Ulnar Neuropathy

This is the second most common nerve entrapment syndrome. It generally occurs due to compression of the ulnar nerve at the elbow. Less commonly it occurs at the level of the wrist. Often this compression is preceded with one or more episodes of minor elbow injuries. Sometimes these patients routinely rest the elbows on hard surfaces. Elbow pain, sensory loss of the little and ring fingers, and grip weakness are common complaints.

As for carpal tunnel syndrome, treatment generally begins with avoiding aggravating or causative activities, such as repetitive elbow trauma, compression of the elbow against hard surfaces, etc. Elbow padding is typically the next step. Patients who still do not improve are offered decompressive surgery.

Figure 1. Intraoperative photograph demonstrating the small incision used to perform an ulnar nerve decompression. The bony landmarks medial epicondyle (M) and olecranon (O) are also indicated.

Figure 2. Highly magnified intraoperative photograph demonstrating the ulnar nerve (U) following division of the overlying compressive tissues. Additional decompression is performed several centimeters proximal and distal to the limits of the incision as well.

Figure 3. Intraoperative photograph taken during a submuscular ulnar nerve transposition. The ulnar nerve (U) and the pronator teres muscle (P) prior to division are marked. The Z-plasty muscle incision is outlined in blue marker.

Figure 4. Intraoperative photograph of the patient in Figure 3, after division of the pronator teres muscle (P) and transposition of the ulnar nerve (U), beneath the cut ends of the muscle. Tan sutures have been placed prior to repairing the muscle.