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ULNAR NEUROPATHY (CLINICAL FEATURES (wasting (first dorsal interosseous…
ULNAR NEUROPATHY
CLINICAL FEATURES
Paraesthesiae
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Initially intermittent, later constant.
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Frequently, damage at elbow may spare FCU and FDP 4,5 owing to fascicular sparing
Sensory loss 2–3 cm above wrist crease = C8/T1 or medial cutaneous nerve of forearm (therefore brachial plexus or mononeuritis multiplex)
Palpate ulnar nerve at elbow for tenderness, thickening, or prolapsing of nerve on flexion
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DDX
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MMN (Multifocal Motor Neuropathy) with block, Chronic inflammatory demyelinating polyneuropathy (CIDP)
Brachial plexus—TOS, infiltration (look for Horner’s syndrome = Pancoast tumour)
Roots—C8, T1 radiculopathy
Spinal cord–anterior horn cell disease, syringomyelia
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MANAGEMENT
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Conservative
wear elbow support pad (available from sports shop) even at night if tendency to sleep with elbow flexed
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AETIOLOGY
AT WRIST
around Guyon’s canal—pressure, e.g. cycling, occupational;
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Grading of severity
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Grade 3 (severe) = constant sensory symptoms + sensory loss. Moderate/severe atrophy + weakness grade 4 or less.
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NEUROANATOMY
Most frequent site of damage is elbow. Distal (hand, wrist) rare.
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