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CONDITION/DISORDER SYNONYMS

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  • Cubital tunnel syndrome

  • Cyclists palsy

  • Medial neuritis syndrome

  • Tardy ulnar nerve palsy

  • Ulnar nerve entrapment

  • Ulnar tunnel syndrome (UTS)

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ICD-9-CM CODES

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  • 354.2 Lesion of ulnar nerve

  • 354.5 Mononeuritis multiplex

  • 955.2 Injury ulnar nerve

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ICD-10-CM CODE

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  • G56.20 Lesion of ulnar nerve, unspecified upper limb

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PREFERRED PRACTICE PATTERN

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  • 5F: Impaired Peripheral Nerve Integrity and Muscle Performance Associated with Peripheral Nerve Injury

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PATIENT PRESENTATION

A 14-year-old female comes to clinic reporting sharp and aching pain in the right medial aspect of her elbow, which also radiates to her mid humerus medially and distally. This began 2 weeks ago and appears to be getting worse. She even has symptoms that wake her at night. She reports numbness and tingling that radiates into her little finger and ulnar half of ring finger. Functionally she noticed that her grip is slightly weak especially when it includes her small finger such as opening a jar and feels an overall clumsiness when using her hand.

She believes that this began as a result of her learning to play the acoustic guitar 4 weeks ago. She reports that her symptoms are worse with strumming the guitar or even resting her right arm on the edge of the guitar. Clinically, she presents with hypoalgesia of digit V and ulnar half of IV. Her opponens digiti minimi, flexor digiti minimi and interossei are exhibiting 4-/5 strength. She has a positive percussion test (Tinel’s) over the ulnar nerve at the cubital tunnel, positive elbow flexion test, and reproduction of distal symptoms when performing neurodynamic testing.

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KEY FEATURES

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Description
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  • Motor and/or sensory changes in the ulnar nerve distribution due to pressure from three possible ways

    • Compression

    • Stretch

    • Friction

  • Potential entrapment sites

    • Medial humeral groove

    • Arcade of Struthers

    • Medial intermuscular septum

    • Flexor digitorum profundus (FDP)

    • Flexor carpi ulnaris (FCU)

    • Just proximal to or within Guyon canal

    • Sensory and motor involvement between the abductor digiti minimi and flexor digiti minimi

    • Near hook of hamate, involves motor only

    • Distal end of Guyon canal, involves sensory only

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Essentials of Diagnosis
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  • Night pain

  • Sensory changes on volar aspect of digit V and ulnar aspect of digit IV

  • Hand clumsiness and/or weakness

  • Symptom changes with elbow position and/or pressure over the cubital tunnel

  • Reproduction of symptoms during clinical examination

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General Considerations
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  • Need to differentiate from more proximal and distal ulnar nerve compression, thoracic outlet syndrome (TOS), ulnar tunnel, and cervical radiculopathy

  • Postoperative therapy depends on surgical procedure performed: Endoscopic release, in situ decompression, medial epicondylectomy, and anterior transposition

  • Second-most common nerve compression syndrome in the upper extremity (UE)

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Demographics
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  • Those who work for sustained periods with power tools or on computers

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