Ulnar Neuropathy Questions & Answers

Updated: Jun 08, 2018
  • Author: Charles F Guardia, III, MD; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE  more...
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Questions & Answers

Overview

What is ulnar neuropathy?

Where is the most common site of ulnar nerve entrapment?

How does ulnar neuropathy manifest?

How is ulnar neuropathy managed?

What is the role of the cubital tunnel in the etiology of ulnar neuropathy?

What anatomy is involved in ulnar neuropathy?

How is the arcade of Struthers distinguished from the ligament of Struthers in ulnar neuropathy?

What is the anatomy of the cubital tunnel in ulnar neuropathy?

What is the course of the ulnar nerve upon entering the cubital tunnel?

Which nerve anomalies may confuse the diagnosis of ulnar neuropathy?

Which arteries supply blood to the ulnar nerve?

What is the role of the inferior ulna collateral artery in the etiology of ulnar neuropathy?

Where is the inferior ulnar collateral artery positioned in the anatomy of ulnar neuropathy?

Which terms are used to describe the site of elbow nerve entrapment in ulnar neuropathy?

What is tardy ulnar palsy?

What is cubital tunnel syndrome?

Where in the elbow region is the ulnar nerve most likely to be compressed?

What is the arcade of Struthers in ulnar anatomy?

Which structures have been involved in ulnar entrapment?

How is ulnar compression in the medial epicondylar region characterized?

What is the role of the epicondylar (ulnar) groove in the anatomy of ulnar neuropathy?

What is the role of the region of the HUA in the anatomy of ulnar neuropathy?

What is the role of the region where ulnar nerve exits from flexor carpi ulnaris in the anatomy of ulnar neuropathy?

What are distal entrapment sites in ulnar neuropathy?

How is the canal of Guyon divided in the anatomy of ulnar neuropathy?

What is the Sunderland classification of nerve injuries?

What is the pathophysiology of ulnar neuropathy?

What is the pathophysiology of ulnar neuropathy within the cubital tunnel?

What is the role of subluxation of the ulnar nerve in the pathogenesis of ulnar neuropathy?

What is the role of the flexor carpi ulnaris and the flexor digitorum profundus in the pathogenesis of ulnar neuropathy?

What a double crush condition in the pathogenesis of ulnar neuropathy?

What differentiates axonal damage from demyelination in the pathophysiology of ulnar neuropathy?

What is the Seddon classification of nerve injuries?

How are ulnar nerve injuries classified?

What is the accuracy of the Disabilities of Arm, Shoulder and Hand (DASH) questionnaire for clinical staging of ulnar neuropathy?

What causes cubital tunnel ulnar neuropathy?

What causes ulnar neuropathy at or near the elbow?

What causes ulnar neuropathy at or distal to the wrist?

What is the prevalence of ulnar neuropathy in the US?

How does the prevalence of ulnar neuropathy vary by age?

How does the prevalence of ulnar neuropathy vary by sex?

What is the prognosis of ulnar neuropathy?

What are the prognostic factors in ulnar neuropathy?

Which factors are associated with an unfavorable or poor surgical outcome in ulnar neuropathy?

What is the prognosis following surgery for ulnar neuropathy?

Presentation

How can the presenting symptoms of ulnar neuropathy vary?

What is the focus of history for suspected ulnar neuropathy?

What presentation is characteristic of ulnar neuropathy?

What should be included in the physical exam for ulnar neuropathy?

What causes a clawed hand appearance in patients with ulnar neuropathy?

What does a physical finding of the Froment sign suggest in ulnar neuropathy?

How can a physical finding of an anomalous connection be misinterpreted in the evaluation of ulnar neuropathy?

What is the test for the Tinel sign in ulnar neuropathy?

Which muscles should be testing in the evaluation of ulnar neuropathy?

What causes sparing of the flexor carpi ulnaris in ulnar neuropathy?

Which non-ulnar muscles should be examined in the evaluation of ulnar neuropathy?

