ulnar nerve stimulation #electrotheraphy # electrode placement # positioning # physiotherapy # practical procedure

1. ULNAR NERVE
STIMULATION

2. CONTENTS
 Introduction
 ULNAR nerve :
A) Root value
B) Origin, course, termination
C) Muscle involved
D) Motor point
E) Types of ulnar nerve injury
F) Signs of ulnar nerve injury
G) Applied aspect
H) Practical Procedure
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3. ULNAR NERVE
 Ulnar nerve is also called as musicians nerve
 It is continuation of medial cord of brachial plexus
which arise from the anterior division of lower trunk
 It runs along the medial side /ulnar side of limb
 Root value: ventral rami of C8 and T1.
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4. Origin , Course ,Termination
• It lies behind the medial epicondyle of humerus
• AXILLA:
lies in between axillary vein and axillary artery
• Arm :
Medial to brachial artery
at middle of arm it pierces medial intramuscular septum
Descends on back of medial epicondyle of humerus
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7. Flexor pollicis
brevis
lumbricals Dorsal
Interossei
Flexor Digitorum
Profundus
Adductor Pollicis
Flexor and opponens
digiti minimi
Abductor digiti minimi
Flexor Carpi Ulnaris
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8. Type of ulnar nerve injury
High ulnar nerve palsy Low ulnar nerve palsy
• All extrinsic and intrinsic
muscles affected
• Sensory loss over palmar and
dorsal aspect of medial third of
hand
• Sensory loss over palmar and
dorsal aspect of whole of little
finger and ular half of ring finger
• Only intrinsic muscles affected
• No sensory loss over proximal
and middle phalanx of little and
ring finger due to sparing of
dorsal cutaneous branch
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9. • Causes:
• Sleeping with the arm folded behind
neck, elbows bent.
• Pressing the elbows upon the arms
of a chair while typing.
• Resting or bracing the elbow on the
arm rest of a vehicle.
• Bench pressing.
• Intense exercising and strain
involving the elbow
• Clinical features:
• Numbness in the 4th & 5th fingers
which may progress to complete
weakness if left untreated
• Ulnar claw hand deformity
• Atrophy in advanced cases
• Sensory,trophic,vasomotor changes
• Loss of adduction & abduction of all
fingers
• Loss of adduction of thumb
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10. Signs of ulnar nerve injury
• Egawa test: • Froment’s sign(Book test):
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11. • Duchenne sign:
• Bouvier sign:
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12. Wartenberg’s sign
• Tinel sign:
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13. • Jeanne’s sign:
• Masse sign:
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14. APPLIED ASPECTS
ULNAR PARADOX
CUBITTAL TUNNEL SYNDROME
GUYONS CANNAL SYNDROME
PSEDUO ULNAR NERVE PALSY
TARDY ULNAR NERVE PALSY
ULNAR CLAW HAND 14

15. ULNAR PARADOX
• If the ulnar nerve lesion occurs more proximally the
flexor digitorum profundus muscle is denervated.
• As a result, flexion of the IP joints is weakened
• Instead, the fourth and fifth fingers are paralyzed
• This is called the "ulnar paradox"
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16. Cubittal Tunnel Syndrome
Cubittal tunnel
Syndrome Tunnel Syndrome
is a condition
that involves pressure or
stretching of the
ulnar nerve which
can cause
numbness
or tingling in the ring 16

