Ulnar Neuropathy About the Elbow

Ulnar neuropathy about the elbow has been described and debated for years, though there is no consensus on the best surgical treatment. Current meta-analyses show equivalent outcomes after in situ decompression and anterior transposition. Recent trends have been toward in situ decompression through limited incisions or with endoscopic techniques. Further research is needed to determine the strength of prognostic factors, such as duration of symptoms and preoperative severity of disease, which may change our threshold for surgical intervention. The ulnar nerve should also be addressed in cases of distal humerus fracture, generally with in situ decompression, as transposition does not appear to decrease rates of ulnar neuropathy. In elbow contractures, prophylactic ulnar nerve decompression should be liberally used, especially in cases of heterotopic ossification, scarring about the nerve, and preexisting symptoms, to prevent postoperative and delayed-onset ulnar neuropathy.