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The brachial plexus is a network of nerve fibers, running from the spine, formed by the ventral rami of the lower four cervical and first thoracic nerve roots (C5-C8, T1). It proceeds throughthe neck, the axilla, and into the arm. It is a network of nerves passing through the cervico-axillary canal to reach axilla and suppliesbrachium, antebrachium and hand.
The brachialplexus isresponsiblefor cutaneous and muscularinnervation ofthe entire upperlimb .
The ulnar nerveoriginates from theC8-T1 nerve roots (and occasionally carries C7 fibres)which form part ofthe medial cord of the brachial plexus.
it descends onthe medial side of the 3rd part of axillaryartery between it and axillary vein
it descends on the medial side of brachial artery down to the insertion of coracobrachialis muscle,Pierces the medialintermusular septum at the arcade of Struthers ~ 8cm from medial epicondyle and lies with triceps.Travels on back of medial epicondyle; vulnerable in fractures Runs with superior ulnar collateral artery to reach post.compartment of the arm in front of medial head of triceps .
it reaches the back of med.epicondyle to enter theforearm between2 heads of flexorcarpi ulnaris(and here it isaccompanied by sup.ulnar collateral a. and post. branch of inferior ulnar collateral arteries) .
after passing between 2 heads of flexor carpi ulnaris,it descends vertically infront of med. side of flexor digitormprofunds covered by the flexor carpi ulnaris .
it enters the palm of the hand bypassing in front ofmed. part of flexor retinaculum betweenpisiform(medially) and the ulnar artery(laterally)& finally ends by dividing into superficial and deep branches .
The nerve gives branches to the Flexor Carpi Ulnaris and the medialhalf of the Flexordigitorumprofundus .
The UlnarNerve divides into Dorsal and palmer cutaneous branches.
-The Palmer cutaneous branch of the Ulnar Nerve provides sensation to the palm of the hand . The Finger sensation is provided bythe superficial branch .
-The Dorsal cutaneous branch of the UlnarNerve gives innervation to the medial dorsalaspect of the hand and the one and a Half Fingers .
The Nerve furtherdivides intosuperficial and deep branches .
The superficial branch of the Ulnar nerve divides intoPalmer digitalnerves after it passes under and supplies the Palmarisbrevis muscle.
The Deep branch of the Ulnar nerve innervates the three hypothenar muscles , the medial twolumbricals , theseven interossei , the adductorpollicis and the deep head of flexor pollicis brevis .
The Ulnar Nerve can become pinched in different locations .1- Thoracic outlet syndrome . 2-cubital tunnel syndrome . 3-Ulnar Tunnel syndrome .
causes of UlnarNerve entrapmentaround the cubitaltunnel :1-Cubitus Valgus :Deformity in which theelbow is turned outward
1-Pain, tingling andnumbness in the smalland ring fingers .2-Weakness of themuscles in the hand .3-claw hand deformityif compression belowthe elbow due toflexion of the fingersby a functionalprofundus muscle forthe 4th and 5th fingers.
is made after a thorough history and examination. X-rays or other testsmay be ordered if there is a concern of something abnormal pressing on thenerve. Nerve tests, called EMGs, can help to determine the extent and location of nerve compression.
1-Anti-inflammatorymedications.2-Splinting theelbow, especially atnight.3-Padding theelbow for workactivities .4-Physical therapy. “If these simple treatments fail, surgery may be necessary to remove the pressure from the ulnar nerve.
Guyons canal syndrome, sometimes called Guyonstunnel syndrome, is a common nerve compression affecting the ulnar nerve as it passes through a tunnel in the wrist called Guyons canal.
1- Feeling of pins and needles in the ring andlittle fingers .2- May progress to a burning pain in thewrist and hand .3-Decreased sensation in the ring and littlefingers . N.B :One common cause of this syndrome is from pressure of bicycle handlebars seen with avid cyclists , Another is from hard, repetitivecompression against a desk surface while using a computer mouse .
1- Initial line of treatment is with anti- inflammatory drugs or cortisone injections. 2- Massage therapy . 3- acupuncture . 4- physical therapy . 5- chiropractic and osteopathic care . If these options do not produce the desired results,some doctors may recommend working with surgical option.
The surface marking of thenerve is along a line from themedial bicipital groove behindcoracobrachialis to the pointbehind the medial epicondyleof the humerus where it isreadily palpable.
The ulnar nerve runs from thegroove between the medialepicondyle and olecranonprocess above to the radial orouter side of the pisiform bonebelow. It lies to the ulnar side ofthe ulnar artery in the lower halfof the forearm
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