      Anesthesia is autonomous Zone i.e tip of little finger and hypoaesthesia in hypothenar eminence & medial 1½ fingers on volar and dorsal aspect.
  2. Motor Supply
    1. Fore arm
      1. Flexor Carpi Ulnaris
      2. (weakness of ulnar deviation & flexion of wrist)
      3. Medial half of flexor digitorum profundus
    2. Hand
      1. Hypothenar muscles (Atrophy of hypothenar eminence)
        1. Palmaris brevis
        2. Abductor digiti minimi
        3. Flexor digiti minimi
        4. Opponens digiti minimi
      2. Thenar muscles
        1. Adductor pollicis Forment’s sign/book test
        2. Deep head of flexor pollicis brevis .
      3. Four palmar interossei - Tested by card test (loss of adduction finger)
  3. Four Dorsal interossei - Loss of abduction of finger–Igawa test(middle finger abduction is lost)
    5. Medial two lumbricals
Clinical Picture
  1. Positive Card Test weakness of palmar interossei there is weakness of finger adduction, so patient is unable to hold card firmly between fingers.
Card test

Igawa’s test

Claw hand
  1. Wartenberg’s sign is inability to abduct the small finger in against the ring finger due to weakness of palmar interosseous muscles.
  2. Positive Book Test/Froment Sign is substituting thumb IP joint flexion for thumb adduction due to weakness of adductor pollicis muscle. So patient holds book between thumb & index finger by using Flexor Pollicis longus (supplied by median nerve). This produces flexion at inter-phalyngeal joint, while holding book.
  3. Positive IGAWA’S Test due to weakness of dorsal interossei, side to side movements of middle finger is weak.
  4. Ulnar Claw Hand- clawing of little & ring fingers i.e. hyperextension at M.P. joint and flexion at interphalyngeal joint
  5. In low ulnar n. palsy forearm muscles are spared but the clawing is more (as compared to high ulnar n. palsy) this phenomenon is ulnar paradox due to intact medial ½ of FDP.
  1. Claw hand (Main in griffe)
    1. Partial (Involving medial two fingers only)
      Ulnar nerve palsy
  2. Complete
    Combined Ulnar & Median nerve palsy

Knuckle bender splint

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