Ulnar Neuropathy of the Elbow

Summary

Ulnar nerve entrapment is the second most common compressive neuropathy in the upper extremity because of its anatomy and superficial location. Major aetiological factors in the development of ulnar neuropathy of the elbow are compression, inherent anatomical structures, or lesions within the cubital tunnel. Extrinsic nerve compression may be elicited by acute or recurrent trauma. Nerve mobility may be impeded by congenital deformities. Ulnar nerve dysfunction has been associated with metabolic conditions, certain occupations and athletes involved in repetitive overhead activities. Ulnar nerve injuries may result in both motor and sensory abnormalities.

Common symptoms include point tenderness, digital numbness and hand weakness. Evaluation of suspected neuropathy includes physical inspection for muscle atrophy, bony or muscle hypertrophy, deformities, digital clawing and a radiographic examination. Clinical techniques include the elbow flexion test, strength testing of hand intrinsics, flexor carpi ulnaris and digitorum profundus, and Tinel’s sign. Sensory testing and McGowan’s grading system may confirm the diagnosis and prognosis. Treatment options range from conservative (i.e. rest, splinting, non-steriodal anti-inflammatory drugs, ice and abstinence) to radical surgical intervention (i.e. decompression, medial epicondylectomy and anterior transposition). In the throwing sport athlete, nerve involvement typically occurs along with other medial elbow problems.