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Ulnar Neuropathy
Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Synonyms

                • Ulnar nerve entrapment, cubital tunnel syndrome
              • Definitions

                • Partial fixation, compression, or distortion of ulnar nerve (UN)
                  • Most commonly occurs within cubital tunnel at elbow; uncommon within Guyon tunnel at wrist, or 2° to brachial plexus inflammation

              IMAGING

              • General Features

                • CT Findings

                  • MR Findings

                    • Ultrasonographic Findings

                      • Other Modality Findings

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Staging, Grading, & Classification

                                • Gross Pathologic & Surgical Features

                                  • Microscopic Features

                                    CLINICAL ISSUES

                                    • Presentation

                                      • Demographics

                                        • Natural History & Prognosis

                                          • Treatment

                                            DIAGNOSTIC CHECKLIST

                                            • Consider

                                              • Image Interpretation Pearls

                                                Selected References

                                                1. Bamac B et al: Influence of the long term use of a computer on median, ulnar and radial sensory nerves in the wrist region. Int J Occup Med Environ Health. ePub, 2014
                                                2. Nellans K et al: Ulnar neuropathy as a result of anconeus epitrochlearis. Orthopedics. 37(8):e743-5, 2014
                                                3. Omejec G et al: Diagnostic accuracy of ultrasonographic and nerve conduction studies in ulnar neuropathy at the elbow. Clin Neurophysiol. ePub, 2014
                                                4. Schwarz D et al: Diagnostic Signs of Motor Neuropathy in MR Neurography: Nerve Lesions and Muscle Denervation. Eur Radiol. ePub, 2014
                                                5. Karatas A et al: Regional anatomic structures of the elbow that may potentially compress the ulnar nerve. J Shoulder Elbow Surg. 18(4):627-31, 2009
                                                6. Keiner D et al: Comparison of the long-term results of anterior transposition of the ulnar nerve or simple decompression in the treatment of cubital tunnel syndrome--a prospective study. Acta Neurochir (Wien). 151(4):311-5; discussion 316, 2009
                                                7. Koenig RW et al: High-resolution ultrasonography in evaluating peripheral nerve entrapment and trauma. Neurosurg Focus. 26(2):E13, 2009
                                                8. Andreisek G et al: Upper extremity peripheral neuropathies: role and impact of MR imaging on patient management. Eur Radiol. 18(9):1953-61, 2008
                                                9. Hof JJ et al: What's new in MRI of peripheral nerve entrapment? Neurosurg Clin N Am. 19(4):583-95, vi, 2008
                                                10. Mondelli M et al: Ultrasonography in ulnar neuropathy at the elbow: relationships to clinical and electrophysiological findings. Neurophysiol Clin. 38(4):217-26, 2008
                                                11. Toussaint CP et al: What's new in common upper extremity entrapment neuropathies. Neurosurg Clin N Am. 19(4):573-81, vi, 2008
                                                12. Andreisek G et al: Peripheral neuropathies of the median, radial, and ulnar nerves: MR imaging features. Radiographics. 26(5):1267-87, 2006
                                                13. Vucic S et al: Utility of magnetic resonance imaging in diagnosing ulnar neuropathy at the elbow. Clin Neurophysiol. 117(3):590-5, 2006
                                                14. Bordalo-Rodrigues M et al: MR imaging of common entrapment neuropathies at the wrist. Magn Reson Imaging Clin N Am. 12(2):265-79, vi, 2004
                                                15. Bordalo-Rodrigues M et al: MR imaging of entrapment neuropathies at the elbow. Magn Reson Imaging Clin N Am. 12(2):247-63, vi, 2004
                                                16. Hochman MG et al: Nerves in a pinch: imaging of nerve compression syndromes. Radiol Clin North Am. 42(1):221-45, 2004
                                                17. Matsuzaki H et al: Long-term clinical and neurologic recovery in the hand after surgery for severe cubital tunnel syndrome. J Hand Surg [Am]. 29(3):373-8, 2004
                                                18. Park GY et al: The ultrasonographic and electrodiagnostic findings of ulnar neuropathy at the elbow. Arch Phys Med Rehabil. 85(6):1000-5, 2004
                                                19. Dellon AL et al: Results of the musculofascial lengthening technique for submuscular transposition of the ulnar nerve at the elbow. J Bone Joint Surg Am. 85-A(7):1314-20, 2003
                                                20. Kim DH et al: Surgical outcomes of 654 ulnar nerve lesions. J Neurosurg. 98(5):993-1004, 2003
                                                21. Matev B: Cubital tunnel syndrome. Hand Surg. 8(1):127-31, 2003
                                                22. Murata K et al: Causes of ulnar tunnel syndrome: a retrospective study of 31 subjects. J Hand Surg [Am]. 28(4):647-51, 2003
                                                23. Thornton R et al: Magnetic resonance imaging of sports injuries of the elbow. Top Magn Reson Imaging. 14(1):69-86, 2003
                                                24. Kato H et al: Cubital tunnel syndrome associated with medial elbow Ganglia and osteoarthritis of the elbow. J Bone Joint Surg Am. 84-A(8):1413-9, 2002
                                                25. Chung CB et al: Magnetic resonance imaging of the upper extremity: advances in technique and application. Clin Orthop. (383):162-74, 2001
                                                26. Arle JE et al: Surgical treatment of common entrapment neuropathies in the upper limbs. Muscle Nerve. 23(8):1160-74, 2000
                                                27. Martinoli C et al: US of nerve entrapments in osteofibrous tunnels of the upper and lower limbs. Radiographics. 20 Spec No:S199-213; discussion S213-7, 2000
                                                28. Chiou HJ et al: Cubital tunnel syndrome: diagnosis by high-resolution ultrasonography. J Ultrasound Med. 17(10):643-8, 1998
                                                29. Ruocco MJ et al: MR imaging of ulnar nerve entrapment secondary to an anomalous wrist muscle. Skeletal Radiol. 27(4):218-21, 1998
                                                30. Britz GW et al: Ulnar nerve entrapment at the elbow: correlation of magnetic resonance imaging, clinical, electrodiagnostic, and intraoperative findings. Neurosurgery. 38(3):458-65; discussion 465, 1996
                                                31. Zeiss J et al: The ulnar tunnel at the wrist (Guyon's canal): normal MR anatomy and variants. AJR Am J Roentgenol. 158(5):1081-5, 1992
                                                Related Anatomy
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                                                Related Differential Diagnoses
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                                                References
                                                Tables

