2. Anatomy of Ulnar Nerve

22. Cubital Tunnel Syndrome
• Symptoms & Signs:
- sensory changes volar & dorsal ulnar 11/2 digits
- Pain or Tinel’s sign at elbow
- Positive elbow flexion test
- weakness/atrophy of intrinsic muscles (esp. key pinch)
- Wartenberg’s sign
- Froment’s sign
- Claw hand

23. Cubital Tunnel Syndrome
• Sites of compression:
- Arcade of Struthers
- Medial head of triceps
- Medial intermuscular septum
- Arcuate lig. Of Osbourne
- Aponeurosis of FCU

26. Cubital Tunnel Syndrome
• Non-surgical management
- night splints to keep elbow extended (static)
- Soft elbow pads to prevent direct compression
- Rest & activity modification
- Anti-inflammatories

27. Cubital Tunnel Syndrome
• Surgery
- Principles:
- Release of compression
- Prevention of subluxation

28. Cubital Tunnel Syndrome
• Surgery:
- Simple decompression in situ
- Medial epicondylectomy
- Anterior transposition:
- subcutaneous
- intramuscular
- submuscular
- transmuscular

35. Ulnar Tunnel Syndrome (Guyon’s canal)
• Symptoms & signs:
- numbness volar surface ulnar 1.5digits
- Intrinsic weakness
- Can be pure motor, pure sensory or combination

37. Ulnar Tunnel Syndrome (Guyon’s canal)
• Aetiology:
- carpal ganglion
- Repetitive trauma
- Fracture of hook of hamate
- Hypertrophied palmaris brevis
- Thrombosis or aneurysm of ulnar artery

38. Ulnar Tunnel Syndrome (Guyon’s canal)
• Surgery:
- Release of Guyon’s canal
- Ensure visualization of deep motor branch
- Check for ganglion