Ulnar nerve

The Ulnar Nerve (n. ulnaris) is placed along the medial side of the limb, and is distributed to the muscles and skin of the forearm and hand.

It arises from the medial cord of the brachial plexus, and derives its fibers from the eighth cervical and first thoracic nerves.

It is smaller than the median nerve, and lies at first behind it, but diverges from it in its course down the arm.

At its origin it lies medial to the axillary artery, and bears the same relation to the brachial artery as far as the middle of the arm. Here it pierces the medial intermuscular septum, runs obliquely across the medial head of the Triceps brachii, and descends to the groove between the medial epicondyle and the olecranon, accompanied by the superior ulnar collateral artery. 

At the elbow, it rests upon the back of the medial epicondyle, and enters the forearm between the two heads of the Flexor carpi ulnaris. 

In the forearm, it descends along the ulnar side lying upon the Flexor digitorum profundus; its upper half is covered by the Flexor carpi ulnaris, its lower half lies on the lateral side of the muscle, covered by the integument and fascia. In the upper third of the forearm, it is separated from the ulnar artery by a considerable interval, but in the rest of its extent lies close to the medial side of the artery. About 5 cm. above the wrist it ends by dividing into a dorsal and a volar branch.

The branches of the ulnar nerve are: articular to the elbow-joint, muscular, palmar cutaneous, dorsal, and palmar.

The articular branches to the elbow-joint are several small filaments which arise from the nerve as it lies in the groove between the medial epicondyle and olecranon.

The muscular branches (rami musculares) two in number, arise near the elbow: one supplies the Flexor carpi ulnaris; the other, the ulnar half of the Flexor digitorum profundus.

The palmar cutaneous branch (ramus cutaneus palmaris) arises about the middle of the forearm, and descends on the ulnar artery, giving off some filaments to the vessel. It perforates the volar carpal ligament and ends in the skin of the palm, communicating with the palmar branch of the median nerve.

The dorsal branch (ramus dorsalis manus) arises about 5 cm. above the wrist; it passes backward beneath the Flexor carpi ulnaris, perforates the deep fascia, and, running along the ulnar side of the back of the wrist and hand, divides into two dorsal digital branches; one supplies the ulnar side of the little finger; the other, the adjacent sides of the little and ring fingers. It also sends a twig to join that given by the superficial branch of the radial nerve for the adjoining sides of the middle and ring fingers, and assists in supplying them. A branch is distributed to the metacarpal region of the hand, communicating with a twig of the superficial branch of the radial nerve.On the little finger the dorsal digital branches extend only as far as the base of the terminal phalanx, and on the ring finger as far as the base of the second phalanx; the more distal parts of these digits are supplied by dorsal branches derived from the proper volar digital branches of the ulnar nerve.

The palmar branch (volar branch; ramus volaris manus) of ulnar nerve crosses the transverse carpal ligament on the lateral side of the pisiform bone, medial to and a little behind the ulnar artery. It ends by dividing into a superficial and a deep branch.

• The superficial branch (ramus superficialis [n. ulnaris] supplies the Palmaris brevis, and the skin on the ulnar side of the hand, and divides into a proper palmar digital branch for the ulnar side of the little finger, and a common palmar digital branch which gives a communicating twig to the median nerve and divides into two proper digital nerves for the adjoining sides of the little and ring fingers. The proper digital branches are distributed to the fingers in the same manner as those of the median.
• The deep branch (ramus profundus) accompanied by the deep branch of the ulnar artery, passes between the Abductor digiti quinti and Flexor digiti quinti brevis; it then perforates the Opponens digiti quinti and follows the course of the deep volar arch beneath the Flexor tendons. At its origin it supplies the three short muscles of the little finger. As it crosses the deep part of the hand, it supplies all the Interossei and the third and fourth Lumbricales; it ends by supplying the Adductores pollicis and the medial head of the Flexor pollicis brevis. It also sends articular filaments to the wrist-joint.It has been pointed out that the ulnar part of the Flexor digitorum profundus is supplied by the ulnar nerve; the third and fourth Lumbricales, which are connected with the tendons of this part of the muscle, are supplied by the same nerve. In like manner the lateral part of the Flexor digitorum profundus and the first and second Lumbricales are supplied by the median nerve; the third Lumbricalis frequently receives an additional twig from the median nerve.