Ulnar Nerve Blocks

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- Discussion:
    - ulnar nerve blocks are used for frxs of little finger ray & in along w/
            median and radial sensory blocks for ring finger ray fractures;

- Anatomy:
    - ulnar nerve has two sensory branches that provide sensory innervation
          to ulnar side of the hand;
          - palmar branch
                - found radial to FCU tendon at proximal crease;
          - dorsal branch
                - divides from palmar branch approx 4-5 cm proximal from wrist;
                - courses under FCU   tendon to dorsal ulnar side of the hand;
    - ulnar nerve block at at elbow where nerve courses 0.5 cm below the skin
          between the medial epicondyle & olecranon;
          - ulnar nerve is palpated between medial epicondyle & olecranon;
          - inject 2-3 ml of anesthetic on either side of nerve but not directly into it;
          - paresthesias indicate proximity, and therefore, the needle has to be
                  moved slightly away from the nerve before injection;
    - ulnar block nerve at wrist:
          - ulnar nerve lies just under FCU tendon proximal to the wrist crease;
          - aspiration is necessary prior to injection, as ulnar artery   runs
                  adjacent to the nerve;
                  - note that the ulnar artery lies superficial (volar) and radial to the ulnar nerve;
          - to block dorsal sensory branch of ulnar nerve, the needle is passed
                  subQ & directed dorsally toward the base of the fifth metacarpal;