When is an ulnar nerve lesion in the region of the elbow the suspected cause ulnar neuropathy?

Which muscles are affected in ulnar neuropathy?

Which physical findings are characteristic of ulnar neuropathy at or distal to the wrist?

Which findings help to localize the ulnar lesion in ulnar neuropathy?

What is the role of a sensory exam in the evaluation of ulnar neuropathy?

DDX

What are the challenges in diagnosing ulnar neuropathy?

What causes misdiagnosis in ulnar neuropathy?

What other problems should be considered in the differential diagnoses of ulnar neuropathy?

What are the differential diagnoses for Ulnar Neuropathy?

Workup

Which lab studies are performed to rule out anemia, diabetes mellitus, and hypothyroidism in the differential diagnosis of ulnar neuropathy?

Which lab studies should be considered in the evaluation of ulnar neuropathy?

What is the role of radiography in the evaluation of ulnar neuropathy?

Which radiographic findings suggest ulnar neuropathy?

What is the role of ultrasonography in the evaluation of ulnar neuropathy?

Which ultrasonographic finding suggests ulnar neuropathy?

What does an ultrasound finding of increased intraneural vascularization suggest in the evaluation of ulnar neuropathy?

Which finding on high-resolution ultrasonography suggests cubital tunnel ulnar neuropathy?

What is the role of ultrasonography in the evaluation of traumatic peripheral nerve injuries in the diagnosis of ulnar neuropathy?

What are the limitations of ultrasonography in the evaluation of ulnar neuropathy?

What is the role of MRI in the evaluation of ulnar neuropathy?

Which MRI findings are characteristic of ulnar neuropathy?

What are the advantages of MRI for the evaluation of ulnar neuropathy?

How sensitive is MRI in the workup of ulnar neuropathy?

What are the limitations of MRI in the workup of ulnar neuropathy?

What is the sensitivity of MRI in the diagnosis of cubital tunnel ulnar neuropathy?

What is the role of diffusion-tensor imaging in the evaluation of ulnar neuropathy?

When is MRI indicated in the evaluation of ulnar neuropathy?

What is the role of EMG in the evaluation of ulnar neuropathy?

What is the role of nerve conduction studies in the evaluation of ulnar neuropathy?

Which EMG and nerve conduction study findings are characteristic of ulnar neuropathy?

What are the limitations of EMG and nerve conduction studies in the evaluation of ulnar neuropathy?

What is the inching technique for conducting EMG and nerve conduction studies for the evaluation of ulnar neuropathy?

What does a nerve conduction finding of Martin-Gruber anastomosis indicate in the evaluation of ulnar neuropathy?

What are the possible patterns of Martin-Gruber anastomosis in ulnar neuropathy?

How does the wrist response in nerve conduction studies vary with and without a Martin-Gruber anastomosis?

Why must a Martin-Gruber anastomosis be excluded before an ulnar conduction block is diagnosed in ulnar neuropathy?

What are the characteristic findings for each type of Martin-Gruber anastomosis in nerve conduction studies for ulnar neuropathy?

What are the diagnostic implications of a finding of Martin-Gruber anomaly in the evaluation of ulnar neuropathy?

What is a Riche-Cannieu anastomosis in the evaluation of ulnar neuropathy?

Which histologic findings are characteristic of ulnar neuropathy?

Treatment

What are the treatment options for ulnar neuropathy?

When is surgery indicated for ulnar neuropathy?

Which specialist referrals may be needed for the treatment of ulnar neuropathy?

How often should a patient be seen following surgery for ulnar neuropathy?

How long after surgery for ulnar nerve entrapment is there a return to normal function?

How does chronic palsy affect the outcome of surgery for ulnar neuropathy?

What recovery expectation should be set for patients with ulnar neuropathy?

When is conservative treatment of ulnar neuropathy most likely to succeed?

Which medications are used to address pain and sensory symptoms of ulnar neuropathy?

