Drivers’ Elbow: A Cause of Ulnar Neuropathy

Abstract

The ulnar nerve is vulnerable to compression and vibration injury in drivers who have the shoulder abducted and elbow flexed with the arm lying against the lower edge of the window. Three cases of ulnar neuropathy at the elbow are described in vehicle drivers.

Sonographic Measurements of the Ulnar Nerve at the Elbow With Different Degrees of Elbow Flexion

“…The significant differences between the values obtained by the 2 methods may be related to the fact that an overestimate of nerve area was found with the ellipse because it was difficult to include the entire nerve without capturing an “extra” area with the ellipse method. To compare the measurements of 2 raters and to calculate intraclass correlations, the ellipse method was used because it is more reproducible and therefore ideal for use when calculating intraclass correlations [2]. Our study revealed that, even though the mean CSA of the ulnar nerve at 90° was slightly different from that at 30°, the difference was not statistically significant for the ellipse method or the direct tracing method.…”

“…In addition to the ellipse method, we also measured CSAs by using the direct trace method for its higher diagnostic accuracy [2]. Once again, no significant differences were found between the 30° and the 90° of elbow flexion (Table 2).…”

“…Ulnar nerve neuropathy at the elbow (UNE) is the second most frequent entrapment of the ulnar nerve in the upper limb [1]. Trauma from repeated elbow flexion that increases pressure on the ulnar nerve is thought to cause damage to the nerve [2,3]. It usually is diagnosed with nerve conduction studies and electromyography.…”

Gender, body mass and age as risk factors for ulnar mononeuropathy at the elbow

“…Significantly more women with a BMI ≤22.0 had UME compared to women with a BMI >22.0, suggesting that thin women are at increased risk for UME. However, UME was not associated with a decreased BMI among men despite the belief that compression of the elbow against a hard surface is an important cause of UME 1, 12. Taken together, the data suggest that external compression at the elbow is a more important cause of UME among women than men.…”

Ultrasonographic measurements in cubital tunnel syndrome

“…Cubital tunnel syndrome is the second most common nerve entrapment syndrome of the upper extremity and may occur from trauma within the tunnel during repeated flexion 1, 6. When the elbow is flexed, Osborne's band pulls and the medial collateral ligaments elevate, changing the tunnel shape and increasing pressure on the ulnar nerve, which may lead to ulnar neuropathy 7…”