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The Origin of the Ulnar nerve:
The brachial plexus is a network of nerve fibers, running from the spine, formed by the ventral rami of the lower four
cervical and first thoracic nerve roots (C5-
C8, T1). It proceeds through the neck, the axilla, and into the arm. It is a network of nerves passing through the cervico-axillary canal to reach axilla and supplies
brachium, antebrachium and hand.
The brachial plexus is responsible for cutaneous and muscular innervation of the entire upper limb.
The ulnar nerve originates from the C8-T1 nerve roots (and occasionally carries C7 fibres)
which form part of the medial cord of
the brachial plexus .
course of Ulnar nerve:
-In the Axilla:
it descends on the medial side of the 3rd part
of axillary artery between it and axillary
vein
-In the Arm:it descends on the medial
side of brachial artery down to the insertion of
coracobrachialis muscle,Pierces the medial intermusular septum at the arcade of Struthers ~ 8cm from medial epicondyle
and lies with triceps .Travels on back of
medial epicondyle; vulnerable in fractures
Runs with superior ulnar collateral artery to reach post. compartment of the
arm in front of medial head of triceps.
-At the Elbow:it reaches the
back of med.epicondyle
to enter the forearm between 2 heads of flexor carpi ulnaris(and
here it is accompanied by
sup.ulnar collateral a. and post. branch of inferior ulnar
collateral arteries).
: -In the Forearm
after passing between 2 heads of flexor carpi ulnaris,
it descends vertically infront of med. side of flexor digitorm
profunds covered by the flexor carpi
ulnaris.
-In the Hand:it enters the palm
of the hand by passing in front of med. part of flexor
retinaculum between
pisiform(medially) and the ulnar
artery(laterally)& finally ends by dividing into
superficial and deep branches.
Branches of Ulnar Nerve :
-Just past the Elbow: The nerve
gives branches
to the Flexor Carpi
Ulnaris and the medial
half of the Flexor
digitorum profundus
.
-In the Forearm:
The Ulnar Nerve divides
into Dorsal and palmer cutaneous branches.
-The Palmer cutaneous
branch of the Ulnar Nerve
provides sensation to the palm of
the hand. The Finger sensation is provided by
the superficial branch.
-The Dorsal cutaneous branch of the Ulnar
Nerve gives innervation
to the medial dorsal
aspect of the hand and
the one and a Half Fingers.
-In the Hand:
The Nerve further
divides into superficial and deep branches.
The superficial
branch of the Ulnar nerve divides into
Palmer digital nerves after it passes under and supplies the Palmaris
brevis muscle.
The Deep branch of the Ulnar nerve
innervates the three
hypothenar muscles , the medial two
lumbricals , the seven interossei , the adductor
pollicis and the deep head of flexor pollicis
brevis.
Ulnar Nerve Entrapment: The Ulnar Nerve
can become pinched in different locations.
1 -Thoracic outlet
syndrome. 2-cubital tunnel
syndrome. 3-Ulnar Tunnel
syndrome.
The Cubital Tunnel syndrome:
causes of Ulnar Nerve entrapment around the cubital
tunnel:
1-Cubitus Valgus:
Deformity in which the elbow is turned outward
2 -A spur on the Medial Epicondyle
Symptoms of the cubital tunnel syndrome:
1-Pain, tingling and numbness in the small and ring fingers.
2-Weakness of the muscles in the hand.
3-claw hand deformity if compression below the elbow due to flexion of the fingers by a functional profundus muscle for the 4th and 5th fingers.
claw hand deformity
The diagnosis of cubital tunnel syndrome:
is made after a thorough history and examination. X-rays or other tests
may be ordered if there is a concern of something abnormal pressing on the nerve. Nerve tests, called EMGs, can
help to determine the extent and location of nerve compression.
Treatment of Cubital Tunnel Syndrome:
1-Anti-inflammatory medications.
2-Splinting the elbow, especially at night.
3-Padding the elbow for work activities.
4-Physical therapy.“If these simple treatments fail, surgery may be
necessary to remove the pressure from the ulnar ”nerve .
: Guyon's canal syndrome
Guyon's canal syndrome, sometimes called Guyon's
tunnel syndrome, is a common nerve compression affecting the ulnar nerve as it passes
through a tunnel in the wrist called Guyon's canal.
Symptoms of the Guyon`s canal syndrome:
1 -Feeling of pins and needles in the ring and little fingers.
2 -May progress to a burning pain in the wrist and hand.
3-Decreased sensation in the ring and little fingers.
N.B :One common cause of this syndrome is from pressure of bicycle handlebars seen with avid cyclists , Another is from hard, repetitive
compression against a desk surface while using a computer mouse.
Treatment of Cubital Guyon`s canal Syndrome:
1- Initial line of treatment is with anti-inflammatory drugs or cortisone injections .
2 -Massage therapy.
3- acupuncture.
4- physical therapy.
5- chiropractic and osteopathic care.
If these options do not produce the desired results, some doctors may recommend working with surgical
option.
Surface Anatomy of the Ulnar nerve:
The surface marking of the nerve is along a line from the medial bicipital groove behind coracobrachialis to the point behind the medial epicondyle of the humerus where it is readily palpable.
The ulnar nerve runs from the groove between the medial epicondyle and olecranon process above to the radial or outer side of the pisiform bone below. It lies to the ulnar side of the ulnar artery in the lower half of the forearm
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