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ulnar neuropathy

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 [4] - 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 [1] Special laboratory: - 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.

Related

carpal tunnel syndrome (median neuropathy) ulnar nerve

Specific

cubital tunnel syndrome (ulnar nerve entrapment)

General

entrapment neuropathy; nerve entrapment syndrome; pinched nerve mononeuropathy

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 15, 16. American College of Physicians, Philadelphia 2009, 2012
  2. Caliandro P, La Torre G, Padua R, Giannini F, Padua L. Treatment for ulnar neuropathy at the elbow. Cochrane Database Syst Rev. 2011 Feb 16;(2):CD006839. PMID: 21328287 - Cochrane Database Syst Rev. 2012 Jul 11;7:CD006839 PMID: 22786500
  3. NEJM Knowledge Plus. Question of the Week. http://knowledgeplus.nejm.org/question-of-week/1381/
  4. Doughty CT, Bowley MP. Entrapment neuropathies of the upper extremity. Med Clin North Am 2019 Mar; 103:357 PMID: 30704687