OVERVIEW
Overview of ulnar nerve palsy
Ulnar nerve palsy refers to ulnar nerve injury caused by various reasons, which results in motor and sensory impairment of the ulnar nerve innervation area. Typical manifestations are claw-shaped hand deformity, especially in the ring finger and little finger, with the thumb often in an abducted state, limited finger separation and merging movements, and loss of movement of the little finger.
Whether medical insurance
Yes, it is
Department
Neurology, Orthopedics
Clinical symptoms
Claw-shaped hand deformity, characterized by ring and little fingers.
Harms
This disease can affect the fine movements of the fingers, leading to inconvenience in life.
Examination
Physical examination, electromyography, etc.
Diagnosis
Diagnosis is based on medical history, clinical manifestations of claw hand deformity, combined with electromyography.
Treatment principle
Remove the cause of the disease, give nutritive nerve, anti-infectious drug therapy and rehabilitation therapy, and give surgery if necessary.
Curability
Symptoms can be improved by active treatment.
Dietary advice
Give a diet rich in vitamins and avoid cold, spicy and irritating foods.
Causes
Etiology
Common causes include trauma, compression, and inflammation.
Symptoms and Diagnosis
Typical symptoms
Typical clinical manifestations are “claw shaped hand”, with the hand inclined to the radial side, external thumb, hyperextension of the metacarpophalangeal joints, flexion of the terminal phalangeal joints, accompanied by atrophy of the interosseous muscles of the pisiform and interosseous muscles; at the same time, there are ulnar hemisensory deficits in the dorsal ulnar side of the hand, the pisiform, and ulnar half-sensory deficits in the little and ring fingers.
Other symptoms
Sensory symptoms such as pain, numbness, tingling, and ankylosis may be present depending on the cause of the disease.
Diagnostic basis
1. Medical history: most of the symptoms have a sudden onset, and may reach a peak rapidly after trauma, or appear gradually after repeated pulling, compression and strain, and show incomplete damage. 2. Clinical manifestations: typical clinical manifestations are “claw shaped hand”, with the hand inclined to the radial side, the thumb outwardly, the metacarpophalangeal joint hyper-extension, and the terminal phalangeal joint flexion, accompanied by the small fiducial and the interosseous muscle atrophy. At the same time, the patient has ulnar hemisensory deficits on the ulnar side of the dorsum of the hand, the small fisheye, the little finger and the ring finger.3. Auxiliary examination (1) Positive paper clip sign. If the thumb and the index finger are stretched out to hold a piece of paper, and the examiner pulls the paper with force, it can be seen that the patient’s thumb interphalangeal joints are flexed, while the thumb interphalangeal joints of the healthy hand are straightened and stretched out. (2) Electromyography shows neurogenic damage in the muscles of the ulnar nerve innervation area, with slowing of nerve conduction velocity and reduction of wave amplitude, and the determination of nerve conduction velocity in different parts of the body can provide a basis for localization.
Treatment
Treatment guidelines
Remove the cause of the disease, give nutritive nerve, anti-infective drugs, glucocorticoid therapy and rehabilitation therapy, and give surgical treatment if necessary.
Drug treatment
1. Non-steroidal anti-inflammatory drugs: e.g. indomethacin, ibuprofen, etc. can reduce local inflammatory reaction. 2. Neurotrophins and cytokines: e.g. murine nerve growth factor, etc. 3. Others: e.g. diprazole, B vitamins, etc.
Surgical treatment
For those who are not cured for a long time, nerve decompression, release or anastomosis can be considered according to the damage.
Other treatments
1. Etiological treatment: remove the injury or compression factors, elbow tube syndrome can be treated by splinting the elbow. 2. Rehabilitation: including physical therapy, such as infrared radiation, ultrasound therapy, short-wave diathermy, neuromuscular electrical stimulation therapy in the acute stage; exercise training and work training, such as massage and passive movement, the use of paper clips and tearing paper, and other specific movements and supports to immobilize the limb in a functional position, etc. 3. Other: eg. Acupuncture, etc.
Prognosis
After active treatment, the prognosis of mild cases is good, and the prognosis of severe cases is bad.
Nursing care
Daily care
1. Keep the environment quiet and comfortable, keep the indoor air fresh and pay attention to ventilation. 2. Ensure sufficient sleep, take appropriate physical exercise, and avoid exertion. 3. Follow the doctor’s instructions for medication, and review regularly.
Diet
Give vitamin-rich diet, avoid eating cold, spicy and stimulating food.