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Figure 2. Atrophy of interossei muscles due to chronic ulnar compression. chronic illness. Patients who are restricted to bed or a wheel chair on which they may place their elbows for support often entrap the ulnar nerve at the olecranon notch ("tardy ulnar palsy")- The inimobile supine position, with the arms in a position of mild flexion and the forearm pronated, exposes the ulnar nerve to chronic pressure. Injury of the ulnar nerve can also result from occupational or athletic movements of simultaneous flexion-extension and supina-tion-pronation movements such as holding rifles, shoveling, and throwing. 3. Diagnostic Aids Slowing of nerve conduction velocity or drop in amplitude across the elbow supports the clinical diagnosis. 4. Other Locations The ulnar nerve can be trapped in several other locations which cause characteristic clinical deficits.^® A lesion low in the forearm, but still proximal to the sensory branch preserves function of the more proximal branches feeding the flexor digitorum profundus; only ulnar sensory deficit and weak intrinsic hand muscles resuh. When the superficial distal branch of the ulnar nerve is injured, only sensory loss in the ulnar distribution (which does not supply the forearm but only the ulnar surface of the hand) is present without motor loss; an unusual injury. The more common ''jackhammer palsy" is caused by damage to the ramus profundus (deep branch) of the ulnar nerve in the hand. Injury to this branch in the palm, distal to origin of the sensory branch which takes off in the wrist, produces no sensory loss at all. Strength in the hypothenar muscles, abductor digiti quinti and opponens digiti quinti is intact; the only muscles affected are the third and fourth lumbri-cals and the dorsal interossei. Atrophy of the intrinsic hand muscles, loss of dexterity of all the fingers, inability to spread the fingers, and obvious weakness of the hand result. Nerve conduction may be normal if the evoked response is measured only in the (spared) hypothenar muscles, but if evoked response is performed from the ulnar nerve to the ftrst dorsal interosseous, or if EMG is per- formed upon the interossei, the abnormality will be detectable. 5. Treatment Avoidance of elbow pressure is the primary treatment. Flexor surface transfer of the nerve is required only when signs are severe. Radial Nerve (Plate III) 1. Symptoms and Signs The hallmark motor deficit of radial nerve palsy is wrist drop (figure 3). Since extension of the wrist is necessary for useful grip and finger flexion, the hand is rendered essentially useless, and it may paradoxically appear that there is weakness of finger flexions. The patient may complain of weakness in grip but when the hand is held in extension all flexor functions are normal. The position of the injury can be localized by testing the triceps muscles. If the triceps muscle and reflex are affected, the damage is more proximal, such as that occurring from crutches. It is important to distinguish a radial nerve injury from C7 root injury. The brachioradialis muscle (C5, g) ^^^ extensors of the wrist (C7. 8) are both supplied by the radial nerve. Muscles supplied by C5 include the deltoid and the biceps; C^ supplies the supra- and infraspinatus as well as the biceps but none of these muscles are supplied by the radial nerve. The radial nerve from its more proximal branches suppHes the triceps muscle. The brachioradialis Radial n. Post cut aorarm Lowerlat-cuLacfarm PosLcuLn-oF forearm Plate m. Radial Nerve Supply January 1985, NCMJ 18
Object Description
Rating | |
Fixed Title * | NCHH-17: North Carolina Medical Journal [1940-Present] |
Document Title | North Carolina Medical Journal [1940-Present] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1985 |
Identifier | NCHH-17-046 |
Form General | Periodicals |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 46 |
Health Discipline | Medicine |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-046.pdf |
Document Sort | all; nchh-17 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-046 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
Description
Fixed Title * | Page 9 (images) |
Document Title | North Carolina Medical Journal [1940-Present] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1985 |
Identifier | NCHH-17-046-0017 |
Form General | Periodicals |
Page Type | all; all images; photo; all images; diagram; article |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Filename | ncmed461985medi1_0017.jp2 |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 46 |
Issue Number | 1 |
Page Number | 9 |
Health Discipline | Medicine |
Full Text | Figure 2. Atrophy of interossei muscles due to chronic ulnar compression. chronic illness. Patients who are restricted to bed or a wheel chair on which they may place their elbows for support often entrap the ulnar nerve at the olecranon notch ("tardy ulnar palsy")- The inimobile supine position, with the arms in a position of mild flexion and the forearm pronated, exposes the ulnar nerve to chronic pressure. Injury of the ulnar nerve can also result from occupational or athletic movements of simultaneous flexion-extension and supina-tion-pronation movements such as holding rifles, shoveling, and throwing. 3. Diagnostic Aids Slowing of nerve conduction velocity or drop in amplitude across the elbow supports the clinical diagnosis. 4. Other Locations The ulnar nerve can be trapped in several other locations which cause characteristic clinical deficits.^® A lesion low in the forearm, but still proximal to the sensory branch preserves function of the more proximal branches feeding the flexor digitorum profundus; only ulnar sensory deficit and weak intrinsic hand muscles resuh. When the superficial distal branch of the ulnar nerve is injured, only sensory loss in the ulnar distribution (which does not supply the forearm but only the ulnar surface of the hand) is present without motor loss; an unusual injury. The more common ''jackhammer palsy" is caused by damage to the ramus profundus (deep branch) of the ulnar nerve in the hand. Injury to this branch in the palm, distal to origin of the sensory branch which takes off in the wrist, produces no sensory loss at all. Strength in the hypothenar muscles, abductor digiti quinti and opponens digiti quinti is intact; the only muscles affected are the third and fourth lumbri-cals and the dorsal interossei. Atrophy of the intrinsic hand muscles, loss of dexterity of all the fingers, inability to spread the fingers, and obvious weakness of the hand result. Nerve conduction may be normal if the evoked response is measured only in the (spared) hypothenar muscles, but if evoked response is performed from the ulnar nerve to the ftrst dorsal interosseous, or if EMG is per- formed upon the interossei, the abnormality will be detectable. 5. Treatment Avoidance of elbow pressure is the primary treatment. Flexor surface transfer of the nerve is required only when signs are severe. Radial Nerve (Plate III) 1. Symptoms and Signs The hallmark motor deficit of radial nerve palsy is wrist drop (figure 3). Since extension of the wrist is necessary for useful grip and finger flexion, the hand is rendered essentially useless, and it may paradoxically appear that there is weakness of finger flexions. The patient may complain of weakness in grip but when the hand is held in extension all flexor functions are normal. The position of the injury can be localized by testing the triceps muscles. If the triceps muscle and reflex are affected, the damage is more proximal, such as that occurring from crutches. It is important to distinguish a radial nerve injury from C7 root injury. The brachioradialis muscle (C5, g) ^^^ extensors of the wrist (C7. 8) are both supplied by the radial nerve. Muscles supplied by C5 include the deltoid and the biceps; C^ supplies the supra- and infraspinatus as well as the biceps but none of these muscles are supplied by the radial nerve. The radial nerve from its more proximal branches suppHes the triceps muscle. The brachioradialis Radial n. Post cut aorarm Lowerlat-cuLacfarm PosLcuLn-oF forearm Plate m. Radial Nerve Supply January 1985, NCMJ 18 |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-046.pdf |
Document Sort | all; nchh-17 |
Article Title | Common Mononeuropathies |
Article Author | E. Wayne Massey |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-046 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
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