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

Abstract

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.