Review of treatment results for ulnar nerve entrapment at the elbow

Abstract

A review of 50 published reports between 1898 and 1988, comprising more than 2000 patients treated for ulnar nerve compression at the elbow, demonstrated that little more than personal bias is available for guidance in selecting treatment. To provide uniform data, the degree of nerve compression of the patients from these articles was staged using a sensory plus motor classification based on contemporary concepts of the pathophysiology of chronic nerve compression. The results of these studies are reinterpreted in light of this staging system. This analysis suggests that for a minimal degree of compression, excellent results can be achieved in 50% of the patients by nonoperative techniques and in almost 100% of patients by any of five surgical techniques. For a moderate degree of compression, the anterior submuscular technique yields the most excellent results with the fewest recurrences. For a severe degree of compression, the anterior intramuscular transposition yielded the fewest excellent and the most recurrent results. This review suggests that an internal neurolysis, combined with an anterior submuscular transposition, may be the best approach when the ulnar nerve is severely compressed.