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Compressive Ulnar Neuropathy



Related narratives: Ulnar Nerve Transposition

Ulnar neuropathy is a common and disabling condition usually occurring in active people during the 3rd through the 5th decades of life. Pathologic compression of the ulnar nerve as it travels through the upper extremity is usually the cause. It occurs most commonly at the elbow as the ulnar nerve courses behind the medial aspect of the elbow joint referred to as Cubital Tunnel Syndrome. However, compression may occur at several places throughout its length. Trauma is frequently an initiating event but not always the cause. Patients with other systemic diseases such as Diabetes Mellitus, arteriosclerosis, rheumatic diseases and other collagen vascular disorders are at slightly increased risk. Work related activities including repetitive elbow flexion and extension and certain work related positions are aggravating factors, but there are no scientific data to support work activities or positions as causal risk factors.

Patients usually present with paresthesia and pain about the posteromedial aspect of the elbow, paresthesia and pain in the medial forearm and ulnar aspect of the hand, or fatigue and weakness in the forearm and hand. In advanced cases, patients may also present with atrophy and clawing due to dennervatoin of the intrinsic hand muscles supplied by the ulnar nerve.

The diagnosis is primarily based on the physical examination. This includes careful evaluation of the neck, shoulder, elbow, wrist and hand beginning with assessment of range of motion, palpation along the nerves in the upper extremity, motor and neurological testing as well as performing several specialized tests. A positive Tinel's sign is present when percussion of the ulnar nerve along its course (especially behind the elbow) reproduces symptoms. The elbow flexion test is performed by maximally flexing the elbow and placing the ulnar nerve on stretch, looking for reproduction of the patientís symptoms. In addition, electro diagnostic studies (EMG, Nerve Conduction Studies) may reveal delayed nerve conduction velocity and altered muscle innervation parameters.

Once the diagnosis is made and the site of compression is identified, initial treatment involves conservative management with the use of anti-inflammatory agents, elbow splinting and/or local steroid injections.

Options for surgical treatment are aimed at decompressing the nerve as it courses posteriorly around the elbow in the cubital tunnel as well as eliminating other potential areas for compression. In cases clearly isolated to post traumatic compression within the cubital tunnel, simple decompression of the tunnel may be warranted. However, the nerve is often compressed at several places along its course and there is also a dynamic component to the neuropathy, so more extensive release and transposition of the nerve is required.

Splinting provides protection in the early post-operative phase, and gradual return to elbow range of motion is initiated under the supervision of an Occupational Therapist in 7-10 days. Recovery varies but most people return to normal activities within 2-3 months.


Dellon, AL: Review of Results for Ulnar Nerve Entrapment at the Elbow. J Hand Surg 1989;14:688-670.

Novak CB, Lee GW, Mackinnon SE, Lay L: Provacative Testing for Cubital Tunnel Syndrome. J Hand Surg 1994;19A:817-820.

Posner MA: Compressive Ulnar Neuropathies at the Elbow: I. Etiology and Diagnosis. J Am Acad Orthop Surg 1998;6:282-288.

Posner MA: Compressive Ulnar Neuropathies at the Elbow: II. Treatment. J Am Acad Orthop Surg 1998;6:289-297.

Terrono AL, Millender LH: Management of Work-Related Upper-Extremity Nerve Entrapments. Orthop Clin North Am 1996;27:783-793.

This page was last modified on 30-Jan-2001.