Login

Ulnar Nerve Lesion

Definitions:

 

Clinically Definite Ulnar Nerve Compression Criteria:

 

  • Medial elbow pain
  • Sensory symptoms down medial forearm
  • Sensory loss within ulnar palm and 1½ fingers
  • Weakness/wasting ulnar muscles

- finger abductors

- wrist flexion

- 4th and 5th finger flexion

 

Fixed Neurological Deficit:

  • Weakness of flexion of the fourth and fifth fingers -if proximal portions of these fingers are held steady, the patient is unable to flex terminal phalanges.
  • Weakness of abduction of the fifth finger
  • Hypothenar muscle wasting
  • Sensory loss of the dorsal & palmar aspects of the medial side of the hand and medial one and a half fingers

 

Causes of Ulnar Nerve Compression:

 

  • Cubital tunnel syndrome– ulnar nerve compression at the elbow

o   Most common cause

 

  • Ulnar tunnel syndrome/Guyon’s canal syndrome– ulnar nerve compression at the wrist

o   Second most common cause

o   Positive Tinel’s and Phalen’s test with paraesthesiae in the fourth and fifth fingers

 

Differential diagnoses include:

  • Cervical disc disease
  • Brachial plexus compression
  • Elbow abnormalities, epicondylitis
  • Neuropathy e.g. associated with Diabetes, hypothyroidism, Rheumatoid arthritis, alcohol excess
  • Wrist fractures
  • Ulnar artery aneuryms or thrombosis at the wrist

 

 

Referral form for Nerve Conduction Studies

 

 

Elective referral algorithm:

 

Conservative measures:

The treatment of ulnar nerve palsy depends on the site of the lesion:

  • At the elbow - avoidance of full elbow flexion and pressure on the elbow may be sufficient in mild cases
  • At the wrist

o   avoidance of aggravating factors may be sufficient in mild cases e.g. repetitive hand motions, resting palm against hard surfaces and working with wrist bend down and out

o   a wrist splint will sometimes decrease symptoms in early stages

  • Non-steroid anti-inflammatories may be beneficial in those patients who can tolerate

 

 

Date reviewed                     13/08/2024

Next review due                  13/08/2026

Sifter name                          Dr Rebecca Hopkins

Contributors:                     Dr Brendan McLean, Neurology Consultant, Royal Cornwall Hospital

        Dr Natalie Dawes, General Practitioner, Referral Management Service

 

 

Version No. 2.1