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  • Updated 06.07.2021
  • Released 03.09.1998
  • Expires For CME 06.07.2024

Ulnar neuropathies

Introduction

This article includes discussion of ulnar neuropathies, Guyon canal neuropathy, ulnar neuropathy at the wrist, and flexor carpi ulnaris exit compression. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Historical note and terminology

Surgery to achieve ulnar nerve decompression at the elbow has been performed for nearly two centuries. Several methods have been developed, some of which have been abandoned. Historical insight improves understanding of current techniques and provides the basis for the development of new methods. A systematic chronological overview of the surgical treatment of ulnar nerve compression at the elbow is presented in one article, with special attention to people who described a treatment method for the first time (05).

Weir Mitchell, in an overlooked contribution, mentions a case of ulnar neuropathy at the elbow developing 29 years after an injury in his 1872 book entitled, Injuries to Nerves and Their Consequences (49). In 1878, Panas described the operative treatment of an ulnar neuropathy at the elbow that developed 12 years after an elbow fracture (43). Broca and Mouchet applied the term "tardy" to this syndrome in 1899. The appellation "tardy ulnar palsy" eventually came to be applied to almost any ulnar neuropathy at the elbow, assumed that previous trauma had been forgotten. Physicians even began to use that line of reasoning to apply to median neuropathies, and the term "tardy median palsy" was used to refer to progressive thenar atrophy until 1947, when Lord Brain described the entity of carpal tunnel syndrome (08). In 1922, Buzzard and Sargent reported a case of ulnar neuropathy at the elbow where "the nerve passed beneath a dense fibrous archway which constricted it." This is clearly a description of entrapment by the humeroulnar aponeurotic arcade (the bridging aponeurosis that connects the two heads of origin of the flexor carpi ulnaris) at what later came to be known as the "cubital tunnel" (09). In 1957, Osborne rediscovered the humeroulnar aponeurotic arcade, also known as “Osborne band,” as a compression site (41). In 1958, Feindel and Stratford affirmed Osborne's observations and coined the term "cubital tunnel syndrome" to refer to entrapment by the humeroulnar aponeurotic arcade (27).

In 1861, Guyon described the anatomical details of the ulnar nerve at the wrist and pointed out the potential for entrapment (25). The clinical descriptions of ulnar nerve entrapment in the wrist and hand largely originate from Ramsay Hunt in the early 20th century, and these conditions, especially the deep palmar branch neuropathy, are sometimes referred to as Ramsay Hunt syndrome (several syndromes bear his name) (30).

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