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Ulnar nerve palsy
• This occurs due to
nerve compression at
the elbow (cubital
tunnel) or at the wrist
(Guyon's canal) (Ulnar
canal)
• Muscle weakness and
atrophy predominate
the clinical presentation
Ulnar nerve palsy/Causes
Cubital Tunnel Syndrome
Guyon's Canal Syndrome
• Frequent bending of the
elbow
• Leaning on the elbow,
resting it on an elbow, rest
during a long distance
drive or running machinery
may cause repetitive
pressure and irritation on
the nerve.
• A direct hit on the cubital
tunnel may damage the
ulnar nerve
• A cyst within the canal.
• Clotting of the ulnar artery.
• Fracture of the hamate
bone.
• Arthritis of the wrist bones
Ulnar nerve palsy/Causes
• Symptoms & signs:
– numbness and tingling in the ring and little finger and the sides and
back of the hand. At Guyon's Canal, sensory supply to the skin of the
back of the hand is spared.
– The hand may become weaker resulting in trouble opening bottles or
jars
– Clawing may occur in the ring and little fingers
– Froment's test: by asking the patient to hold a piece of paper
between their thumb and index finger (hence checking adductor
pollicis). In a patient with Ulnar nerve palsy the interphalangeal joint
of the thumb will flex to compensate
• Treatment:
– Nonsurgical therapy: elbow or wrist splints to limit mobility in addition
to an anti-inflammatory drug such as ibuprofen.
– Surgical decompression maybe required in some cases
Froment's test
Radial nerve palsy
• Aka:
– wrist drop
– Saturday night palsy
• Causes
– Caused by excessive compression of the radial nerve against a hard
surface in individuals insensitized by the intake of alcohol or sedatives
– Broken humerus
– lead poisoning
– Stab wounds to the chest at or below the clavicle. Damage the
posterior cord of the brachial plexus
• Symptoms:
– Wrist drop
– Occasionally, the back of the hand may lose feeling
Wrist Drop
Erb’s Palsy
• Aka:
– Waiter's tip deformity
– Erb-Duchenne Palsy
Erb’s Palsy
• Due to brachial plexus damage, by excessive lateral neck flexion away from
sholder:
– Forceps delivery
– Falling on the neck
• Leads to loss of the lateral rotators of the shoulder, arm flexors, and hand
extensor muscles.
• The position of the limb, under such conditions, is characteristic:
– the arm hangs by the side and is rotated medially;
– the forearm is extended and pronated.
– The hand is flexed
– The arm cannot be raised from the side; all power of flexion of the
elbow is lost, as is also supination of the forearm
Erb’s Palsy
• The three most common treatments from Erb's Palsy are:
– Nerve transfers (usually from the opposite leg),
– Sub Scapularis releases
– and Latissimus Dorsi Tendon Transfers.
• Although range of motion is recovered in many children under one year in
age, individuals who have not yet healed after this point will rarely gain
full function in their arm and may develop arthritis