                                                Tables

                                                KEY FACTS

                                                • Terminology

                                                  • Imaging

                                                    • Top Differential Diagnoses

                                                      • Pathology

                                                        • Clinical Issues

                                                          • Diagnostic Checklist

                                                            TERMINOLOGY

                                                            • Synonyms

                                                              • Ulnar nerve entrapment, cubital tunnel syndrome
                                                            • Definitions

                                                              • Partial fixation, compression, or distortion of ulnar nerve (UN)
                                                                • Most commonly occurs within cubital tunnel at elbow; uncommon within Guyon tunnel at wrist, or 2° to brachial plexus inflammation

                                                            IMAGING

                                                            • General Features

                                                              • CT Findings

                                                                • MR Findings

                                                                  • Ultrasonographic Findings

                                                                    • Other Modality Findings

                                                                      • Imaging Recommendations

                                                                        DIFFERENTIAL DIAGNOSIS

                                                                          PATHOLOGY

                                                                          • General Features

                                                                            • Staging, Grading, & Classification

                                                                              • Gross Pathologic & Surgical Features

                                                                                • Microscopic Features

                                                                                  CLINICAL ISSUES

                                                                                  • Presentation

                                                                                    • Demographics

                                                                                      • Natural History & Prognosis

                                                                                        • Treatment

                                                                                          DIAGNOSTIC CHECKLIST

                                                                                          • Consider

                                                                                            • Image Interpretation Pearls

                                                                                              Selected References

                                                                                              1. Bamac B et al: Influence of the long term use of a computer on median, ulnar and radial sensory nerves in the wrist region. Int J Occup Med Environ Health. ePub, 2014
                                                                                              2. Nellans K et al: Ulnar neuropathy as a result of anconeus epitrochlearis. Orthopedics. 37(8):e743-5, 2014
                                                                                              3. Omejec G et al: Diagnostic accuracy of ultrasonographic and nerve conduction studies in ulnar neuropathy at the elbow. Clin Neurophysiol. ePub, 2014
                                                                                              4. Schwarz D et al: Diagnostic Signs of Motor Neuropathy in MR Neurography: Nerve Lesions and Muscle Denervation. Eur Radiol. ePub, 2014
                                                                                              5. Karatas A et al: Regional anatomic structures of the elbow that may potentially compress the ulnar nerve. J Shoulder Elbow Surg. 18(4):627-31, 2009
                                                                                              6. Keiner D et al: Comparison of the long-term results of anterior transposition of the ulnar nerve or simple decompression in the treatment of cubital tunnel syndrome--a prospective study. Acta Neurochir (Wien). 151(4):311-5; discussion 316, 2009
                                                                                              7. Koenig RW et al: High-resolution ultrasonography in evaluating peripheral nerve entrapment and trauma. Neurosurg Focus. 26(2):E13, 2009
                                                                                              8. Andreisek G et al: Upper extremity peripheral neuropathies: role and impact of MR imaging on patient management. Eur Radiol. 18(9):1953-61, 2008
