74 Ulnar nerve palsy
Salient features
History
• Repeated trivial trauma to the elbow; the patient feels the ‘funny bone’
• Patient may be immobilized in the orthopaedic ward and use the elbows to shuffle in bed
• History of fracture of the upper arm in childhood (supracondylar fractures of humerus in childhood has an insidious course and can result in acute ulnar nerve palsy 20–30 years later: tardy-ulnar palsy).
Examination
• Generalized wasting of the small muscles of the hand.
• There may be features of ulnar claw hand: hyperextension at the metacarpophalangeal joints and flexion at the interphalangeal joints of the fourth and fifth fingers (Fig. 74.1).
• There is weakness of movement of the fingers, except that of the thenar eminence.
• There is sensory loss over the medial one and half fingers.
