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Ulnar neuropathy at the elbow and wrist

Timothy J Doherty, MD, PhD, FRCPC
Section Editor
Jeremy M Shefner, MD, PhD
Deputy Editor
John F Dashe, MD, PhD


Entrapment or compressive neuropathies are common problems that may lead to functional impairment and disability of the upper limb due to weakness, altered sensation, loss of dexterity, and sometimes pain [1]. Ulnar neuropathy, especially at the elbow, is a common focal neuropathy affecting the upper extremity and is second in frequency only to entrapment of the median nerve at the wrist (the carpal tunnel syndrome). Accurate and timely diagnosis is important for clarifying the presence and severity of nerve injury, determining prognosis, avoiding unnecessary investigation or surgery, and establishing a treatment plan.

This topic will review the clinical features, diagnosis, and treatment of ulnar neuropathy at the elbow and wrist. Other focal neuropathies affecting the arm and hand are discussed separately. (See "Overview of upper extremity peripheral nerve syndromes" and "Brachial plexus syndromes" and "Carpal tunnel syndrome: Clinical manifestations and diagnosis".)


The ulnar nerve is derived from the anterior rami of the C8 and T1 spinal nerves with a variable contribution from C7 (figure 1). These contributing fibers are initially carried in the lower trunk and medial cord of the brachial plexus with the ulnar nerve arising in the proximal axilla.

In the upper arm, the ulnar nerve lies in close proximity to the brachial artery and the median nerve. It has no motor or sensory branches above the elbow (figure 2). This anatomic feature can lead to challenges in localizing proximal ulnar nerve lesions in some cases.

At the midpoint of the upper arm, the ulnar nerve pierces the medial intermuscular septum (the arcade of Struthers) and heads posteriorly where it lies close to the humerus and the medial head of the triceps brachii muscle and tendon. Distal to this segment, the ulnar nerve travels within the retrocondylar groove of the elbow, posteromedial to the medial epicondyle. As the nerve exits the groove it passes under the aponeurotic arch of the flexor carpi ulnaris muscle, also called the humeroulnar arcade [2], which is formed by attachments of this muscle to the medial epicondyle and olecranon (figure 3). The proximal edge of the arcade lies about 1 to 2 cm distal to a line joining the medal epicondyle and olecranon. This is an important structure clinically because it is often implicated as the cause of compressive ulnar neuropathy at the elbow (UNE).

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Literature review current through: Nov 2017. | This topic last updated: Mar 21, 2017.
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