ulnar neuropathy

Introduction

Also see cubital tunnel syndrome

Epidemiology

• second most common entrapment neuropathy (after carpal tunnel syndrome)

Pathology

• entrapment of the ulnar nerve at the wrist or elbow

Clinical manifestations

• numbness of the 4th & 5th fingers
• normal grip strength
  • occasionally weakness of the hand
    • unable to hold a piece of paper between the thumb & lateral aspect of the index finger
• ulnar entrapment at the elbow
  • pain with flexion of the arm at the elbow
  • paresthesias on both the palmar & dorsal aspect of the 4th & 5th fingers
  • normal triceps reflex
  • Tinel sign at the elbow
• ulnar entrapment at the wrist
  • paresthesias generally involve only the palmar aspect of 4th & 5th fingers
• pain with flexion at the wrist may also be noted with entrapment at the wrist or the elbow

Diagnostic procedures

• nerve conduction studies & electromyography are confirmatory
  • shows location & severity of nerve injury

Differential diagnosis

• C8 radiculopathy (cubital tunnel syndrome)
• carpal tunnel syndrome
  • numbness of the palmar side & fingertips of the 1st 3 & 1/2 fingers
  • numbness of the radial side of the palm
• cervical radiculopathy
  • neck or arm pain, comprrange of motion of the neck, positive Spurling test
• radial neuropathy
  • weakness of the wrist extensors & finger extensors (wrist drop & finger drop)

Management

• conservative management
  • activity modifications & splinting
• surgery may be needed in advanced or refractory cases.

More general terms

• entrapment neuropathy; nerve entrapment syndrome; pinched nerve
• mononeuropathy

More specific terms

• cubital tunnel syndrome (ulnar nerve entrapment)

Additional terms

• carpal tunnel syndrome (median neuropathy)
• ulnar nerve