eMedicine Specialties > Orthopedic Surgery > Hand & Upper Extremity

Ulnar Nerve Entrapment: Workup

Author: Mark Stern, MD, Former Chief, Department of Orthopedic Surgery, Cedars-Sinai Medical Center
Coauthor(s): Scott P Steinmann, MD, Assistant Professor of Orthopedics, Mayo Medical School; Consulting Staff, Department of Orthopedic Surgery, Mayo Clinic of Rochester
Contributor Information and Disclosures

Updated: Sep 21, 2009

Workup

Laboratory Studies

  • Routine studies for ulnar nerve entrapment are used to rule out anemia, diabetes mellitus, and hypothyroidism and include the following:
    • CBC
    • Urinalysis
    • Fasting blood sugar
  • If rheumatoid diseases are suspected, order the appropriate tests.

Imaging Studies

  • Obtain radiographs of the neck if cervical disc disease is suspected and to rule out cervical ribs.
  • Obtain radiographs of the chest if Pancoast tumor or tuberculosis is suspected.
  • Radiographs of the elbow and wrist are mandatory in ulnar nerve compression because double crush syndrome may be present. Entrapment of the ulnar nerve may occur at more than one level.
    • Radiographs of the elbow reveal abnormal anatomy, such as a valgus deformity, bone spurs or bone fragments, a shallow olecranon groove, osteochondromas, and destructive lesions (eg, tumors, infections, abnormal calcifications).
    • Radiographs of the wrist reveal fractures of the hook of the hamate, dislocations of the wrist bones, and to a lesser extent, soft tissue masses and calcifications.
  • MRI is not usually necessary unless delineation of soft tissue masses or visualization of swelling or other abnormalities in the nerve is desired.15

Diagnostic Procedures

  • Electromyography tests and nerve conduction studies are indicated to confirm the area of entrapment, document the extent of the pathology, and detect or rule out the possibility of double crush syndrome.16,17,18,19
  • Motor and sensory conduction velocities are more useful in a recent entrapment of the ulnar nerve, whereas conduction velocities and EMG are useful in chronic neuropathies because EMG shows axonal degeneration.

More on Ulnar Nerve Entrapment

Overview: Ulnar Nerve Entrapment
Workup: Ulnar Nerve Entrapment
Treatment: Ulnar Nerve Entrapment
Follow-up: Ulnar Nerve Entrapment
References
Further Reading
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References

  1. Spinner M, Spencer PS. Nerve compression lesions of the upper extremity. A clinical and experimental review. Clin Orthop. Oct 1974;0(104):46-67. [Medline].

  2. Szabo RM, Steinberg DR. Nerve Entrapment Syndromes in the Wrist. J Am Acad Orthop Surg. Mar 1994;2(2):115-123. [Medline].

  3. Elhassan B, Steinmann SP. Entrapment neuropathy of the ulnar nerve. J Am Acad Orthop Surg. Nov 2007;15(11):672-81. [Medline].

  4. Pearce C, Feinberg J, Wolfe SW. Ulnar Neuropathy at the Wrist. HSS J. Jun 9 2009;[Medline].

  5. Zimmerman NB, Kaye MB, Wilgis EF, Zimmerman RM, Dubin NH. Are standardized patient self-reporting instruments applicable to the evaluation of ulnar neuropathy at the elbow?. J Shoulder Elbow Surg. May-Jun 2009;18(3):463-8. [Medline].

  6. Charles YP, Coulet B, Rouzaud JC, Daures JP, Chammas M. Comparative clinical outcomes of submuscular and subcutaneous transposition of the ulnar nerve for cubital tunnel syndrome. J Hand Surg Am. May-Jun 2009;34(5):866-74. [Medline].

  7. Jaddue DA, Saloo SA, Sayed-Noor AS. Subcutaneous vs Submuscular Ulnar Nerve Transposition in Moderate Cubital Tunnel Syndrome. Open Orthop J. Aug 27 2009;3:78-82. [Medline].

  8. Posner MA. Compressive ulnar neuropathies at the elbow: I. Etiology and diagnosis. J Am Acad Orthop Surg. Sep-Oct 1998;6(5):282-8. [Medline].

  9. Kleinman WB. Cubital tunnel syndrome: anterior transposition as a logical approach to complete nerve decompression. J Hand Surg [Am]. Sep 1999;24(5):886-97. [Medline].

  10. Merolla G, Staffa G, Paladini P, Campi F, Porcellini G. Endoscopic approach to cubital tunnel syndrome. J Neurosurg Sci. Sep 2008;52(3):93-8. [Medline].

  11. Gellman H. Compression of the ulnar nerve at the elbow: cubital tunnel syndrome. Instr Course Lect. 2008;57:187-97. [Medline].

