Ulnar Nerve Entrapment Workup

  • Author: Mark Stern, MD; Chief Editor: Mary Ann E Keenan, MD   more...
 
Updated: Feb 10, 2012
 

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.
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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.[16]
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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.[17, 18, 19, 20]
  • 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.
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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.

Specialty Editor Board

Joseph E Sheppard, MD  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, and Orthopaedics Overseas

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Michael Yaszemski, MD, PhD  Associate Professor, Departments of Orthopedic Surgery and Bioengineering, Mayo Foundation, Mayo Medical School

Disclosure: Nothing to disclose.

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

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.

References

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  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. Iyer V, Thirkannad S. Focal hand dystonia in a patient with ulnar nerve neuropathy at the elbow. Hand (N Y). Dec 2010;5(4):453-7. [Medline]. [Full Text].

  16. 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].

  17. 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].

  18. 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].

  19. 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].

  20. 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].

  21. Zhong W, Zhang W, Zheng X, Li S, Shi J. Comparative study of different surgical transposition methods for ulnar nerve entrapment at the elbow. J Int Med Res. 2011;39(5):1766-72. [Medline].

  22. Karthik K, Nanda R, Storey S, Stothard J. Severe ulnar nerve entrapment at the elbow: functional outcome after minimally invasive in situ decompression. J Hand Surg Eur Vol. Feb 2012;37(2):115-22. [Medline].

  23. 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].

  24. Caliandro P, La Torre G, Padua R, Giannini F, Padua L. Treatment for ulnar neuropathy at the elbow. Cochrane Database Syst Rev. Feb 16 2011;2:CD006839. [Medline].

 
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