neurology surgery

1. Injury of ulnar nerve
HAMAD EMAD HAMAD DHUHAYR
10110067

2. Ulnar Nerve
Roots: C8 and T1.
Motor Functions: Innervates the muscles of the hand (apart from the thenar
muscles and two lateral lumbricals), flexor carpi ulnaris and medial half of flexor
digitorum profundus.
Sensory Functions: Innervates the anterior and posterior surfaces of the medial
one and half fingers, and associated palm area.

3. Injury to the Ulnar Nerve
(motor at elbow)
Flexor carpi ulnaris & medial half of flexor digitorum profundus are paralyzed
In a tightly clenched fist the tightening of the tendon of profundus is absent
Profundus tendon to the ring & little fingers will be functionless
Terminal phalanges of these fingers fail to flex properly

4. Injury to the Ulnar Nerve
(motor at elbow)
Flexion of wrist joint will result in abduction due to paralysis of flexor carpi
ulnaris.
Small muscles of hand will be paralyzed except the muscles of thenar eminence
and first 2 lumbricals.
Adductor pollicis longus is paralyzed so the adduction of thumb is not possible

5. Injury to the Ulnar Nerve
(motor at elbow)
Metacarpophalangeal joints become hyperextended due to the paralysis of
lumbrical and interosseous muscles
Interphalangeal joints are flexed due to the same reason as mentioned above
Dorsum of hand will show hollowing due to the wasting of dorsal interosseous
muscles

6. Injury to the Ulnar Nerve
(sensory at elbow)
Loss of skin sensation of anterior & posterior surfaces of the medial 3rd of the
hand and medial 1 & ½ fingers
The skin areas involved in sensory loss are warmer and drier than normal
Arteriolar dilatation and absence of sweating resulting from loss of sympathetic
control

7. Injury to the Ulnar Nerve
(motor at wrist)
Small muscles of the hand will be paralyzed
Claw hand is more obvious as flexor digitorum profundus is not
paralyzed
Marked flexion of the terminal phalanges occur

9. Injury to the Ulnar Nerve
(sensory at wrist)
The sensory loss is usually confined to the palmar surface of medial 3rd of the hand and the
medial 1 & ½ finger
Trophic changes are same as that injuries of ulnar nerve at elbow
Unlike median nerve injuries, lesions of ulnar nerve leave a relatively efficient hand
Pincer like action is good

11. a- Closed injury:-
- Expectant TTT for 6 m.
• Electric stimulation of m.
• Physiotherapy.
• Splint in position of best function.
!f no response:- -
• Exploration of nerve.
• Remove any neuroma, glioma or intervening T.
• Trim & anastomosis the ends.
lf wide gap:-
- N. graft or n. transposition (infront of med. Epicondyle)
b- Open injury:-
Only debridement (no 1ry repair)
Repair lf not infected) delayed '1ry repair (after 3 w.)
lf infected ) 2'Y reoair (after 6 w.