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• W2124836531 abstract "Compression mononeuropathies are related to mechanical disruption of the myelin sheaths at sites of external compression. Carpal tunnel syndrome affecting the median nerve is the most common but ulnar and lateral popliteal nerves are also commonly involved. 2 A case is described of ulnar neuropathy and a brief synopsis of the present understanding of diabetic mononeuropathy is given. Case history A 56-year-old type 1 diabetic male of 20 years duration, controlled on a twice daily 30/70 insulin regime, with a mean glycated haemoglobin of 7.6% (n.r. 5.0‐6.2%) over the previous two years, complained of a gradual numbness and tingling in his right (dominant) hand over the previous six months. These sensory abnormalities were present in the medial part of the palm and medial one and a half digits. Examination confirmed diminished sensation to light touch and pin prick in this ulnar nerve distribution. On further inspection, it was noted that there was a characteristic claw hand appearance (main-en-griffe) typical of ulnar nerve entrapment at the elbow. The fourth and fifth metacarpal phalangeal joints were hyper-extended with an inability to flex the distal interphalangeal joints and an inability to extend the interphalangeal joints (see figure 1). In addition, it was noted that there was moderate wasting of the inter-ossei muscles and abductor digiti minimi. The muscles of the thenar eminence were spared. There was no other disease e.g. cervical spondylosis, noted to cause small muscle wasting of the hand. Background retinal changes were present on fundoscopy. The blood pressure was 130/80 mmHg. No microalbuminuria was detected. There were no clinical features of peripheral or autonomic neuropathy. There were no obvious macro-angiopathic complications with no previous history of heart disease, stroke or peripheral vascular problems. Motor conduction velocities were measured in the upper arm, transsulcal (elbow) and forearm segments of the right and left ulnar nerves. There were normal conduction velocities on the left side but the findings in the right arm confirmed entrapment with the ulnar nerve compressed in the cubital tunnel formed by the two tendon heads of flexor carpi ulnaris which arch across between the humerus and the ulna. Surgical decompression was performed. The sensory features resolved after 3‐4 weeks. The motor features of the ulnar nerve palsy were more slow to improve and after a further year the claw hand appearance was less marked and the inter-osseal muscles less wasted. The patient had full functional use of the hand at this stage. Discussion In a series of fifty-one diabetic patients with mononeuropathy, fifteen had an ulnar neuropathy. 3" @default.
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