Summary
There are five major anatomical locations where the ulnar nerve may be compressed near the elbow. Multiple sites of compression are often noted clinically; in other cases, the site of compression is difficult to identify. Clinical experience and results of a series of 20 anatomical dissections suggest that local decompression or subcutaneous transfer may be performed without necessarily exposing all five locations, posing a risk of incomplete decompression. Submuscular transfer of the ulnar nerve decompresses all five locations simultaneously and thus theoretically may be more reliable. The potentially superior results predicted by this anatomical investigation have been confirmed in a clinical case review. Submuscular transposition of the ulnar nerve is reliable and safe, not only in the primary treatment of ulnar neuropathy at the elbow but also in revision of previous operations.
Résumé
Il existe cinq points près du coude où le nerf cubital peut être comprimé. Plusieurs de ces points peuvent être trouvés cliniquement mais dans d'autres cas le point de compression est difficile à identifier. A partir de plusieurs expériences cliniques et du résultat d'une série de vingt dissections anatomiques, l'auteur suggère que la décompression et le transfert sous-cutané du nerf peuvent être réalisés sans que soient exposées les cinq localisations préférentielles de compression. Le transfert sous-musculaire du nerf cubital décomprime les cinq localisations simultanément et devient théoriquement plus fiable. L'amélioration des résultats prévus par ce travail anatomique a été confirée dans un cas clinique spécifique. La transposition sous-musculaire du nerf cubital est simple, fiable, non seulment comme traitement initial des neuropathies cubitales au niveau du coude mais aussi dans les reprises chirurgicales.
Similar content being viewed by others
References
Adelaar RS, Foster WC, McDowell C (1984) The treatment of the cubital tunnel syndrome. J Hand Surg [Am] 9: 90–95
Amadio PC, Beckenbaugh RD (1986) Entrapment of the ulnar nerve by the deep flexor-pronator aponeurosis. J Hand Surg [Am] 11: 83–87
Apfelberg DB, Larson SJ (1973) Dynamic anatomy of the ulnar nerve at the elbow. Plast Reconstr. Surg 51: 76–81
Barss P (1984) Ulnar compression neuropathy due to an occult post-traumatic synovial cyst. Med J Aust 140: 428–429
Caffinière JY de la, Bex M (1983) L'epitrochléoplastie: Un procédé di libération et de protection du nerf cubital du coude. Rev Chir Orthop 69: 649–651
Carpendale MT (1966) The localization of ulnar nerve compression in the hand arm: an improved method of electroneuromyography. Arch Phys Med Rehabil 47: 325–330
Chan RC, Paine KWE, Varughese G (1980) Ulnar neuropathy at the elbow: comparison of simple decompression and anterior transposition. Neurosurgery 7: 545–550
Curtis BF (1898) Traumatic ulnar neuritis: transplantation of the nerve. J Nerv. Ment Dis 25: 480–484
Dahners LE, Wood FM (1984) Anconeus epitrochlearis, a rare cause of cubital tunnel syndrome: a case report. J Hand Surg [Am] 9: 579–580
Dimond ML, Lister GD (1985) Cubital tunnel syndrome treated by long arm splintage. Presented at the 40th Annual Meeting of the American Society for Surgery of the Hand, Las Vegas, Nevada, January 21–23
Eaton RG, Crowe JF, Parkes JC III (1980) Anterior transposition of the ulnar nerve using a non-compressing fasciodermal sling. J Bone Joint Surg [Am] 62: 820–825
Eisen A, Danon J (1974) The mild cubital tunnel syndrome: its natural history and indications for surgical intervention. Neurology 24: 608–613
Escobar PL (1983) Short segment stimulations in ulnar nerve lesions around elbow. Orthop Rev 12: 65–69
Fannin TF (1978) Local decompression in the treatment of ulnar nerve entrapment at the elbow. J R Coll Surg Edinb 23: 362–366
Feindel W, Stratford J (1958) The role of the cubital tunnel in tardy ulnar plasy. Can J Surg 1: 287–300
Foster RJ, Edshage S (1981) Factors related to the outcome of surgically managed compressive ulnar neuropathy at the elbow level. J Hand Surg [Am] 6: 181–192
Freundlich BD, Spinner M (1968) Nerve compression syndrome in derangements of the proximal and distal radial ulnar joints. Bull Hosp Jt Dis Orthop Inst 29: 38–47
Froimson AI, Zahrawi F (1980) Treatment of compression neuropathy of the ulnar nerve at the elbow by epicondylectomy and neurolysis. J Hand Surg [Am] 5: 391–395
Gay JR, Love JG (1947) Diagnosis and treatment of tardy paralysis of the ulnar nerve: based on a study of 100 cases. J Bone Joint Surg [Am] 29: 1087–1097
Hagström P (1977) Ulnar nerve compression at the elbow: results of surgery in 85 cases. Scand J Plast Reconstr Surg 11: 59–62
Harrison MJG, Nurick S (1970) Results of anterior transposition of the ulnar nerve for ulnar neuritis. Br Med J 1: 27–29
