II. Indications

  1. Anesthesia of Ulnar Nerve distribution

III. Precautions

  1. Avoid injecting directly into Ulnar Nerve
  2. Avoid injection into ulnar artery

IV. Preparation

  1. Needle: 27 gauge 1.5 inch
  2. Anesthetic: Lidocaine 1%: 10 ml

V. Technique: Ulnar Nerve Block at wrist

  1. Injection site 1: Palmar branch of the Ulnar Nerve
    1. Between flexor carpi ulnaris tendon and ulnar artery
    2. Inject at depth of 1-2 cm at proximal wrist crease
    3. Needle parallel to wrist crease toward radius
  2. Injection site 2: Dorsal branch of the Ulnar Nerve
    1. Distal aspect of ulnar styloid process (dorsum)
    2. Infiltrate 3-4 ml subcutaneously
  3. Warning: Distal Paresthesias with needle with injection
    1. Indicates needle is at Ulnar Nerve
    2. Do not inject here!
    3. Remove needle and reposition

VI. Technique: Ulnar Nerve Block at elbow

  1. Higher risk procedure due to nerve injury
  2. Position
    1. Flex elbow to 90 degrees
  3. Injection
    1. Inject between olecranon and medial epicondyle
    2. Inject 3-5 ml at depth of 0.5 cm

VII. References

  1. Pfenninger (1994) Procedures, Mosby, p. 1036-54
  2. Salam (2004) Am Fam Physician 69(4):896 [PubMed]

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