What is the role of vitamin B-6 in the treatment of ulnar neuropathy?

Which activity modifications are used in the treatment of ulnar neuropathy?

What is the initial conservative treatment of cubital tunnel ulnar neuropathy?

How are mild cubital tunnel symptoms of ulnar neuropathy treated?

How is pain and paresthesia in ulnar neuropathy treated?

What does patient education for ulnar neuropathy consist of?

Which conservative approach to the treatment of mild and moderate ulnar neuropathy is most beneficial?

When is surgery indicated for ulnar neuropathy?

What is the preoperative treatment for ulnar neuropathy?

What are the indications for ulnar nerve decompression in situ in ulnar neuropathy?

What are the indications for ulnar nerve decompression with anterior transposition in ulnar neuropathy?

What are the indications for medial epicondylectomy in ulnar neuropathy?

What are the contraindications for surgery in ulnar neuropathy?

What is the efficacy of surgery for ulnar neuropathy at the elbow?

What is decompression in situ for treatment of ulnar neuropathy?

What are the advantages of decompression in situ for ulnar neuropathy?

What are the disadvantages of decompression in situ for ulnar neuropathy?

What incisions are made in decompression in situ for ulnar neuropathy?

How is decompression in situ performed for ulnar neuropathy?

What are the advantages of decompression with anterior transposition for the treatment of ulnar neuropathy?

What are the disadvantages of decompression with anterior transposition for the treatment of ulnar neuropathy?

What are the types of anterior transposition in the treatment of ulnar neuropathy?

What is the role of subcutaneous transposition for the treatment of ulnar neuropathy?

What are the advantages and disadvantages of a subcutaneous transposition for the treatment of ulnar neuropathy?

What incisions are made in a subcutaneous transposition for ulnar neuropathy?

What is the goal of subcutaneous transposition for ulnar neuropathy?

What techniques are used in subcutaneous transposition for ulnar neuropathy?

What is the postoperative management following subcutaneous transposition for ulnar neuropathy?

What are the advantages and disadvantages of an intramuscular transposition for the treatment of ulnar neuropathy?

How is intramuscular transposition performed for ulnar neuropathy?

What is postoperative management following intramuscular transposition for ulnar neuropathy?

What are the advantages and disadvantages of a submuscular transposition for ulnar neuropathy?

What must be released in a submuscular transposition for ulnar neuropathy?

How is submuscular transposition performed for ulnar neuropathy?

What is postoperative management following submuscular transposition for ulnar neuropathy?

What is the efficacy of decompression with anterior transposition for ulnar neuropathy?

What is the indication for a medial epicondylectomy for the treatment of ulnar neuropathy?

What are the advantages and disadvantages of a medial epicondylectomy for ulnar neuropathy?

How is medial epicondylectomy performed for ulnar neuropathy?

What is postoperative management following medial epicondylectomy for ulnar neuropathy?

What is the efficacy of medial epicondylectomy for ulnar neuropathy?

What is the indication for an endoscopic cubital tunnel release for ulnar neuropathy?

What are serious complications of surgical decompression of the ulnar nerve for treatment of ulnar neuropathy?

What are possible complications of surgical decompression of the ulnar nerve for treatment of ulnar neuropathy?

What complications can occur after decompression with anterior transposition for ulnar neuropathy?

What complications can occur after a medial epicondylectomy for ulnar neuropathy?

What complications can occur in postoperative ulnar neuropathies?

Medications

What are the goals of drug treatment for ulnar neuropathy?

Which medications in the drug class Anticonvulsants are used in the treatment of Ulnar Neuropathy?

Which medications in the drug class Analgesics, Opioids are used in the treatment of Ulnar Neuropathy?

Which medications in the drug class Antiarrhythmic Agents Class 1b are used in the treatment of Ulnar Neuropathy?

Which medications in the drug class Tricyclic Antidepressants are used in the treatment of Ulnar Neuropathy?