Ulnar neuropathy at the elbow

Mazen M Dimachkie MD (Dr. Dimachkie, Director of the Neuromuscular Disease Division and Vice Chairman for Research Programs, Department of Neurology, The University of Kansas Medical Center, received honorariums from Baxter, Genzyme, and Pfizer for serving as a guest speaker; consultation fees from Catalyst and Nufactor; and honorariums from Alnylam, CSL-Behring, Malinckrodt, and Novartis for advisory board meetings.)
Randolph W Evans MD, editor. (Dr. Evans of Baylor College of Medicine received honorariums from Allergan and DepoMed for speaking engagements.)
Originally released March 4, 1998; last updated September 11, 2016; expires September 11, 2019

This article includes discussion of ulnar neuropathy at the elbow, cubital tunnel syndrome, and tardy ulnar palsy. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

The authors highlight the utility of sonography in the diagnosis of ulnar neuropathy at the elbow.

Historical note and terminology

In 1878 Panas first described ulnar neuropathy at the elbow developing long after an elbow injury, and later applied the term "tardy ulnar palsy" to ulnar neuropathy at the elbow following remote elbow trauma, generally after an old fracture or dislocation (Panas 1878). The term soon degenerated into a nonspecific, generic term for any ulnar neuropathy at the elbow, based on the presumption that trauma must have occurred, but had been forgotten. The humeroulnar aponeurotic arcade is a dense fibrous aponeurosis joining the humeral and ulnar heads of origin of the flexor carpi ulnaris muscle, beneath which the ulnar nerve passes just distal to the ulnar groove. The first recorded description of ulnar compression by the humeroulnar aponeurotic arcade, and its treatment by surgical release, was by Buzzard and Sargent, but this contribution has never been recognized (Buzzard 1922). Osborne, Feindel, and Stratford rediscovered the humeroulnar aponeurotic arcade as a compression site nearly 40 years later (Osborne 1957; Feindel and Stratford 1958), and Feindel and Stratford introduced the term "cubital tunnel syndrome" (Feindel and Stratford 1958). They were attempting to define a subgroup of "tardy ulnar palsy" patients who suffered from a focal entrapment at the origin of the flexor carpi ulnaris and who could be spared a transposition procedure and managed with simple release of the aponeurotic arcade. Furthering the confusion over proper nomenclature, this condition has through the years been referred to as traumatic ulnar neuritis, compression neuritis of the ulnar nerve, Feindel-Osborne syndrome, and, more recently, as cubital tunnel syndrome. As with tardy ulnar palsy, the term "cubital tunnel syndrome" soon degenerated into a useless, nonspecific, generic label for any ulnar neuropathy at the elbow as the term increasingly grew in popularity with few bothering to read the original papers. Many think "cubital tunnel" refers to the nerve's subcutaneous passage through the ulnar groove; this is, however, a major misconception. To avoid miscommunication these terms are best avoided altogether, but it is likely that "cubital tunnel syndrome" will remain a popular, if imprecise, idiom.

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