Ulnar neuropathy: evaluation and management

Abstract

Ulnar neuropathy is commonly encountered, both acutely after elbow trauma and in the setting of chronic compression neuropathy. Careful clinical evaluation and discerning evaluation of electrodiagnostic studies are helpful in determining the prognosis of recovery with nonoperative and operative management. Appreciation of the subtleties in clinical presentation and thoughtful consideration of the timing and type of surgical intervention are critical to optimizing outcomes after treatment of ulnar neuropathy. The potential need for decompression at both the cubital tunnel and Guyon's canal must be appreciated. Supplementation of decompression with supercharged end-to-side nerve transfer can expedite motor recovery of the ulnar intrinsic muscles in the appropriately selected patient. The emergence of nerve transfer techniques has also changed the management of acute ulnar nerve injuries.

Keywords: Cubital tunnel; Guyon’s canal; Ulnar nerve compression; Ulnar nerve transposition; Ulnar neuropathy.

Fig. 1

a Distal intermuscular septum between the flexor/pronator mass (anteriorly) and the flexor carpi ulnar (posteriorly). If not divided, this septum (overlying the tenotomy scissors) is a potential point of new compression after anterior transposition of the ulnar nerve. b Completed anterior transmuscular transposition of the ulnar nerve. Note the loose reapproximation of the Z-lengthened flexor-pronator fascia—there is intentional redundancy to avoid creating a new iatrogenic site of compression