  12. Seddon HJ. Surgical Disorders of the Peripheral Nerves. Edinburgh, Scotland:. Churchill Livingstone;1972.

  13. Sunderland S. Nerves and Nerve Injuries. 2nd ed. London, England:. Churchill Livingstone;1978:780-95.

  14. Dunselman HH, Visser LH. The clinical, electrophysiologic and prognostic heterogeneity of ulnar neuropathy at the elbow. J Neurol Neurosurg Psychiatry. Jul 17 2008;[Medline].

  15. Husarik DB, Saupe N, Pfirrmann CW, Jost B, Hodler J, Zanetti M. Elbow nerves: MR findings in 60 asymptomatic subjects--normal anatomy, variants, and pitfalls. Radiology. Jul 2009;252(1):148-56. [Medline].

  16. Caliandro P, Foschini M, Pazzaglia C, La Torre G, Aprile I, Granata G, et al. IN-RATIO: a new test to increase diagnostic sensitivity in ulnar nerve entrapment at elbow. Clin Neurophysiol. Jul 2008;119(7):1600-6. [Medline].

  17. Bartels RH, Meulstee J, Verhagen WI, Luttikhuis TT. Ultrasound imaging of the ulnar nerve: correlation of preoperative and intraoperative dimensions. Clin Neurol Neurosurg. Jul 2008;110(7):687-90. [Medline].

  18. Yoon JS, Hong SJ, Kim BJ, Kim SJ, Kim JM, Walker FO, et al. Ulnar nerve and cubital tunnel ultrasound in ulnar neuropathy at the elbow. Arch Phys Med Rehabil. May 2008;89(5):887-9. [Medline].

  19. Toros T, Karabay N, Ozaksar K, Sugun TS, Kayalar M, Bal E. Evaluation of peripheral nerves of the upper limb with ultrasonography: a comparison of ultrasonographic examination and the intra-operative findings. J Bone Joint Surg Br. Jun 2009;91(6):762-5. [Medline].

  20. Ruchelsman DE, Lee SK, Posner MA. Failed surgery for ulnar nerve compression at the elbow. Hand Clin. Aug 2007;23(3):359-71, vi-vii. [Medline].

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Further Reading

Related eMedicine topics

 Nerve Entrapment Syndromes

Cubital Tunnel Syndrome

Elbow and Forearm Overuse Injuries

Hand, Nerve Compression Syndromes: Upper Extremity

Ulnar Neuropathy

Acute Nerve Injury

Clinical guidelines

Chronic elbow pain.
American College of Radiology - Medical Specialty Society. 1998 (revised 2005). 5 pages. NGC:004605

Elbow disorders.
American College of Occupational and Environmental Medicine - Medical Specialty Society. 1997 (revised 2007). 67 pages. NGC:005681

European Federation of Neurological Societies/Peripheral Nerve Society Guideline on management of multifocal motor neuropathy. Report of a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society.
European Federation of Neurological Societies - Medical Specialty Society
Peripheral Nerve Society - Disease Specific Society. 2006 Mar. 8 pages. NGC:005171

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Keywords

ulnar nerve entrapment, cubital tunnel syndrome, ulnar tunnel syndrome, ulnar neuropathy, ulnar neuropathy, Guyon canal entrapment, decompression in situ, decompression with anterior transposition, acute nerve injury, elbow and forearm, elbow dislocation, nerve entrapment, ulnar nerve compression, entrapment neuropathy, nerve compression

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Contributor Information and Disclosures

Author

Mark Stern, MD, Former Chief, Department of Orthopedic Surgery, Cedars-Sinai Medical Center
Mark Stern, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, California Medical Association, and Western Orthopaedic Association
Disclosure: Nothing to disclose.

Coauthor(s)

Scott P Steinmann, MD, Assistant Professor of Orthopedics, Mayo Medical School; Consulting Staff, Department of Orthopedic Surgery, Mayo Clinic of Rochester
Scott P Steinmann, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Society for Surgery of the Hand, and Minnesota Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Joseph E Sheppard, MD, Associate Professor of Clinical Orthopedic Surgery, Chief of Hand and Upper Extremity Service, Department of Orthopedic Surgery, University of Arizona Health Sciences Center, University Physicians Healthcare
Joseph E Sheppard, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Society for Surgery of the Hand, Clinical Orthopaedic Society, and Western Orthopaedic Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Michael Yaszemski, MD, PhD, Associate Professor, Departments of Orthopedic Surgery and Bioengineering, Mayo Foundation, Mayo Medical School
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Mary Ann E Keenan, MD, Professor, Vice Chair for Graduate Medical Education, Department of Orthopedic Surgery, University of Pennsylvania School of Medicine; Chief of Neuro-Orthopedics Program, Department of Orthopedic Surgery, Hospital of the University of Pennsylvania
Mary Ann E Keenan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, American Society for Surgery of the Hand, and Orthopaedic Rehabilitation Association
Disclosure: Nothing to disclose.

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