Ulnar Nerve Paralysis

Aka: Ulnar Nerve Paralysis, Cubital Tunnel

1. See Also
   1. Overuse Syndromes of the Hand and Wrist
   2. Ulnar Tunnel
2. Pathophysiology
   1. Chronic trauma to Ulnar Nerve
      1. Injury as it passes behind medial epicondyle at elbow
   2. Results in Ulnar Nerve Paralysis
3. Associated conditions
   1. Cubitus Valgus deformity
      1. Secondary to Growth Plate Fracture or infection
      2. Results in progressive Ulnar NerveStretching
   2. Shallow ulnar groove
      1. Ulnar Nerve subluxation in and out of groove
   3. Rheumatoid Arthritis
   4. Elbow Fracture and immobilization
   5. Excessive leaning on elbow
   6. Increased elbow flexion and extension
4. Symptoms and signs
   1. Tapping or pressure over medial epicondyle
      1. Reproduces Paresthesias or numbness along Ulnar Nerve
      2. Radiation into Forearm and hand
   2. Weakness or Atrophy suggests moderate to severe injury
      1. Forearm weakness
      2. Hypothenar weakness
      3. Intrinsic muscles of hand weakness
5. Differential Diagnosis
   1. Ulnar Tunnel (Symptoms isolated to wrist)
6. Labs: Electromyogram
   1. Delayed conduction at elbow
7. Management
   1. NSAIDs
   2. Moist heat
   3. Splinting
   4. Protect nerve from pressure
8. Management: Surgical Repair
   1. Perform early before motor dysfunction
   2. Transfer nerve anterior to medial epicondyle
   3. Release of constricting bands
   4. Results in immediate relief of pain
      1. Sensory recovery delayed
      2. Motor recovery may be incomplete