Cubital Tunnel Syndrome

  • Glenn C. Terry
  • Todd E. Zeigler


Compressive neuropathy of the ulnar nerve at the elbow is a common problem, and many acute cases resolve with nonoperative treatment. Before considering operative treatment for chronic cases, the surgeon must consider differential diagnoses and must localize the lesion to the elbow. The type of procedure chosen depends on many factors. There is a paucity of good comparative studies in the literature to aid the surgeon in selection of the most effective procedure. The surgical treatment must be tailored to each case after determining the cause of the neuropathy and after examining patient factors, such as occupation, activity level, and coexisting systemic conditions. Often, the type of surgery performed is the one with which the surgeon has the most experience and is most comfortable. Recurrent problems most often are due to failure to relieve the true source of compression at the original procedure. Repeat exploration to address all potential areas of compression, with subsequent submuscular transposition, is effective in most of these difficult cases.


Carpal Tunnel Syndrome Ulnar Nerve Ulnar Collateral Ligament Cubital Tunnel Intermuscular Septum 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Lundborg G. Ischemic nerve injury. Experimental studies on intraneural microvascular pathophysiology and nerve function in a limb subjected to temporary circulatory arrest. Scan J Plast Reconstr Surg Suppl 1970;6:3–113.Google Scholar
  2. 2.
    Eversmann WW Jr, Ritsick JA. Intraoperative changes in motor nerve conduction latency in carpal tunnel syndrome. J Hand Surg 1978;3:77–81.Google Scholar
  3. 3.
    Sunderland S. The nerve lesion in the carpal tunnel syndrome. J Neurol Neurosurg Psychiatry 1976;39:615–626.PubMedCrossRefGoogle Scholar
  4. 4.
    Posner MA. Compressive ulnar neuropathies at the elbow: I. Etiology and diagnosis. J Am Acad Orthop Surg 1998;6:282–288.PubMedGoogle Scholar
  5. 5.
    Adelaar RS, Foster WC, McDowell C. The treatment of the cubital tunnel syndrome. J Hand Surg 1984;9A:90–95.Google Scholar
  6. 6.
    Posner MA. Compressive ulnar neuropathies at the elbow: II. Treatment. J Am Acad Orthop Surg 1998;6:289–297.PubMedGoogle Scholar
  7. 7.
    Posner MA. Compressive ulnar neuropathies of the ulnar nerve at the elbow and wrist. Instr Course Lect 2000;49:305–317.PubMedGoogle Scholar
  8. 8.
    Feindel W, Stratford J. The role of the cubital tunnel in tardy ulnar palsy. Can J Surg 1958;1:287–300.PubMedGoogle Scholar
  9. 9.
    Eversmann WW Jr. Entrapment and compression neuropathies. In: Green DP, ed. Operative hand surgery, 3rd ed. New York: Churchill Livingstone; 1993:1356–1365.Google Scholar
  10. 10.
    Spinner M, Kaplan EB. The relationship of the ulnar nerve to the medial intermuscular septum in the arm and its clinical significance. Hand 1976;8:239–242.PubMedCrossRefGoogle Scholar
  11. 11.
    Hunt JR. Tardy or late paralysis of the ulnar nerve. A form of chronic progressive neuritis developing many years after fracture dislocation of the elbow joint. JAMA 1916;66:11–15.Google Scholar
  12. 12.
    Lazaro L III. Ulnar nerve instability: Ulnar nerve injury due to elbow flexion. South Med J 1977;70:36–40.PubMedGoogle Scholar
  13. 13.
    Werner C-O, Ohlin P, Elmqvist D. Pressures recorded in ulnar neuropathy. Acta Orthop Scand 1985;56:404–406.PubMedCrossRefGoogle Scholar
  14. 14.
    Pechan J, Julis I. The pressure measurement in the ulnar nerve. A contribution to the pathophysiology of the cubital tunnel syndrome. J Biomech 1975;8:75–79.PubMedCrossRefGoogle Scholar
  15. 15.
    Jobe FW, Fanton GS. Nerve injuries. In: Morrey BF, ed. The elbow and its disorders. Philadelphia: WB Saunders, 1985: 497.Google Scholar
