Ulnar neuropathy - Revision history

Rossdonaldson1: /* References */

2022-08-31T18:09:47Z

References

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	<references/>		<references/>

	Category:Neurology		[[Category:Neurology]]

Rossdonaldson1: /* References */

2022-08-31T18:09:29Z

References

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	*Beekman R, Schoemaker MC, Van Der Plas JP, Van Den Berg LH, Franssen H, Wokke JH, Uitdehaag BM, Visser LH. Diagnostic value of high-resolution sonography in ulnar neuropathy at the elbow. Neurology. 2004 Mar 9;62(5):767-73.		*Beekman R, Schoemaker MC, Van Der Plas JP, Van Den Berg LH, Franssen H, Wokke JH, Uitdehaag BM, Visser LH. Diagnostic value of high-resolution sonography in ulnar neuropathy at the elbow. Neurology. 2004 Mar 9;62(5):767-73.
	<references/>		<references/>

			Category:Neurology

Rossdonaldson1: /* Differential Diagnosis */

2022-02-05T14:29:37Z

Differential Diagnosis

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	*Amyloidosis		*Amyloidosis
	*Peripheral nerve tumor		*Peripheral nerve tumor

			{{Upper extremity peripheral nerve syndromes}}

	==Evaluation==		==Evaluation==

Codjwill: /* Workup */

2021-10-27T05:10:21Z

Workup

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	*No imaging necessary if no history of trauma		*No imaging necessary if no history of trauma
	**XR/CT if considering hook of hamate fracture		**XR/CT if considering hook of hamate fracture
	**US can reveal nerve thickening or compression ~~from ganglion cyst~~		**US can reveal nerve thickening, hypoechoic texture, or anatomic compression
	***Maximum diameter at medial epicondyle >2.4 mm (81% sensitive, 91% specific)		***Maximum diameter at medial epicondyle >2.4 mm (81% sensitive, 91% specific)
	*Labs unlikely to be revealing in absence of systemic symptoms		*Labs unlikely to be revealing in absence of systemic symptoms

	===Diagnosis===		===Diagnosis===
	*Clinical diagnosis		*Clinical diagnosis

Codjwill: /* Diagnosis */

2021-10-27T04:37:44Z

Diagnosis

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	===Diagnosis===		===Diagnosis===
	*Clinical diagnosis		*Clinical diagnosis
	**EMG can confirm in outpatient setting		**EMG and/or nerve conduction study can confirm in outpatient setting

	==Management==		==Management==
	*NSAIDs		*NSAIDs

Codjwill: /* History */

2021-10-27T04:33:45Z

History

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	===History===		===History===
	*Paresthesias, numbness, and pain in 4th and 5th digits		*Paresthesias, numbness, and pain in 4th and 5th digits
			*Symptoms often worse with repetitive elbow flexion
	*Grip weakness, weak thumb adduction		*Grip weakness, weak thumb adduction
	*Severe cases with muscle atrophy and clawing of fingers		*Severe cases with muscle atrophy and clawing of fingers

Codjwill: /* Physical */

2021-10-27T04:22:38Z

Physical

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	===Physical===		===Physical===
	*Sensation testing - deficits in ulnar distribution		*Sensation testing - deficits in ulnar distribution
	*Strength testing - weak abduction and adduction of the fingers and thumb ~~(specifically~~ adductor pollicis)		*Strength testing - weak abduction and adduction of the fingers and thumb
			**Specifically adductor pollicis weakness resulting in positive Froment sign
	*Tinel test at elbow and/or wrist (nonspecific)		*Tinel test at elbow and/or wrist (nonspecific)

Rossdonaldson1: /* Background */

2021-09-22T20:21:34Z

Background

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	*Ulnar nerve provides cutaneous sensation to the 5th digit and ulnar side of 4th digit and motor innervation to flexor carpi ulnaris, flexor digitorum profundus, hypothenar, interossei, and adductor pollicis muscles		*Ulnar nerve provides cutaneous sensation to the 5th digit and ulnar side of 4th digit and motor innervation to flexor carpi ulnaris, flexor digitorum profundus, hypothenar, interossei, and adductor pollicis muscles
	*Etiology: Intrinsic/extrinsic compression, trauma, more rarely infectious or vasculitis		*Etiology: Intrinsic/extrinsic compression, trauma, more rarely infectious or vasculitis
	*Risk Factors
	**Male > Female		===Risk Factors===
	**Increasing age		*Male > Female
	**Smoking		*Increasing age
	**Cyclists (handlebar palsy)		*Smoking
			*Cyclists (handlebar palsy)

