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Neuropathies

Elbow neuropathies: ulnar (cubital tunnel), radial, and median nerve compression – diagnosis & management strategies.

Overview

Peripheral nerve injuries significantly impact patient quality of life [4]. Compressive ulnar neuropathies at the elbow require surgical intervention when symptoms persist or muscle weakness develops, with procedure selection guided by neuropathy severity and patient factors [1]. Median nerve entrapment neuropathies, such as pronator syndrome, are managed to consolidate knowledge and improve outcomes [3]. Surgical decompression of the median nerve or anterior interosseous nerve (AIN) in the forearm is rarely indicated, warranting a prolonged nonsurgical approach in most cases [22]. Clinical findings remain critical in median nerve compression cases because imaging and nerve conduction studies may fail to provide a definitive answer [7].

Neuropathy symptoms following shoulder surgery are often refractory to conservative management [2]. Surgical decompression leads to nearly 90% symptom resolution for these neuropathies [2]. Nerve-conduction studies serve as a prognostic factor in carpal tunnel syndrome, with patients having motor abnormalities showing more favorable results than those with only sensory abnormalities [5]. Recent literature supports the AAOS guideline for carpal tunnel syndrome but demonstrates a trend towards recommending early surgery for cases with or without median nerve denervation [32].

Radial nerve palsy treatment is usually non-operative with satisfactory results [8]. Surgery for radial nerve palsy is indicated for nerve transection or lack of improvement after conservative treatment [8]. Nerve transfers are replacing other techniques as the gold standard for brachial plexus and other proximal peripheral nerve injuries [33]. Nerve transfers offer functional outcomes surpassing those obtained from traditional nerve repair or tendon transfers [33]. A comprehensive and individualized treatment plan is crucial for optimizing patient outcomes with painful traumatic peripheral nerve neuromas [20].

Anatomy & Pathophysiology

Kinematics and Ligamentous Integrity

Dynamic compressive neuropathies around the elbow are rare entities that present unique diagnostic challenges [10]. Pitching 100 balls induces a significant reduction in dynamic stabilizing ability against elbow valgus laxity [34]. Tearing of the ulnar collateral ligament (UCL) significantly increases elbow valgus laxity [35]. This increased valgus laxity elongates the ulnar nerve during simulated throwing motion [35].

Vascular & Neural Dynamics

Increased elbow flexion influences the intraneural blood flow of the ulnar nerve in patients with cubital tunnel syndrome (CuTS) [43]. Ulnar nerve gliding is most severe during passive wrist movement in elbow flexion and forearm supination [44]. Dynamic compressive neuropathies around the elbow often require dynamic nerve conduction studies for diagnosis [10]. There was no significant difference in the motor nerve conduction velocity of the ulnar nerve across the elbow between different angles of flexion in patients with ulnar nerve entrapment or in healthy controls [54]. Ulnar nerve instability does not appear to be associated with elbow symptoms in the general population [51].

Osseous Deformity and Surgical Reconstruction

A cadaveric study could not detect a definitive effect of elbow deformity on ulnar nerve strain [45]. A cadaveric study could not demonstrate the extent of acceptable clinical elbow deformity regarding ulnar nerve strain [45]. A distally based tendon graft reconstruction of the annular ligament of the elbow using the tendon of the superficial head of the brachialis muscle is feasible in most patients [56].

Classification

Epidemiology: Ulnar neuropathies are less common than median neuropathies but are more frequent in men [11]. Ulnar nerve entrapment is the second most common nerve entrapment syndrome of the upper extremity [14], occurring most commonly in the cubital tunnel [14]. Radial neuropathies are rare [11]. Nontraumatic neuropathies of the upper limb are rare in children [9].

Etiology and Presentation: Median nerve entrapment neuropathies include pronator syndrome [3], which can be secondary to a high insertion of the pronator teres [7]. Dynamic compressive neuropathies around the elbow are rare entities that present unique diagnostic challenges [10]. Physicians treating peripheral nerve disorders in individuals from endemic regions should consider leprosy when confronted with a mass in or near the ulnar nerve associated with peripheral neuropathy [13].

