ULNA NERVE

ROOTS OF ULNA NERVE

 Terminal branch of the medial cord of

the brachial plexus .
 Contains fibers mainly from the spinal nerves of
C8 and T1, but may sometimes carry C7 fibers as
well.
 From its origin, the ulnar nerve courses distally
through the arm, forearm and into the hand.
 COURSE OF THE ULNA NERVE

• Descends along the medial side of the axillary and the

brachial arteries in the anterior compartment of the arm.
• At the arm, it pierces the medial intermuscular septum and
passes behind the medial epicondyle of the humerus.
• Enters the anterior compartment of the forearm and
descends behind the flexor carpi ulnaris medial to the ulnar
artery.
• At the wrist, it passes anterior to the flexor retinaculum and
lateral to the pisiform bone.
BRANCHES AND INNERVATION

 ARM
 No Branch in the arm
 FOREARM
 Muscular branches: Flexor carpi ulnaris and medial half of the flexor digitorum
profundus muscles.
 Articular branches: Elbow joint.
 Dorsal cutaneous branch: Supplies the skin over the medial side of the back of the
hand and back of the medial one and a half fingers over the proximal phalange
HAND
• Superficial terminal branch :

Muscular branch: Palmaris brevis muscle.

Cutaneous branches: Supply the skin over the palmar aspect of the medial
one and a half fingers (including their nail beds)

• Deep terminal branch:

Muscular branches: Abductor digiti minimi, flexor digiti minimi, opponens

digiti minimi, all palmar and all dorsal interossei, third and fourth lumbricals,
and adductor pollicis muscles.
Articular branches: Carpal joints
CLINICAL CORRELATIONS
ULNA NERVE INJURY
 Common sites of injury or compression include posterior to the medial
epicondyle, the cubital tunnel and Guyon’s canal.
 Ulnar nerve injuries symptoms are paresthesia (tingling), numbness and
depending on the severity may cause impairment of both motor and sensory
functioning in the hand.
 The characteristic presentation of an ulnar nerve injury is the "claw hand".
 It is the hyperextension of the metacarpophalangeal joints 
 And flexion of the interphalangeal joints of 4th and 5th fingers .
 The severity of this deformity, however, depends on the location of the injury.
Higher (proximal) injuries, such as at the elbow, may denervate the ulnar part of
flexor digitorum profundus such that the flexed appearance may not be apparent.
• Sensory loss also occur in ulna nerve injury.
• This is known by assessing the function of the dorsal cutaneous branch which
arises in the distal forearm and supplies the medial side of the dorsum of hand.

• Usually, the more proximal a nerve injury, the worse it is.

• This is because the flexor digitorum profundus (in the forearm) that flexes the
fingers is partially innervated by the nerve.
• A proximal injury removes innervation to both the forearm muscles and hand
muscles.
• A distal injury, on the other hand, only denervates the hand muscles; hence the
still functioning finger flexors give the patient a pronounced clawed appearance in
the ring and little fingers.
• With a proximal injury leading to an open palm, there is more capacity for hand
function. This phenomenon is called the ulnar paradox
• Proximal ulnar nerve compression often occurs when a person rests their elbow
on the table for a long time, or on a window (for long distance drivers).
• It can also occur as an athletic injury, particularly in throwing athletes e.g.
baseball pitchers, cricketers, and javelin throwers.
• The rapid movement of the elbow joint from flexion into whip-like extension
can results in compression of the nerve.

• Cyclists often suffer ulnar nerve problems as they rest the medial border of their
hand on their handlebars, resulting in the compression of the hamate and
therefore distal ulnar nerve compression (handlebar neuropathy).
References:

•Moore, K. L., Dalley, A. F., & Agur, A. M. R. (2014). Clinically Oriented

Anatomy (7th ed.).
•Lawerence .E. Wineski ,(2019). Snells Clinical Anatomy (10th ed).
•http:// Kenhub Medical. Google. com/terms ( accesed 27th May 2023)