1) Arcade of Struthers:
- thick fascism structure 8 cm proximal to the medial epicondyle between medial head if triceps and medial intermuscular septum.
- present in 70% of pts with ulnar nerve compression
2) medial intermuscular septum
- dense fascia that covers ulnar nerve as it travels in postcondylar groove
3) Osbornes's band
- leading edge of fascia that connects ulnar and humeral heads of flexor carpi ulnaris
4) aponeurosis of flexor-pronator mass
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Examination:
- 2point discrimination, pinch and grip strength, motor strength for entire upper arm
- tinel's sign through course of ulnar nerve
- brachial plexus: arm raised to stress brachial plexus and observ for parasthesias
- nerve conduction studies. But normal study in the setting f painshould not preclude an operative repair.
Management:
- conduction greater than 40m/sec treat conservatively for 8 wks and or only if still symptomatic
- conduction < 40m/sec should be managed with release electively Conduction may not improve post procedure on basis of permanent axonal injury.
- <30m/sec release within 3 months
- <20m/sec release ASAP
Conservative treatment
- activity modification
- Ulnar nerve loose when arm extended. Therefore avoid elbow flexed positions
- elbowpads at night
Many options for surgical treatment.
- simple decompression
- medial epicondylectomy
- subcutaneous transposition
- intramuscular transposition
- trnasmuscular transposition
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