Physical examination reveals weakness of medial deviation of the wrist (adduction), loss of sensation on the medial side of the hand, and clawing of the fingers. Where is the most likely place of injury?
The ulnar nerve enters the forearm by passing between the two heads of the flexor carpi ulnaris and descends between and innervates the flexor carpi ulnaris (for medial wrist deviation) and flexor digitorum profundus (medial half) muscles. Injuring the ulnar nerve results in claw hand. It enters the hand superficial to the flexor retinaculum and lateral to the pisiform bone, where it is vulnerable to damage. The ulnar nerve also enters Guyon's canal, but damage to it here would not present with the aforementioned symptoms. The median nerve enters the carpal tunnel and the radial nerve passes deep to the brachioradialis.
Compression of a nerve passing between the humeral and ulnar heads of origin of flexor carpi ulnaris
Compression of a nerve passing at Guyon's canal between the pisiform bone and flexor retinaculum
Compression of a nerve passing through the carpal tunnel
Compression of a nerve passing between the ulnar and radial heads of origin of flexor digitorum superficialis
Upper Extremity