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Review
. 2020 Aug;13(4):449-456.
doi: 10.1007/s12178-020-09639-7.

Management of the Ulnar Nerve in Throwing Athletes

S Blake Dowdle  1 , Peter N Chalmers  2
Affiliations
Review

Management of the Ulnar Nerve in Throwing Athletes

S Blake Dowdle et al. Curr Rev Musculoskelet Med. 2020 Aug.

Abstract

Purpose of review: During overhead throwing, there are tremendous forces placed on the medial elbow that can result in injury to the ulnar nerve. The purpose of this article is to review the anatomy, biomechanics, and appropriate clinical care of an overhead throwing athlete suffering from injury to their ulnar nerve. The authors preferred clinical work-up; non-operative and operative care are included in this review.

Recent findings: More recent findings support the use of subcutaneous transposition instead of the submuscular transpositions and only to perform a transposition in the setting of specific pre-operative findings. Subcutaneous transpositions have led to decreased rates of post-operative symptoms and complications. Understanding the complexity of the medial elbow is essential to making an accurate diagnosis of ulnar neuritis/neuropathy in the overhead throwing athlete. In general, non-operative management has shown to be successful; however, in those refractory or recurrent cases of ulnar neuritis, ulnar nerve decompression with or without transposition provides these athletes with a surgical procedure that has shown to provide patients with excellent outcomes. Continued refinement surgical indications and surgical technique will allow for a high percentage of athletes who return to competitive sports following surgery for ulnar neuropathy.

Keywords: Throwing athlete; Transposition; Ulnar nerve; Ulnar neuritis.

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Conflict of interest statement

S. Blake Dowdle declares no conflict of interest.

Peter N. Chalmers conflicts listed below:

1. Arthrex, Inc.: paid consultant

2. DePuy, A Johnson & Johnson Company: IP royalties; paid presenter or speaker

3. Journal of Shoulder and Elbow Surgery: publishing royalties, financial or material support

4. Mitek: paid consultant

Figures

Fig. 1
Fig. 1
Gentle palpation of the ulnar nerve while the elbow is moved through flexion and extension evaluating for instability of subluxation
Fig. 2
Fig. 2
Ulnar nerve decompression with release of the intermuscular septum
Fig. 3
Fig. 3
Ulnar nerve decompression demonstrating full decompression proximally through the Arcade of Struthers and distally to the 2 heads of FCU
See this image and copyright information in PMC

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