Ulnar neuropathy

An ulnar neuropathy most commonly presents with sensory changes in the fourth and fifth digits and usually does not involve weakness in hand grip. There is usually no specific injury, but any activity that results in repetitive or prolonged wrist extension, as with cycling or playing catcher, may increase the risk of this problem. It is important to examine the neck for cervical disc disease and to examine the shoulder to see if motion elicits the pain, which would indicate a brachial plexus problem. If symptoms are reproduced by compressing the ulnar nerve at the elbow this could be the site of entrapment. Clinical tests may include a positive Tinel sign on percussion of the ulnar nerve over Guyon’s canal.

Also, there may be a positive Phalen sign, with maximum passive flexion of the wrist for 1 minute inducing paresthesias in the fourth and fifth fingers. With ulnar neuropathy, plain radiographs are usually normal. Ultrasonography of the peripheral nerves may be helpful in identifying compression etiologies. However, electromyelography and nerve conduction velocities may be required to identify the area of entrapment.” ABFM

Reference

Evaluation and diagnosis of wrist pain: A case-based approach. Am Fam Physician 2013;87(8):568-573.

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