ULNAR NERVE
Presented by:
Anshul Sharma (19)
Ayush Sharma (26 )
Bhawna (28)
Chanchal (30)
Introduction
Ulnar nerve is a major nerve of the upper limb
Arises from the medial cord of the Brachial Plexus
Also known as the ‘musician’s nerve’ - because it
controls fine movements of the fingers.
Origin and Root Value
Branch of medial cord of Brachial Plexus
Root value - C7, C8, T1
COURSE
In Axilla:
Runs between axillary artery and vein
Medially to Axillary Artery
Laterally to Axillary Vein
In Arm:
Lies medial to brachial artery in the upper arm
Mid-arm: pierces medial inter muscular septum
Enters posterior compartment
Passes behind medial epicondyle of humerus in
cubital tunnel
Not a content of Cubital Fossa
In Forearm:
Enters forearm between two heads of flexor
carpi ulnaris
Travels between FDP(Flexor digitorum
profoundus) & FCU(Flexor carpi ulnaris)
In lower part: under skin, between FCU and
ulnar artery
In Palm:
Enters palm by passing superficial to flexor retinaculum
covered only by the superficial slip of the retinaculum (volar
carpel ligament)
Divides into two branches
then terminates into adductor pollicis muscle
a) superficial branch
b) deep branch
Superficial branch is cutaneous
The deep branch passes through the muscles of the
hypothenar eminence to lie in concavity of deep palmar arch
BRANCHES
In Arm: No branches
In Forearm:
(a) Muscular Branches
flexor carpi ulnaris and
medial half of flexor digitorum profundus
(b) Palmer cutaneous branch
supply skin over the hypothenar eminence
(c) Dorsal cutaneous branch
supplies proximal parts of medial 1 ½ digits and
adjoining area of the dorsum of hand
(d) Articular Branches
given off to the elbow Joint
Clinical Anatomy:
Ulnar nerve injuries
The ulnar nerve is commonly injured at
elbow, behind the medial epicondyle
distal to elbow when it passes between two heads of
flexor carpi ulnaris(cubital tunnel)
at the wrist in front of the flexor retinaculum
Ulnar nerve injury at the elbow
Ulnar nerve lesion at the wrist
Ulnar claw hand or Spinster claw deformity
Motor loss:
Hyperextension at the metacarpophalangeal
joints
Flexion at interphalangeal joints involving
ring and little fingers- more than the index
and middle fingers
Intermetacarpal spaces are hollowed out
due to wasting of the interossei muscles
Claw hand is more prominent in low ulnar nerve
injury (at wrist), as FDP still works and causes
more clawing
Ulnar Paradox- higher the lesion, lesser the claw
because FDP is also paralysed and IP joints don’t
flex
Sensory loss:
Confined to medial ⅓ of palm
palmar and dorsal surfaces of
the medial 1 ½ fingers,
including their nail beds
Vasomotor changes:
Skin areas with sensory loss are warmer due to arteriolar
dilation
Also dry due to absence of sweating because of loss of
sympathetic supply
Tropic changes:
Long standing cases of paralysis lead to dry and scaly skin
The nails crack easily with atrophy of the pulp of fingers
The patient is unable to spread out the fingers
due to paralysis of dorsal interossei
Power of adduction of the thumb and
flexion of little and ring fingers are lost
Thank You
