Ulnar Nerve Anatomy

Polatsch, Daniel B.; Melone, Charles P.; Beldner, Steven; Incorvaia, Angelo

doi:10.1016/j.hcl.2007.05.001

Cited by 76 publications

(73 citation statements)

References 36 publications

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“…The predominant intraoperative finding of a thickened FCU aponeurosis or Osborne's band causing the entrapment for the ulnar nerve is not unique to our experience [4,7,8,[20][21][22]33]. Osborne's band, while tauter with elbow flexion, represents a good candidate for chronic compression because compression is commonly present at this site even in elbow extension.…”

Section: Discussionmentioning

confidence: 85%

Scratch Collapse Test Localizes Osborne's Band as the Point of Maximal Nerve Compression in Cubital Tunnel Syndrome

Brown

Mokhtee

Evangelista

et al. 2009

Hand (New York, N,Y.)

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The objective of this study is to demonstrate the utility of the scratch collapse test (SCT) in localizing the point of maximal compression in cubital tunnel syndrome. From January 1, 2004 to December 1, 2005, 64 adult patients with cubital tunnel syndrome were evaluated by a single surgeon. Cubital tunnel syndrome was diagnosed based upon symptoms of numbness, tingling, and/or pain in the ulnar nerve distribution or by the presence of weakness or wasting of the ulnar-innervated intrinsic hand muscles. All diagnoses were confirmed with electrodiagnostic studies. As part of the physical examination, the SCT was performed along three subdivided segments in the region of the cubital tunnel. Results of the SCT were recorded and correlated with intraoperative findings. Of the 64 patients evaluated, 44 had a positive SCT that was either more profound or solely present a few centimeters distal to the medial epicondyle in the region of Osborne's band. All of these patients subsequently underwent anterior submuscular transposition and were found to have a tight compression point at Osborne's band corresponding to their preoperative SCT. This study suggests that the scratch collapse test may be a reliable physical examination technique for localizing the point of maximal nerve compression in patients with cubital tunnel syndrome. That point, in this series, corresponded with Osborne's band.

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Section: Discussionmentioning

confidence: 85%

Scratch Collapse Test Localizes Osborne's Band as the Point of Maximal Nerve Compression in Cubital Tunnel Syndrome

Brown

Mokhtee

Evangelista

et al. 2009

Hand (New York, N,Y.)

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“…12,18 The ulnar nerve exits beneath the Arcade of Struthers via a V-shaped opening and is recognized as a confined space that has potential for compression of the ulnar nerve. 4,12,18 The medial intermuscular septum was then identified spanning the Arcade of Struthers and the medial epicondyle, and dividing the anterior and posterior compartments of the arm (Figures 2 and 3). This structure can be problematic for compression or friction particularly at its distal edge where the fibrous septum attaches to the medial epicondyle.…”

Section: Anatomymentioning

confidence: 99%

“…If the ulnar nerve subluxes over the medial epicondyle during elbow flexion, the nerve can become entrapped between the skin and this taut fibrous structure. 4,19 The cubital tunnel is formed by osseous and fibrous structures in the medial elbow through which the ulnar nerve must pass. The roof is described as being formed by a retinaculum spanning the medial epicondyle and the olecranon and the aponeurosis between the two heads of flexor carpi ulnaris (FCU).…”

Section: Anatomymentioning

confidence: 99%

“…[1][2][3] The ulnar nerve is at risk from compression in four distinct anatomical regions of the medial elbow; the Arcade of Struthers, the medial intermuscular septum, the cubital tunnel and the deep flexor aponeurosis. [2][3][4][5][6] These structures form confining spaces through which the ulnar nerve must pass and create the potential for mechanical pressure on the nerve. Compression may also be caused by local soft tissue lesions or inflammatory pathologies.…”

Section: Introductionmentioning

confidence: 99%

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Ulnar neuropathy at the elbow: a review and single case cadaveric study

Collis

2011

Hand Therapy

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Introduction. Ulnar neuropathy at the elbow (UNE) causes sensory and motor dysfunction of the ulnar nerve and can lead to permanent loss of hand function. Hand therapists frequently encounter this pathology and are required to be cognisant of symptoms, diagnosis, therapeutic and surgical management. A detailed understanding of the anatomical structures will give the therapist greater expertise in managing this pathology. Methods. A single case cadaveric study was undertaken to investigate known sites of ulnar nerve compression and observe the mechanisms by which compression occurs. A literature review reports on knowledge relating to the pathology, diagnosis, therapeutic and surgical management of UNE. Results. Anatomic structures compressing the ulnar nerve are the Arcade of Struthers, the medial intermuscular septum, the cubital tunnel and the deep flexor aponeurosis. UNE is attributable to mechanical compression from fibrous and bony structures at these sites and to traction on the ulnar nerve from elbow flexion. Provocative tests are a useful tool in the diagnosis of UNE but should be used cautiously due to limitations in statistical accuracy. Conservative treatment approaches of splintage, ergonomic adaptations, education and neural mobilizations lack high-quality evidence but may have benefit primarily for early or mild to moderate disease. There is some evidence in support of conservative management in longer standing disease. Discussion. Therapists play an important role in the diagnosis and management of UNE and should have a sound understanding of the relevant anatomy, pathology, diagnosis and treatment. Conservative treatment may be efficacious for UNE but lacks evidence from randomized, controlled trials. Further research is needed to verify current precepts and traditional approaches.

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“…1,6 -11 Structures distal or proximal to the cubital tunnel can also compress the ulnar nerve, producing symptoms related to cubital tunnel syndrome. 12 Proximally, the canal (arcade) of Struthers, where the ulnar nerve transverses the intermuscular septum from the anterior to the posterior compartments of the arm, is a potential site for compression. 13 The importance of nerve gliding and longitudinal excursion has been associated with normal neural function.…”

mentioning

confidence: 99%