  16. 16.
    Alvine FG, Schurrer ME. Postoperative ulnar-nerve palsy. Are there predisposing factors? J Bone Joint Surg 1987;69A:255–259.Google Scholar
  17. 17.
    Amadio PC, Beckenbaugh RD. Entrapment of the ulnar nerve by the deep flexor-pronator aponeurosis. J Hand Surg 1986; 11:83–87.Google Scholar
  18. 18.
    Wilgis EF, Murphy R. The significance of longitudinal excursion in peripheral nerves. Hand Clin 1986;2:761–766.PubMedGoogle Scholar
  19. 19.
    Butters KP, Singer KM. Nerve lesions of the arm and elbow. In: DeLee JC, Drez D Jr, eds. Orthopaedic sports medicine: Principles and practice. Philadelphia: WB Saunders; 1994:802.Google Scholar
  20. 20.
    James GH. Nerve lesions about the elbow [abstract]. J Bone Joint Surg 1956;38B:589.Google Scholar
  21. 21.
    Rayan GM, Jensen C, Duke J. Elbow flexion test in the normal population. J Hand Surg 1992;17A:86–89.Google Scholar
  22. 22.
    Upton AR, McComas AJ. The double crush in nerve entrapment syndromes. Lancet 1973;2:359–362.PubMedCrossRefGoogle Scholar
  23. 23.
    Wadsworth TG. The external compression syndrome of the ulnar nerve at the cubital tunnel. Clin Orthop 1977;124:189–204.PubMedGoogle Scholar
  24. 24.
    Dellon AL, Mackinnon SE. Injury to the medial antebrachial cutaneous nerve during cubital tunnel surgery. J Hand Surg 1985;10B:33–36.Google Scholar
  25. 25.
    Watchmaker GP, Lee G, Mackinnon SE. Intraneural topography of the ulnar nerve in the cubital tunnel facilitates anterior transposition. J Hand Surg 1994;19A:915–922.Google Scholar
  26. 26.
    Eaton RG, Crowe JF, Parkes III JC. Anterior transposition of the ulnar nerve using a non-compressing fasciodermal sling. J Bone Joint Surg 1980;62A:820–825.Google Scholar
  27. 27.
    Broudy AS, Leffert RD, Smith RJ. Technical problems with ulnar nerve transposition at the elbow: Findings and results of reoperation. J Hand Surg 1978;3:85–89.Google Scholar
  28. 28.
    Gabel GT, Amadio PC. Reoperation for failed decompression of the ulnar nerve in the region of the elbow. J Bone Joint Surg 1990;72A:213–219.Google Scholar
  29. 29.
    Leffert RD. Anterior submuscular transposition of the ulnar nerves by the Learmonth technique. J Hand Surg 1982;7A: 147–155.Google Scholar
  30. 30.
    Dellon AL, Mackinnon SE, Hudson AR, et al. Effect of submuscular versus intramuscular placement of ulnar nerve. Experimental model in the primate. J Hand Surg 1986;11B:117–119.Google Scholar
  31. 31.
    Kleinman WB, Bishop AT. Anterior intramuscular transposition of the ulnar nerve. J Hand Surg 1989;14A:972–979.Google Scholar
  32. 32.
    Dellon AL. Operative technique for submuscular transposition of the ulnar nerve. Contemp Orthop 1988;16:17–24.Google Scholar
  33. 33.
    Pasque CB, Rayan GM. Anterior submuscular transposition of the ulnar nerve for cubital tunnel syndrome. J Hand Surg 1995; 20B:447–453.Google Scholar
  34. 34.
    Mass DP, Silverberg B. Cubital tunnel syndrome: Anterior transposition with epicondylar osteotomy. Orthopedics 1986; 9:711–715.PubMedGoogle Scholar
  35. 35.
    Cole RJ, Jemison DM, Hayes CW. Anterior elbow dislocation following medial epicondylectomy: A case report. J Hand Surg 1994;19A:614–616.Google Scholar
  36. 36.
    Dellon AL. Review of treatment results for ulnar nerve entrapment at the elbow. J Hand Surg 1989;14A:688–700.Google Scholar
  37. 37.
    Rogers MR, Bergfield TG, Aulicino PL. The failed ulnar nerve transposition. Etiology and treatment. Clin Orthop 1991;269:193–200.PubMedGoogle Scholar

Copyright information

© Springer-Verlag New York, Inc. 2002

Authors and Affiliations

  • Glenn C. Terry
  • Todd E. Zeigler

There are no affiliations available

Personalised recommendations