17. Guyon’s Canal Syndrome:
• Ulnar nerve impingement along an
anatomical space in the wrist
called Guyon's canal is known as Guyon's
canal syndrome
• called "hypothenar hammer syndrome,"
seen in workers who repetitively use a
hammer, and "occupational neuritis" due
to hard, repetitive compression against a
desk surface.
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18. Pseduo ulnar nerve palsy
It refers to weakness in the hand
in an ulnar distribution
due to contralateral cerebral
infarction in the white matter
of the angular gyrus of the
inferior parietal lobe
Tardy ulnar nerve palsy
• It occurs of non-union of pediatric
lateral epicondyle fractures which
leads to a cubitus valgus deformity.
• When the child grows,the
deformity worsens and the ulnar
nerve is gradually stretched
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19. Ulnar claw hand( deformity)
• It also known as claw hand, or 'spinster's claw' or an abnormal
attitude of the hand that develops due to ulnar nerve damage causing
paralysis of the lumbricals.
• A claw hand presents with a hyper-extension at the MCP Joint and
flexion at the PIP and DIP Joint of the 4th and 5th fingers.
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20. Practical procedure
• Receiving the patient :
Good morning sir /mam . I am a student
Physiotherapist going to treat you today.
Please wait until I go through your case
sheet
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21. Case sheet reading
• Check the following details during case sheet reading :-
Name
Age
Gender
Occupation
IP number
Address
Chief complaints
History –present ,past ,family & medical
Examination :
Check the site and side of injury where the treatment has to be given ..so that the
contraindications are ruled out 21

22. Check for contraindications
General
• Fever
• Hypertension
• Hypersensitive skin
• Metal implant in the tissue
• Renal/ cardiac disease
• Infections
• Pregnant women
• Malignancy
• Cardiac pacemakers
Local
• Open wounds
• Hairy skin
• Scars
• Local skin infection
• Cuts
• Abrasion
• Eczema
• Haemorrhagic spots
• Recent fracture
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23. Preparation of tray
 skin resistance lowering tray :
water ,bowl, soap ,cotton ,towel
 Treatment tray :-
water bowl
Salt
Lint cloth
Pen electrode
Plate electrode
Main Cable
Wires
Strap
Soft pad
Mackinstosh sheet
Pillow
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24. Instructions to patient
• Ask the patient not to sleep during
the treatment session
• Ask them not to touch the
apparatus
• Inform the patient the feel of
current : mild prickling sensation
• If there is any discomfort or
burning sensation, patient should
inform the therapist
• Enquire about the feel of current
Checking the apparatus
• Check the connection of the apparatus with
the cable and also the main cable and also
the main connection with the plug point .
• Before treatment self test should be done to
check the flow of current
• Check whether the knobs are at zero,before
switching the apparatus
• Check for any damage to the apparatus, cable
and plug point
• Check the insulation of wire
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25. Position of patient
Place patient in well supported,
comfortable relaxed position.
Expose the body part to be treated
Remove all jewellery from the part
to be treated
Use adequate Pillow, towel,& bed
sheet
Patient is made to sit in a wooden
/plastic chair with back support
Place his hand on the couch with
arm abducted ,forearm supinated
and elbow semi extended
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26. Position of therapist :
Walk stance by the side of the patient.
Therapist should be close to the machine & near to the
affected side of the patient.
The therapist should position self as to observe face of the
patient in a triangular manner.
Spacing of the electrode :
Inactive electrode - over
medial epicondyle
Active electrode - over motor point
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27. Treatment procedure: Clean the treatment area with soap and water and wipe it softly using
cotton
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28. Selection of current :-
Faradic current is given in case of ulnar nerve injuries.
Treatment :-
After the placement of electrode ,the duration ,intensity, rest time is adjusted according to the type and day of
nerve injury.
Nerve stimulation : Faradic Current
Checking the treatment area :-
After the treatment ,check whether if there is any erythema formation over the skin
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29. Do’s & Dont’s
• Avoid overhead activities
• Do not apply hot pack over skin because vessels are dilated
• Avoid weight bearing on affected side
• Limit activities that can make it worse, such as tennis or golf.
• Do not lean on your elbow while driving or sitting.
• Keep your arm straight while at rest.
• Wear a splint while you sleep to prevent the elbow from bending.
• Try to prevent falls or direct impact to the inside of the elbow
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30. Home exercise :
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36. • Fixing up the next appointment:-
Next treatment time should be scheduled according to
patient & therapist convenience.
Winding up :-
Replace the material and tray back to its place
Check the apparatus again whether all the knobs are at
zero
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37. Follow up:-
It has to be filled up by the patient as well as the therapist as it
may be useful for future reference
The feedback of the patient is much important as it helps in
progression of future treatment .
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