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From the American Academy of Orthopaedic Surgeons

Ulnar Nerve Palsy

by George J. Mundanthanam, MD; Rebecca Bennett Anderson, MD; Charles Day, MD

Paralysis of the ulnar nerve causes substantial functional impairment of the hand. Based on the level of injury, there is a relatively consistent pattern of motor and sensory deficits. The greatest motor disability results from paralysis of the dorsal and volar interossei, abductor digiti minimi, and deep head of flexor pollicis brevis. Paralysis of these muscles, in turn, results in a claw deformity (flattening of the transverse metacarpal arch and longitudinal arches with hyperextension of the metacarpophalangeal joints and flexion of the proximal interphalangeal and distal interphalangeal joints), difficulty with fine motor pinch and grasp, and diminished precision and fine motor coordination. A variety of reconstructive options are available for ulnar nerve palsy in the form of tendon transfers and soft-tissue rearrangements (flexor pulley advancement, fasciodermadesis, volar capsulodesis), which are designed to restore motor function and correct the secondary deformity. All surgical interventions require dedicated intensive postoperative rehabilitation.

Keywords: ulnar nerve paralysis, ulnar nerve injury, ulnar nerve compression, ulnar nerve entrapment, high ulnar nerve palsy, low ulnar nerve palsy, cubital tunnel syndrome, tendon transfer

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