Clinical Presentation – Wrist and Elbow Combination

Symptoms may vary from mild transient paraesthesia to severe intrinsic muscle atrophy. Pain may be in the elbow, or wrist, and may radiate to the hand or shoulder.

In mixed nerve involvement, numbness usually precedes motor loss.

Early muscle weakness may cause difficulty in opening bottles or doors, or early fatigue in repetitive moments, and may be painless.


Dorsal sensation to the ring and little finger is preserved in wrist entrapment, but not in elbow entrapment because the dorsal cutaneous branch of the ulnar nerve leaves the ulnar nerve about 9cm proximal to the wrist.

Intrinsic muscle function is tested by asking the patient to cross the index and middle fingers.

Other tests include:

Froment’s sign

Weakness of adductor pollicis can be demonstrated by eliciting Froment’s sign when grasping a piece of paper. The flexor pollicis longus (FPL Median) is used causing the thumb to flex because adduction is insufficient.

Ulnar claw

In lesions of the ulnar nerve below the mid-forearm, a claw hand is produced. In lesions above the mid-forearm, clawing does not occur because the long flexors to these fingers are also denervated (Ulnar paradox, shown above).