Ulnar Nerve Injury

ULNAR NERVE INJURY

Q. 1

In Ulnar nerve injury of arm, all of the following are seen, EXCEPT?

 A

Hypothenar atrophy

 B

Adduction of thumb

 C

Loss of sensation of medial 1/3 of the hand

 D

Claw hand

Q. 1

In Ulnar nerve injury of arm, all of the following are seen, EXCEPT?

 A

Hypothenar atrophy

 B

Adduction of thumb

 C

Loss of sensation of medial 1/3 of the hand

 D

Claw hand

Ans. B

Explanation:

The ulnar nerve is most vulnerable near the elbow where it curves posteriorly around the medial epicondyle. The chief motor disability from palsy is loss of the finer intrinsic motions of the hand. Inspection will show an abduction deformity of the little finger from paralysis of the interossei, interosseous muscle wasting, and partial claw hand from interphalangeal flexion deformities of the ring and little fingers.

Claw Hand—Klumpke Paralysis: An LMN lesion at the brachial plexus or ulnar nerve produces paralysis of the intrinsic hand muscles results in the claw hand. Sensation on the ulnar aspect of the arm, forearm, and hand may be lost.

Q. 2

Ulnar nerve injury at wrist involves following except :

 A

Palmar interossei

 B

Opponems pollicis

 C

Dorsal interossei

 D

Adductor pollicis

Q. 2

Ulnar nerve injury at wrist involves following except :

 A

Palmar interossei

 B

Opponems pollicis

 C

Dorsal interossei

 D

Adductor pollicis

Ans. B

Explanation:

B. i.e. Oppenens polices

Ulnar nerve in hand supply-3rd & 4″1 lumbricals, interossei (pabnar & dorsal), adductor pollicis & hypothenar musclesQ.


Q. 3

Ulnar nerve injury causes:

 A

Weakness of adduction of thumb

 B

Froment’s sign

 C

Thenar eminence atrophy

 D

a and b

Q. 3

Ulnar nerve injury causes:

 A

Weakness of adduction of thumb

 B

Froment’s sign

 C

Thenar eminence atrophy

 D

a and b

Ans. D

Explanation:

A i.e. Weakness of thumb adduction; B i.e. Froment’s sign


Q. 4

Low ulnar nerve palsy is characterised by:

 A

Claw hand

 B

Sensory loss of medial four digits

 C

Weakness of grips

 D

A & C

Q. 4

Low ulnar nerve palsy is characterised by:

 A

Claw hand

 B

Sensory loss of medial four digits

 C

Weakness of grips

 D

A & C

Ans. D

Explanation:

Grip is weak in ulnar n. palsy due to paralysis of intrinsic muscles (all interossei, lateral two 3rd & 4th lumbricals, hypothenar & adductor pollicis muscles)Q.

In low ulnar n. palsy forearm muscles are spared but the clawing is moreQ (as compared to high ulnar n. palsy) this phenomenon is k/a ulnar paradox.

Sensory supply of ulnar n. is medial % fingersQ.

Abductor pollicis is supplied by median nerve.

Finger drop i.e. loss of extension of metacarpophalyngeal jointQ is seen in Radial & Posterior interosseous nerve palsy


Q. 5

Growth disturbance, nonunion, elbow instability & late ulnar nerve palsy is commonly seen in

 A

Fracture supracondylar humerus

 B

Fracture medial condyle

 C

Fracture lateral condyle

 D

Fracture head radius

Q. 5

Growth disturbance, nonunion, elbow instability & late ulnar nerve palsy is commonly seen in

 A

Fracture supracondylar humerus

 B

Fracture medial condyle

 C

Fracture lateral condyle

 D

Fracture head radius

Ans. C

Explanation:

C i.e. Fracture lateral condyle

Milch Classification of Fracture Lateral Condyle Humerus

 Mitch type I (Salter Harris type IV)

–    Less common type

–    Fracture running through the secondary ossification centre of capitullum and entering the joint lateral to capitulotrochlear groove Cause growth defectQ

Mitch type II (Salter Harris type II (?) IV (?))

– Commonest

– Fracture starting in metaphysis and running along the physis of lateral condyle into trochlear i.e. fracture extends medial to capitulotrochlear groove.

–  Make ulnar

– humeral (elbow) joint unstableQ.

* If the lateral condyle is left capsized nonunion is inevitableQ : with growth elbow becomes increasingly valgus and tardy ulnar nerve palsyQ is then likely to develop.


Q. 6

Deformity associated with ulnar nerve injury is:

 A

Wrist drop

 B

Simon hand

 C

Claw hand

 D

Ape thumb deformity

Q. 6

Deformity associated with ulnar nerve injury is:

 A

Wrist drop

 B

Simon hand

 C

Claw hand

 D

Ape thumb deformity

Ans. C

Explanation:

Ans:C.)Claw Hand.