Hayashi Y, Kojima T, Kohno T (1984) A case of cubital tunnel syndrome caused by the snapping of the medial head of the triceps brachii muscle. J Hand Surg 9: 96–99
Hollinshead WH (1969) Anatomy for Surgeons. Vol. 3. The Back and Limbs, Second edition. New York, Harper and Row, Publishers, p 375
Holtzman RN, Mark MH, Patel MR, Wiener LM (1984) Ulnar nerve entrapment neuropathy in the forearm. J Hand Surg [Am] 9: 576–578
Jones RE, Gauntt C (1979) Medial epicondylectomy for ulnar nerve compression syndrome at the elbow. Clin Orthop 139: 174–178
Kane E, Kaplan EB, Spinner M (1973) Observations of the course of the ulnar nerve in the arm. Ann Chir 27: 487–496
Keret D, Porter KM (1984) Synovial cyst and ulnar nerve entrapment: a case report. Clin Orthop 188: 213–216
Kim DJ, Kalantri A, Guha S, Wainapel SF (1981) Dorsal cutaneous ulnar nerve conduction: diagnostic aid in ulnar neuropathy. Arch Neurol 38: 321–322
King T, Morgan FP (1959) Late results of removing the medial humeral epicondyle for traumatic ulnar neuritis. J Bone Joint Surg [Br] 41: 51–55
Kleinert HE, Hayes JE (1971) The ulnar tunnel syndrome. Plast Reconstr Surg 47: 21–24
Laha RK, Panchal PD (1979) Surgical treatment of ulnar neuropathy. Surg Neurol 11: 393–398
Lalanandham T, Laurence WN (1984) Entrapment of the ulnar nerve in the callus of a supracondylar fracture of the humerus. Injury 16: 129–130
Learmonth JR (1942) A technique for transplanting the ulnar nerve. Surg Gynecol Obstet 75: 792–793
Leffert RD (1982) Anterior submuscular transposition of the ulnar nerves by the Learmonth technique. J Hand Surg 7: 147–155
Levy DM, Apfelberg DB (1972) Results of anterior transposition for ulnar neuropathy at the elbow. Am J Surg 123: 304–308
Lugnegård H, Juhlin L, Nilsson BY (1982) Ulnar neuropathy at the elbow treated with decompression: a clinical and electrophysiological investigation. Scand J Plast Reconstr Surg 16: 195–200
Lugnegård H, Walheim G, Wennberg A (1977) Operative treatment of ulnar nerve neuropathy in the elbow region: a clinical and electrophysiological study. Acta Orthop Scand 48: 168–176
Macnicol MF (1979) The results of operation for ulnar neuritis. J Bone Joint Surg [Br] 61: 159–164
McGowan AJ (1950) The results of transposition of the ulnar nerve for traumatic ulnar neuritis. J Bone Joint Surg [Br] 32: 293–301
Miller RG (1979) The cubital tunnel syndrome: diagnosis and precise localization. Ann Neurol 6: 56–59
Mooij JJA (1982) Ulnar nerve pathology at the elbow: the place of anterior transposition today. Acta Neurochir (Wien) 64: 75–85
Neblett C, Ehni G (1970) Medial epicondylectomy for ulnar palsy. J Neurosurg 32: 55–62
Osborne G (1970) Compression neuritis of the ulnar nerve at the elbow. Hand 2: 10–13
Payan J (1970) Anterior transposition of the ulnar nerve: an electrophysiological study. J Neurol Neurosurg Psychiatry 33: 157–165
Platt H (1926) The pathogenesis and treatment of traumatic neuritis of the ulnar nerve in the post-condylar groove. Br J Surg 13: 409–431
Posner MA (1984) Submuscular transposition for the ulnar nerve at the elbow. Bull Hosp Jt Dis Orthop Inst 44: 406–423
Sharara KH, Nairn DS (1983) Metastatic calcification as a cause of ulnar nerve compression at the wrist. Hand 15: 300–304
Spinner M, Kaplan EB (1976) The relationship of the ulnar nerve to the medial intermuscular septum in the arm and its clinical significance. Hand 8: 239–242
Sunderland S (1978) Nerves and Nerve Injuries. Second edition. New York, Churchill Livingstone, p 728–729
Tackmann W, Vogel P, Kaeser HE, Ettlin Th (1984) Sensitivity and localizing significance of motor and sensory electroneurographic parameters in the diagnosis of ulnar nerve lesions at the elbow: a reappraisal. J Neurol 231: 204–211
Thomsen PB (1977) Compression neuritis of the ulnar nerve treated with simple decompression. Acta Orthop Scand 48: 164–167
Vanderpool DW, Chalmers J, Lamb DW, Whiston TB (1968) Peripheral compression lesions of the ulnar nerve. J Bone Joint Surg [Br] 50: 792–803
Wadsworth TG (1977) The external compression syndrome of the ulnar nerve at the cubital tunnel. Clin Orthop 124: 189–204
Weingarden SI, Weingarden HP (1984) Spasmodic torticollis as a cause of ulnar nerve entrapment. Neurosurgery 14: 332–334
Williams PL, Warwick R (editors) (1980) Gray's Anatomy. Thirty-sixth edition. Philadelphia, WB Saunders Company, p 1100
Wilson DH, Krout R (1973) Surgery of ulnar neuropathy at the elbow: 16 cases treated by decompression without transposition; technical note. J Neurosurg 38: 780–785
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Amadio, P.C. Anatomical basis for a technique of ulnar nerve transposition. Surg Radiol Anat 8, 155–161 (1986). https://doi.org/10.1007/BF02427843
Issue Date:
DOI: https://doi.org/10.1007/BF02427843