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Ulnar nerve Anatomy: Origin, Course, Branches, Cubital Tunnel Syndrome, Guyon's canal syndrome
Origin
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โข Ulnar nerve comes from the medial cord of the brachial plexus (C8-T1)
Course
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Arm
โข lies posteromedial to brachial artery in anterior compartment of upper 1/2 arm
โข pierces medial IM septum at the arcade of Struthers ~ 8cm from medial epicondyle and lies medial to the triceps
โข the arcade of Struthers is an aponeurotic band extending from the medial IM septum to the medial head of the triceps
Elbow
โข runs behind medial epicondyle with superior ulnar collateral artery
Cubital tunnel
โข roof - Osbourneโs ligament proximally (extension of deep forearm fascia between heads of FCU) and FCU aponeurosis distally
โข floor - posterior and transverse bands of MCL and elbow joint capsule
โข sends small sensory branch to elbow that can be sacrificed
Forearm
โข enters forearm between 2 heads (humeral and ulnar heads) of FCU
โข runs between FCU and FDP
Wrist
the ulnar nerve and artery pass superficial to the transverse carpal ligament
bifurcates into sensory and deep motor branches in Guyon's canal
โข roof - volar carpal ligament
โข floor - transverse carpal ligament, hypothenar muscles
โข ulnar border - pisiform and pisohamate ligament, abductor digiti minimi muscle belly
โข radial border - hook of hamate
Innervation
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Motor Innervation
forearm
โข FCU
โข FDP ring and small
Thenar
โข adductor pollicis
โข deep head of flexor pollicis brevis (FPB)
fingers
โข interossei (dorsal & palmar)
โข 3rd & 4th lumbricals
hypothenar muscles
โข abductor digiti minimi
โข opponens digiti minimi
โข flexor digiti minimi
Sensory Innervation
sensory branches of ulnar nerve
โข dorsal cutaneous branch
โข palmar cutaneous branch
โข superficial terminal branches
Clinical Anatomy
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โข Cubital Tunnel Syndrome is a condition that involves pressure or stretching of the ulnar nerve (also known as the โfunny boneโ nerve), which can cause numbness or tingling in the ring and small fingers, pain in the forearm, and/or weakness in the hand.
โข Guyon's canal syndrome is an entrapment of the ulnar nerve as it passes through a tunnel in the wrist called Guyon's canal. This problem is similar to carpal tunnel syndrome but involves a completely different nerve. Sometimes both conditions can cause a problem in the same hand.
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