Ulnar nerve palsy
Low Ulnar Nerve Palsy
– the major functional deficits are weakness of pinch (adductor pollicis), weakness of grip (intrinsic paralysis) and sometimes clawing of the ring and little fingers.
– weakness of pinch secondary to loss of thumb ADDUCTION (adductor pollicis paralysis)
– this should be restored, as it represents a major loss of function
Transfers: (to restore thumb adduction)
FDS of 4 swung over to thumb (Brand)
Brachioradialis or ECRL to a free tendon graft (plantaris or palmaris longus) through the 3-4 interspace, then through the palm to the thumb (Boyes)
FDS of 4 split into two limbs then swung over to thumb (Royle-Thompson)
FDS of 4 split into 3 limbs, one to the thumb, the other two transferred dorsally to 4
and 5 to restore intrinsic function (Omer)
– the loss of intrinsic power make grip weak:
Transfers: (to restore intrinsic power)
FDS transfer from volar to dorsal (Bunnell)
EDC 3 and 4 split then transferred under deep transverse metacarpal ligament then dorsally
ECRL or ECRB to a free plantaris graft (divided into 4) then transferred under deep
transverse metacarpal ligament, then dorsally again (Brand)
– to prevent the clawing, the MCP’s should be stabilized so that they don’t fall into hyperextension: (this allows the fingers to be flexed by the extrinsics and extended by the extrinsics.
Procedures: (to stabilize the MCPs)
volar capsulodesis (Zancolli)
High Ulnar Nerve Palsy
– all the same applies, but you cannot use FDS of 4 because its FDP is also paralyzed. Flexion of the ring and little finger can be restored by suturing their FDPs to that of the long FDP.