Ulnar Nerve Release

Indications

• Progressive clinical symptoms of cubital tunnel syndrome include numbness and paresthesias or pain in the ulnar nerve distribution of the hand, primarily the little finger and ring finger. Sensory symptoms are usually exacerbated by activities that require prolonged elbow flexion, such as holding a telephone or prolonged pressure on the elbow (e.g., long hours working on the computer or flexing the elbow against table while sitting). There may be weakness, stiffness, or clumsiness of the hand with difficulty in fine movement of the hand and fingers (e.g., writing or removing the lid from a jar).

• Clinical signs include dulled sensation or mixed hypoesthesia and hyperesthesia in the little finger or ring finger or both. Weakness of the intrinsic hand muscles, including the lumbricals to the little finger and ring finger and the abductor digiti minimi muscle, usually precedes flexor digitorum profundus weakness. Subacute ulnar neuropathy may produce marked atrophy of the hypothenar and first dorsal interosseous muscles. Weakness or hand’s intrinsic muscle atrophy are usually a later and more severe sign. Chronic ulnar neuropathy results in a claw deformity. A Tinel sign is usually present in the distribution of the ulnar nerve with tapping along the olecranon notch.

• Nerve conduction slowing that is localized at the elbow should be confirmed with electrodiagnostic studies. A difference in conduction before and after the elbow along with right clinical signs is very suggestive for cubital tunnel syndrome.

• A positive magnetic resonance neurogram showing increased intensity of the ulnar nerve at the level of the cubital tunnel and distally provides further diagnostic evidence.