Anatomy and Examination of Ulnar & Sciatic Nerves
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Anatomy and Examination of Ulnar & Sciatic Nerves
- 2. ULNAR NERVE
- 11. Palmar cutaneous branch Superficial branch Deep branch Sensation to skin of the palmar and distal dorsal aspects of digit 5 and medial side of digit 4 and proximal portion of palm Deep head of flexor pollicis brevis
- 14. • Ulnar nerve injured around elbow – elbow fractures or dislocations • Wasting of hypothenar eminence & hollowing between metacarpals seen from dorsum of hand • Paralysis of all muscles supplied • Sensory deficit High Ulnar Nerve Palsy
- 15. • Injury to the distal third of forearm • Cuts on shattered glass • C/F : Numbness, claw hand deformity, hypothenar & interosseous wasting, weak finger abduction, loss of thumb adduction • Sensory loss • Froment’s sign +ve Low Ulnar Nerve Palsy
- 16. Tardy Ulnar Nerve Palsy • Slow in onset & progression • Appears between age of 30-50 • Preceding injury to the elbow in childhood • Ischemic and fibrotic changes in nerve • Seen most frequently in cubitus valgus deformity • Treatment: Transposition of nerve from its normal position to the front of the joint
- 17. Ulnar Paradox • The higher the lesion of the ulnar nerve injury, the less prominent is the deformity & vice versa (less clawing of fingers) • Because in higher lesions the medial half of FDP is paralysed . • The loss of finger flexion makes the deformity look less obvious the closer to the Paw, the worse the Claw
- 18. • Froment’s sign • Egawa’s test • Card test
- 19. Ulnar Neuritis & Ulnar Tunnel Syndrome • Ulnar neuritis – complication of local trauma at elbow or wrist • Nerve is subjected to pressure • Exposed to frictional damage • Treatment : Reacnchorage or transposition, epicondylectomy
- 20. Combined Low Median & Ulnar Nerve Palsy • Both ulnar & median nerve injured at wrist • Hyperextension of the metacarpophalangeal joints and flexion of the Interphalangeal joints of the hand • Referred to as “Intrinsic minus” hand • Motor palsy : all intrinsic muscles of hand unopposed by long flexors of forearm • Sensory loss : whole palm & fingers
- 26. Sciatic Nerve Palsy • Traumatic hip dislocations + pelvic fractures, total hip replacement C/F: • Complete lesion- hamstrings & all muscles below knee paralysed, absent ankle jerk, sensation loss(except medial side), drop foot, high stepping gait • Trophic ulcers • Treatment: Suture or nerve grafting
Hinweis der Redaktion
- Brachial artery is the continuation of axillary artery, and it starts at the inferior border of teres major, and ends at cubital fossa It extends from the lower part of the crest of the lesser tubercle of the humerus below the teres major, and passes along the medial supracondylar ridge to the medial epicondyle; it is blended with the tendon of the coracobrachialis, and gives attachment to the triceps brachii behind and the brachialis in front.
- Motor paralysis : flexor carpi ulnaris (flexor of wrist) & medial half of flexor digitorum profundus (flexor of DIP of ring & little fingers), hypothenar muscles, all palmar & dorsal interosseous muscles, adductor pollicis & medial 2(3rd & 4th) lumbricals Sensory loss : skin area over medial third of hand & medial one & half fingers
- Ulnar nerve injured at wrist Motor paralysis : only intrinsic muscles of hand Ulnar claw hand : hyperextension MCP joint & flexion PIP & DIP joints of medial ring & little fingers Sensory loss : medial third of hand & fingers
- Froment’s sign (book test) : grip book by thumb, flexion of IP joint (using thumb flexors supplied by median nerve) instead of adduction at MCP joint Egawa’s test : dorsal interossei unable to abduct middle finger & unable to move finger sideways Card test : palmar interossei unable to adduct fingers & unable to grip card tightly
- One method of injuring the nerve is to strike the medial epicondyle of the humerus from posteriorly, or inferiorly with the elbow flexed. The ulnar nerve is trapped between the bone and the overlying skin at this point. This is commonly referred to as bumping one's "funny bone".
- Sciatic nerve injured at hip region Both tibial & peroneal components affected Motor palsy : hamstrings & all muscles below the knee paralysed Absent ankle jerk Foot drop, Sensor loss : leg distal to knee except medial side (supplied by saphenous branch of femoral nerve)