Diagnostic Considerations: Prior to committing an individual to surgery for entrapment neuropathy, careful history, detailed examination, and adequate testing should be carried out to ascertain that there are no non-compressive etiologies for the presentation [6]. Some non-compressive etiologies of entrapment neuropathy presentations may be adversely affected by surgery [6]. Imaging and nerve conduction studies failed to provide a definitive answer for median nerve compression secondary to a high insertion of the pronator teres, emphasizing the importance of clinical findings [7]. High-quality evidence regarding diagnostics and treatment of nontraumatic neuropathies in children remains limited [9].

Treatment Indications: Treatment for radial nerve palsy is usually non-operative with satisfactory results [8]. Surgery is indicated for radial nerve palsy in cases of nerve transection [8] or lack of improvement after conservative treatment [8]. If symptoms persist or muscle weakness develops in compressive ulnar neuropathies at the elbow, surgery is usually indicated [1]. The choice of procedure for compressive ulnar neuropathies at the elbow depends on the severity of the neuropathy and patient factors [1]. Neuropathy symptoms following shoulder surgery were often refractory to conservative management [2], but surgical decompression led to nearly 90% symptom resolution for these symptoms [2].

Other Considerations: Peripheral nerve injuries can dramatically affect a patient's life [4].

Clinical Presentation

Ulnar nerve entrapment is the second most common nerve entrapment syndrome of the upper extremity, occurring most frequently in the cubital tunnel [14]. In nationwide register studies, ulnar neuropathies were more common in men, while radial neuropathies were rare compared to median neuropathies [11]. Prior to surgical commitment for entrapment neuropathy, careful history, detailed examination, and adequate testing are required to rule out non-compressive etiologies, as surgery may adversely affect some of these conditions [6].

Diagnostic Evaluation: Nerve-conduction studies serve as a prognostic factor, with motor abnormalities indicating more favorable results than sensory-only abnormalities [5]. However, clinical findings remain critical when imaging and nerve conduction studies are inconclusive, such as in median nerve compression secondary to a high insertion of the pronator teres [7]. Differentiating pronator syndrome from carpal tunnel syndrome is challenging due to overlapping symptoms and limited reliable literature [27]. A diagnosis of ulnar nerve compression warrants a comprehensive workup with high suspicion for concomitant median nerve compression [18]. Dynamic compressive neuropathies around the elbow are rare entities requiring dynamic nerve conduction studies for diagnosis [10].

Pediatric Considerations: Nontraumatic neuropathies of the upper limb are rare in children, and high-quality evidence regarding diagnostics and treatment remains limited [9]. Carpal tunnel syndrome in the pediatric population is rare but may signal systemic illness, requiring awareness, detailed physical examination, and electrodiagnostic studies for diagnosis [28]. Delayed ulnar neuropathy after elbow dislocation with an unrecognized medial epicondyle fracture appears associated with complete recovery in children if promptly treated [12].

Specific Etiologies and Outcomes: Neuropathy symptoms following shoulder surgery are often refractory to conservative management, yet surgical decompression leads to nearly 90% symptom resolution [2]. Sensory dysfunction and weakness improved over a 1-year follow-up in a case of cubital tunnel syndrome associated with previous ganglion cyst excision [15]. In endemic regions, physicians should consider leprosy when encountering a mass near the ulnar nerve associated with peripheral neuropathy [13]. Peripheral nerve injuries can dramatically affect a patient's life [4]. Compressive ulnar neuropathies at the elbow are indicated for surgery if symptoms persist or muscle weakness develops [1].

Investigations

Electrodiagnostic Studies: Nerve-conduction studies serve as a prognostic factor for surgical outcomes in carpal tunnel syndrome, with patients exhibiting motor abnormalities demonstrating more favorable results than those with only sensory abnormalities [5]. Dynamic compressive neuropathies around the elbow often require dynamic nerve conduction studies for diagnosis [10]. When clinical signs suggest compression of the ulnar nerve proximal to Guyon's canal from a tortuous artery, nerve conduction studies are useful diagnostic investigations [49].

Imaging: Musculoskeletal ultrasound has emerged as a reasonable alternative to electrodiagnostic studies in the diagnostic work-up of carpal tunnel syndrome, cubital tunnel syndrome, and other peripheral nerve compression syndromes [38]. For suspected ulnar nerve compression proximal to Guyon's canal due to a tortuous artery, MRI is a useful diagnostic investigation [49].

