ULNAE NEEVE PAEALYSIS. 235 



of the hand superficial to the anterior annular ligament, quickly 

 to divide into its superficial and deep divisions. 

 In its course it is distributed as follows : 

 Muscular. In forearm : 

 To flexor carpi ulnaris. 

 To flexor prof undus digitorum, ulnar half. 

 As a consequence of the paralysis of these muscles, adduction 

 of the hand towards the ulnar side and full flexion of the last 

 phalanx of the ring and little fingers is lost. 

 In hand : 



By main trunk to palmaris brevis. 



By deep branch to abductor minimi digiti, flexor brevis 

 minimi digiti, flexor ossis metacarpi minimi digiti, all 

 seven interossei, two ulnar lumbricales, adductor trans- 

 versus pollicis, adductor obliquus pollicis, flexor brevis 

 pollicis, deep part. 



The deep branch runs between the flexor brevis and abductor 

 minimi digiti muscles, and often grooves the ulnar side of the 

 base of the process of the unciform bone, and at this spot it may 

 be divided by a punctured wound. It is easily found between 

 the pisiform bone and the unciform process. 



By paralysis of these muscles the following movements cannot 

 any longer be carried out : abduction of all the digits except 

 the thumb, adduction of the thumb, index, ring and little fingers, 

 flexion of the first phalanx of all the fingers, and perfect extension 

 of the second and third phalanges. It will thus be seen that a very 

 characteristic form of paralysis is induced, which can readily be 

 demonstrated by asking the sufferer to attempt to move the index 

 and little fingers away from the next to which they are placed. 



In its earlier stages the typical claw-hand (main en griffe) of 

 ulnar nerve paralysis is seen in the over-extension (dorsi-flexion) 

 of the first phalanx of the ring and little fingers, with partial 

 flexion of the second and third. This position of these two 

 digits is probably due to the unopposed action of the extensors 

 and of the flexor sublimis tendons owing to the paralysis 

 of the two ulnar lumbricales. If it were dependent upon 



