Ulnar Nerve Examination

Not to miss following points during the examination

Attitute of the limb or hand

cascade of fingers


Look -
           any scars on arm , forarm

       guttering on the dorsum of hand , wasting on hypothenar region


Feel - temperature

           any soft tissue or bony tenderness

           tinel's sign ,scar tenderness , scar pliability

Movement

          active and passive

Measurement if any angulation or bony deformity


Neurovvascular examination

sensation of autonomous zones of hand and  direct the examination to the nerve affected

Power of muscles - Examine both the weaker muscles and donor group of muscles


  Elbow - Brachioradialis

             
Wrist      FCU


Hand       FDP - 4th and 5th finger , FDS Ring Finger , FDP 2nd and 3rd finger

               Lumbricals

              Opponens Digiti Minimi

              Abductor Digiti Minimi

             Adductor Pollicis

             FPB

Special tests to know the names .

    Card test - for Palmar interossei

     Igawa test- for dorsal interossei

     Froment's sign - flexor pollicis sucstitutes adductor pollicis

Reflexes

Pulsation / allen's test






How do you proceed ? 

detailed history , physical examination

NCS and EMG


What next ? 

Like any other nerve injuries ,see previous section on nerve injury management.


What are choices for tendon transfer  ? 

Low Ulnar Nerve Injury

          Brachioradialis

          EIP

         FDS from 2nd or 3rd finger


High Ulnar Nerve injury

         Brachioradialis

          EIP

          FDP from 2nd,3rd finger

          sensory flap



see the mnemonic

       BEF again like in median nerve











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