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: /* References */

2021-09-22T20:20:58Z

References

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	==References==		==References==
	Latinovic R, Gulliford MC, Hughes RA. Incidence of common compressive neuropathies in primary care. Journal of Neurology, Neurosurgery & Psychiatry. 2006 Feb 1;77(2):263-5.		*Latinovic R, Gulliford MC, Hughes RA. Incidence of common compressive neuropathies in primary care. Journal of Neurology, Neurosurgery & Psychiatry. 2006 Feb 1;77(2):263-5.
			*Radiculopathy, Plexopathy, and Mononeuropathies of the Upper Extremity. In: Berkowitz AL. Berkowitz A.L.(Ed.),Ed. Aaron L. Berkowitz.eds. Clinical Neurology and Neuroanatomy: A Localization-Based Approach. McGraw Hill; 2016. Accessed September 06, 2021. https://accessmedicine-mhmedical-com.proxy.medlib.uits.iu.edu/content.aspx?bookid=1984&sectionid=147771511
	Radiculopathy, Plexopathy, and Mononeuropathies of the Upper Extremity. In: Berkowitz AL. Berkowitz A.L.(Ed.),Ed. Aaron L. Berkowitz.eds. Clinical Neurology and Neuroanatomy: A Localization-Based Approach. McGraw Hill; 2016. Accessed September 06, 2021. https://accessmedicine-mhmedical-com.proxy.medlib.uits.iu.edu/content.aspx?bookid=1984&sectionid=147771511		*Gilchrist JM, Dandapat S. Neuromuscular Mimics of Entrapment Neuropathies of Upper Extremities. HAND. 2020 Sep;15(5):599-607.
			*Beekman R, Schoemaker MC, Van Der Plas JP, Van Den Berg LH, Franssen H, Wokke JH, Uitdehaag BM, Visser LH. Diagnostic value of high-resolution sonography in ulnar neuropathy at the elbow. Neurology. 2004 Mar 9;62(5):767-73.
	Gilchrist JM, Dandapat S. Neuromuscular Mimics of Entrapment Neuropathies of Upper Extremities. HAND. 2020 Sep;15(5):599-607.

	Beekman R, Schoemaker MC, Van Der Plas JP, Van Den Berg LH, Franssen H, Wokke JH, Uitdehaag BM, Visser LH. Diagnostic value of high-resolution sonography in ulnar neuropathy at the elbow. Neurology. 2004 Mar 9;62(5):767-73.
	<references/>		<references/>

Codjwill: /* Disposition */

2021-09-08T19:15:53Z

Disposition

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	[[File:Nerves of the left upper extremity.gif\|thumb\|Nerves of the left upper extremity.]]		[[File:Nerves of the left upper extremity.gif\|thumb\|Nerves of the left upper extremity.]]
	[[File:Gray421.png\|thumb\|Transverse section across distal ends of radius and ulna.]]		[[File:Gray421.png\|thumb\|Transverse section across distal ends of radius and ulna.]]
			*2nd most common focal mononeuropathy
			*Results from compression of ulnar nerve either at elbow (cubital tunnel) or wrist (Guyon's canal)
			**Compression at elbow more common
			*Ulnar nerve provides cutaneous sensation to the 5th digit and ulnar side of 4th digit and motor innervation to flexor carpi ulnaris, flexor digitorum profundus, hypothenar, interossei, and adductor pollicis muscles
			*Etiology: Intrinsic/extrinsic compression, trauma, more rarely infectious or vasculitis
			*Risk Factors
			**Male > Female
			**Increasing age
			**Smoking
			**Cyclists (handlebar palsy)

	==Clinical Features==		==Clinical Features==
			===History===
			*Paresthesias, numbness, and pain in 4th and 5th digits
			*Grip weakness, weak thumb adduction
			*Severe cases with muscle atrophy and clawing of fingers

			===Physical===
			*Sensation testing - deficits in ulnar distribution
			*Strength testing - weak abduction and adduction of the fingers and thumb (specifically adductor pollicis)
			*Tinel test at elbow and/or wrist (nonspecific)

	==Differential Diagnosis==		==Differential Diagnosis==
			*C8/T1 nerve root lesion
			*Medial cord brachial plexus lesion
			*Diabetic neuropathy
			*Amyloidosis
			*Peripheral nerve tumor

	==Evaluation==		==Evaluation==
	===Workup===		===Workup===
			*No imaging necessary if no history of trauma
			**XR/CT if considering hook of hamate fracture
			**US can reveal nerve thickening or compression from ganglion cyst
			***Maximum diameter at medial epicondyle >2.4 mm (81% sensitive, 91% specific)
			*Labs unlikely to be revealing in absence of systemic symptoms
	===Diagnosis===		===Diagnosis===
			*Clinical diagnosis
			**EMG can confirm in outpatient setting
	==Management==		==Management==
			*NSAIDs
			*Activity modification
			*Splinting to limit elbow flexion to 45 to 90 degrees
			**Often recommended at night although efficacy data and compliance are variable

	==Disposition==		==Disposition==
			*Discharge
			*Primary care, sports med, or ortho follow up

	==See Also==		==See Also==
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	==References==		==References==
			Latinovic R, Gulliford MC, Hughes RA. Incidence of common compressive neuropathies in primary care. Journal of Neurology, Neurosurgery & Psychiatry. 2006 Feb 1;77(2):263-5.

			Radiculopathy, Plexopathy, and Mononeuropathies of the Upper Extremity. In: Berkowitz AL. Berkowitz A.L.(Ed.),Ed. Aaron L. Berkowitz.eds. Clinical Neurology and Neuroanatomy: A Localization-Based Approach. McGraw Hill; 2016. Accessed September 06, 2021. https://accessmedicine-mhmedical-com.proxy.medlib.uits.iu.edu/content.aspx?bookid=1984&sectionid=147771511

			Gilchrist JM, Dandapat S. Neuromuscular Mimics of Entrapment Neuropathies of Upper Extremities. HAND. 2020 Sep;15(5):599-607.

			Beekman R, Schoemaker MC, Van Der Plas JP, Van Den Berg LH, Franssen H, Wokke JH, Uitdehaag BM, Visser LH. Diagnostic value of high-resolution sonography in ulnar neuropathy at the elbow. Neurology. 2004 Mar 9;62(5):767-73.
	<references/>		<references/>