                                                                                              9. Hof JJ et al: What's new in MRI of peripheral nerve entrapment? Neurosurg Clin N Am. 19(4):583-95, vi, 2008
                                                                                              10. Mondelli M et al: Ultrasonography in ulnar neuropathy at the elbow: relationships to clinical and electrophysiological findings. Neurophysiol Clin. 38(4):217-26, 2008
                                                                                              11. Toussaint CP et al: What's new in common upper extremity entrapment neuropathies. Neurosurg Clin N Am. 19(4):573-81, vi, 2008
                                                                                              12. Andreisek G et al: Peripheral neuropathies of the median, radial, and ulnar nerves: MR imaging features. Radiographics. 26(5):1267-87, 2006
                                                                                              13. Vucic S et al: Utility of magnetic resonance imaging in diagnosing ulnar neuropathy at the elbow. Clin Neurophysiol. 117(3):590-5, 2006
                                                                                              14. Bordalo-Rodrigues M et al: MR imaging of common entrapment neuropathies at the wrist. Magn Reson Imaging Clin N Am. 12(2):265-79, vi, 2004
                                                                                              15. Bordalo-Rodrigues M et al: MR imaging of entrapment neuropathies at the elbow. Magn Reson Imaging Clin N Am. 12(2):247-63, vi, 2004
                                                                                              16. Hochman MG et al: Nerves in a pinch: imaging of nerve compression syndromes. Radiol Clin North Am. 42(1):221-45, 2004
                                                                                              17. Matsuzaki H et al: Long-term clinical and neurologic recovery in the hand after surgery for severe cubital tunnel syndrome. J Hand Surg [Am]. 29(3):373-8, 2004
                                                                                              18. Park GY et al: The ultrasonographic and electrodiagnostic findings of ulnar neuropathy at the elbow. Arch Phys Med Rehabil. 85(6):1000-5, 2004
                                                                                              19. Dellon AL et al: Results of the musculofascial lengthening technique for submuscular transposition of the ulnar nerve at the elbow. J Bone Joint Surg Am. 85-A(7):1314-20, 2003
                                                                                              20. Kim DH et al: Surgical outcomes of 654 ulnar nerve lesions. J Neurosurg. 98(5):993-1004, 2003
                                                                                              21. Matev B: Cubital tunnel syndrome. Hand Surg. 8(1):127-31, 2003
                                                                                              22. Murata K et al: Causes of ulnar tunnel syndrome: a retrospective study of 31 subjects. J Hand Surg [Am]. 28(4):647-51, 2003
                                                                                              23. Thornton R et al: Magnetic resonance imaging of sports injuries of the elbow. Top Magn Reson Imaging. 14(1):69-86, 2003
                                                                                              24. Kato H et al: Cubital tunnel syndrome associated with medial elbow Ganglia and osteoarthritis of the elbow. J Bone Joint Surg Am. 84-A(8):1413-9, 2002
                                                                                              25. Chung CB et al: Magnetic resonance imaging of the upper extremity: advances in technique and application. Clin Orthop. (383):162-74, 2001
                                                                                              26. Arle JE et al: Surgical treatment of common entrapment neuropathies in the upper limbs. Muscle Nerve. 23(8):1160-74, 2000
                                                                                              27. Martinoli C et al: US of nerve entrapments in osteofibrous tunnels of the upper and lower limbs. Radiographics. 20 Spec No:S199-213; discussion S213-7, 2000
                                                                                              28. Chiou HJ et al: Cubital tunnel syndrome: diagnosis by high-resolution ultrasonography. J Ultrasound Med. 17(10):643-8, 1998
                                                                                              29. Ruocco MJ et al: MR imaging of ulnar nerve entrapment secondary to an anomalous wrist muscle. Skeletal Radiol. 27(4):218-21, 1998
                                                                                              30. Britz GW et al: Ulnar nerve entrapment at the elbow: correlation of magnetic resonance imaging, clinical, electrodiagnostic, and intraoperative findings. Neurosurgery. 38(3):458-65; discussion 465, 1996
                                                                                              31. Zeiss J et al: The ulnar tunnel at the wrist (Guyon's canal): normal MR anatomy and variants. AJR Am J Roentgenol. 158(5):1081-5, 1992