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Condition/Disorder Synonyms

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  • Cubital tunnel syndrome
  • Ulnar tunnel syndrome (UTS)
  • Tardy ulnar nerve palsy
  • Medial neuritis syndrome
  • Ulnar nerve entrapment

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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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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 3 possible ways.
    • Compression
    • Stretch
    • Friction
  • Potential entrapment sites
    • Medial humeral groove
    • Arcade of Struthers
    • Medial intermuscular septum
    • Flexor digitorum profundus
    • Flexor carpi ulnaris
    • Just proximal to or within Guyon’s 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’s 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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Clinical Findings

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Signs and Symptoms

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  • Acute or chronic paresthesia in ulnar nerve distribution (digits IV ulnar half and V) dorsally and volarly.
  • Sensory changes, hypo- or hypersensitivity of hand
  • Night pain especially with elbow flexion and wrist extension
  • Inability to separate fingers
  • Hand clumsiness
  • Hand weakness and loss of grip power and dexterity
  • Clawing of the hand (less pronounced than with ulnar tunnel syndrome)1
  • Intrinsic muscle atrophy and possible guttering
  • Wartenberg sign
  • Froment sign
  • Bishops deformity
  • Positive elbow flexion test
  • Resting abduction of digit V

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Functional Implications

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  • Night pain/poor sleep habits
  • Difficulty with hand function during ADLs/IADLs due to hand clumsiness and possible loss of strength.

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Possible Contributing Causes

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  • Prolonged pressure on cubital tunnel, particularly with elbow flexion such as working at a computer2
  • Laxity of soft tissue structures that hold ulnar nerve in cubital tunnel
  • Bony abnormality of the humuerus
  • Shallow ulnar groove
  • Small medial condyle
  • Tightness of the flexor carpi ulnaris (FCU) with distal FCU inflammation
  • Viral infection
  • Ganglion/space occupying lesion
  • Ulnar artery thrombosis
  • Ulnar-sided wrist fractures or dislocations
  • Anomalous muscles
  • Repetitive trauma
  • Sustained pressure over Guyon’s canal such as resting hypothenar eminence on handlebars while long distance cycling.

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Differential Diagnosis

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