In injuries around the medial elbow region, which nerve is most likely damaged?

• A. Median
• B. Ulnar
• C. Radial
• D. Musculocutaneous

Answer: (B)

The nerve most likely damaged in injuries around the medial elbow is the ulnar nerve. It travels behind the medial epicondyle in the area called the cubital tunnel, where it is particularly exposed to trauma from a direct blow or sustained pressure. When this nerve is injured, you see weakness of intrinsic hand muscles that control finger spreading and pinching (interossei and the medial two lumbricals) and weakness of the thumb’s adduction (adductor pollicis). This leads to impaired finger abduction/adduction and a characteristic grip weakness, with sensory loss on the medial one-and-a-half digits of the hand. The other nerves have different, more lateral or anterior courses and distributions: the median nerve supplies the lateral digits and thenar muscles, the radial nerve is more associated with extension and the dorsum of the hand, and the musculocutaneous nerve mainly affects forearm flexors and the lateral forearm sensation. Thus, injury at the medial elbow most commonly implicates the ulnar nerve.