What's involved:

Ulnar Nerve

Location:

Most frequently at the Elbow from leaning on it or trauma

Common symptoms:

	Weak hand, dropping objects, difficulty turning keys, ignition, doorknobs
	Numbness/tingling fourth, fifth fingers
	Wasting of the interosseii muscles
	Occasional elbow soreness
	Symptoms not related to night/daytime
	Frequently on both sides

Onset:

Usually slow, insidious over many months/years

Risk factors:

	Men>Women, Diabetes or family history, Alcoholism, HIV infection, leaning on elbows
	Occupational (telephone operators, receptionists)
	Trauma (hitting elbow), or following a long surgery

Exam:

	Look for First Dorsal Interosseous (FDI) and/or other Interosseii atrophy (looking at the back of the hand)
	Test First Dorsal Interosseous and Interosseii strength (ask patient to spread fingers against resistance)
	Decreased sensation to touch and pinprick over fourth and fifth fingers
	Positive and painful Tinel sign (tingling upon tapping nerve) at the Elbow with appropriate radiation to arm and fourth/fifth digits

EMG:

	Nerve Conductions Workup:
	Median sensory and motor studies with F-waves
	Ulnar sensory and motor studies with F-waves on both sides (disease is frequently bilateral)
	Findings:
	Low Ulnar sensory amplitudes and slowed Ulnar motor conductions across the elbow
	Normal Median Sensory/Motor distal latencies
	If Ulnar and Median Conductions are abnormal, test Lower Extremity to rule out Peripheral Neuropathy
	Active/Chronic denervation in Ulnar muscles on Needle Examination

Recommendations:  

	Stop/decrease cause (leaning on Elbow, repetitive trauma)
	Elbow pads not helpful (except maybe for reminding patients not to lean on elbows!!)
	Ulnar Nerve rubbing at Elbow (rub nerve in the groove up and down for 5 minutes three times a day to see if improvement)
	Surgery (Ulnar nerve transposition) for severe lesions and for atrophy with active denervation in interosseii
	Surgery not always successful; Patients can be left with Elbow pain from surgery and not infrequently, with injury to the Ulnar branch of the Flexor Carpi Ulnaris muscle in the vicinity, with subsequent weakness and elbow pain.

What else could it be:

	Cervical root lesion (C8-T1), usually accompanied by neck and arm pain
	WATCH OUT FOR Amyotrophic Lateral Sclerosis (ALS), if symptoms are in more areas than just the Ulnar Nerve, or if accompanied by speech and swallowing problems and  fasciculations
	Could be Syringomyelia but then would be accompanied by dissociated pain/temperature sensory loss
	Thoracic outlet syndrome (very rare)