  • An ulnar claw, also known as claw hand, or ‘Spinster’s Claw’ is an abnormal hand position that develops due to a problem with the ulnar nerve. A hand in ulnar claw position will have the 4th and 5th fingers extended at the metacarpophalangeal joints and flexed at the interphalangeal joints. The patients with this condition can make a full fist but when they extend their fingers, the hand posture is referred to as claw hand. The ring- and little finger can usually not fully extend at the PIP joint.
  • This can be commonly confused with the “Hand of benediction”, which is caused by high (at elbow level) median nerve damage.

Q. 7

Ulnar nerve injury results in:    

March 2012

 A

Ape thumb deformity

 B

Wrist drop

 C

Clawing of fingers

 D

Pointing index

Q. 7

Ulnar nerve injury results in:    

March 2012

 A

Ape thumb deformity

 B

Wrist drop

 C

Clawing of fingers

 D

Pointing index

Ans. C

Explanation:

Ans: C i.e. Clawing of fingers


Q. 8

Knuckle bender splint is used for:          

September 2009

 A

Ulnar nerve palsy

 B

Radial nerve palsy

 C

Median nerve palsy

 D

Axillary nerve palsy

Q. 8

Knuckle bender splint is used for:          

September 2009

 A

Ulnar nerve palsy

 B

Radial nerve palsy

 C

Median nerve palsy

 D

Axillary nerve palsy

Ans. A

Explanation:

Ans. A: Ulnar Nerve Palsy


Q. 9

Tardy ulnar nerve palsy is seen in

 A

Medial condyle # humerus

 B

Lateral condyle # humerus

 C

Humerus shaft fracture

 D

Fracture shaft radius

Q. 9

Tardy ulnar nerve palsy is seen in

 A

Medial condyle # humerus

 B

Lateral condyle # humerus

 C

Humerus shaft fracture

 D

Fracture shaft radius

Ans. B

Explanation:

Ans. is ‘b’ i.e., Lateral condyle # humerus

Causes of tardy ulnar nerve palsy are : –

  1. Malunited lateral condyle humerus fracture (cubitus valgus)
  2. Displaced medial epicondyle humerus fracture
  3. Cubitus varus deformity (due to supracondylar fracture humerus)
  4. Elbow dislocation
  5. Contusions of ulnar nerve
  6. Shallow ulnar groove
  7. Hypoplasia of humeral trochlea
  8. Joint deformity after prolonged arthritis of elbow

Q. 10

The splint shown in the picture below is used for ? 

 A

Ulnar nerve palsy.

 B

Radial nerve palsy.

 C

Median nerve palsy.

 D

Axillary nerve palsy.

Q. 10

The splint shown in the picture below is used for ? 

 A

Ulnar nerve palsy.

 B

Radial nerve palsy.

 C

Median nerve palsy.

 D

Axillary nerve palsy.

Ans. A

Explanation:

The splint shown in the picture above represents Knuckle bender splint, which is used for ulnar nerve palsy.


Q. 11

A 40-year old male after binge drinking slept on a chair. On the next day, he presented with weakness of the right arm and was not able to move his hand. Examination showed ulnar nerve palsy. What would be the management

 A

Instant exploration

 B

Give a knuckle bender splint

 C

Electromyography after 2 days and decide after results

 D

Neurolysis

Q. 11

A 40-year old male after binge drinking slept on a chair. On the next day, he presented with weakness of the right arm and was not able to move his hand. Examination showed ulnar nerve palsy. What would be the management

 A

Instant exploration

 B

Give a knuckle bender splint

 C

Electromyography after 2 days and decide after results

 D

Neurolysis

Ans. B

Explanation:

Ans. b. Give a knuckle bender splint


Q. 12

Which of the following movement of thumb is lost in ulnar nerve injury ‑

 A

Opposition

 B

Extension

 C

Adduction

 D

Abduction

Q. 12

Which of the following movement of thumb is lost in ulnar nerve injury ‑

 A

Opposition

 B

Extension

 C

Adduction

 D

Abduction

Ans. C

Explanation:

Ans. is ‘c’ i.e., Adduction 

  • There is loss of adduction of thumb, as adductor pollicis is supplied by the ulnar nerve.

Movements                                   Muscles causing movements

Flexion                                         Flexor pollicis brevis (median and ulnar N)(accompanied by medial rotation) Opponens pollicis (median N) assisted by flexor pollicis longus (median N)

Extension                                      Extensor pollicis longus (radial N)

(accompanied by lateral rotation)    Extensor pollicis brevis (radial N) Abductor pollicis longus (radial N)

Abduction                                     Abductor pollicis brevis (median N) Abductor pollicis longus (radial N)

!Adduction                                    Adductor pollicis (ulnar N)

Opposition                                    Opponens pollicis (median N)



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