Clinical Assessment: Careful history, detailed examination, and adequate testing should be carried out prior to committing an individual to surgery for entrapment neuropathy to ascertain that there are no non-compressive etiologies for the presentation [6]. Clinical findings are important in diagnosing median nerve entrapment neuropathy because imaging and nerve conduction studies may fail to provide a definitive answer [7]. A diagnosis of ulnar nerve compression merits a comprehensive workup by the treating surgeon and a high suspicion for concomitant median nerve compression [18]. Physicians treating peripheral nerve disorders in individuals from endemic regions should consider leprosy when confronted with a mass in or near the ulnar nerve associated with peripheral neuropathy [13]. Once the diagnosis of thoracic-outlet syndrome has been made, the possibility of an additional distal compression neuropathy should be investigated [42].

Treatment

Non-Operative

Intermittent paraesthesia in idiopathic cubital tunnel syndrome should be primarily managed non-operatively with avoidance of flexion and ergonomic advice [37]. Nonsurgical management is also appropriate for distal ulnar nerve compression lesions caused by repetitive activity [40]. The majority of compression neuropathies in cyclists resolve after appropriate rest and conservative treatment [23]. However, neuropathy symptoms following shoulder surgery are often refractory to conservative management [2]. In cases of carpal-tunnel syndrome associated with vasospasm, only three patients in the conservatively treated group showed improvement [36].

Operative

Indications: Surgery is usually indicated for compressive ulnar neuropathies at the elbow if symptoms persist or muscle weakness develops [1]. Surgical decompression is indicated for ulnar nerve entrapment at the wrist if symptoms persist or worsen over 2 to 4 months [40]. For median or anterior interosseous nerve (AIN) entrapment in the forearm, surgical decompression is indicated only after a prolonged nonsurgical approach has failed, as surgery is rarely indicated initially [22]. Surgery is indicated for radial nerve palsy in cases of nerve transection or lack of improvement after conservative treatment [8]. Nerve decompression may be indicated for cyclists if compression neuropathy symptoms persist despite conservative treatment [23].

Preoperative Assessment: Prior to committing an individual to surgery for entrapment neuropathy, careful history, detailed examination, and adequate testing should be carried out to ascertain that there are no non-compressive etiologies for the presentation [6]. Nerve-conduction studies can be used as a prognostic factor, with patients having motor abnormalities appearing to have more favorable results than those with only sensory abnormalities [5]. Clinical findings are important because imaging and nerve conduction studies may fail to provide a definitive answer for median nerve compression secondary to a high insertion of the pronator teres [7]. A comprehensive and individualized treatment plan is crucial for optimizing patient outcomes with painful traumatic peripheral nerve neuromas [20].

Surgical Approach: The choice of surgical procedure for compressive ulnar neuropathies at the elbow depends on the severity of the neuropathy and patient factors [1]. Treatment options for compressive ulnar neuropathy include in situ decompression, subcutaneous transposition, submuscular transposition, and endoscopic release [21]. Treatment for tardy ulnar nerve palsy consists of ulnar nerve decompression with or without corrective osteotomy, with overall successful results usually achieved [31]. Internal neurolysis of the median nerve is a safe and effective procedure for severe carpal-tunnel syndrome if performed by a surgeon skilled in microsurgery [30]. Cross-palm nerve grafting may be a useful adjunct to enhance sensory recovery in severe ulnar neuropathy [19].

Outcomes: Surgical decompression led to nearly 90% symptom resolution for neuropathies following shoulder surgery [2]. All patients with carpal-tunnel syndrome associated with vasospasm treated surgically had an excellent result regarding carpal-tunnel symptoms [36].

Complications

Nerve palsy: Compressive ulnar neuropathies at the elbow can lead to persistent symptoms or muscle weakness, which usually indicate the need for surgery [1]. Ulnar neuropathies are more frequent in men [11], whereas radial neuropathies are rare [11]. Neuropathy symptoms following shoulder surgery are often refractory to conservative management [2]. Peripheral nerve injuries can dramatically affect a patient's life [4]. Sensory dysfunction and weakness associated with cubital tunnel syndrome can improve over a 1-year follow-up period [15]. Delayed ulnar neuropathy associated with elbow dislocation and unrecognized medial epicondyle fracture in pediatric patients appears to be associated with complete recovery if promptly treated [12].

Nerve repair: Definitive nerve repair should be deferred until after the third week following injury [24]. Nerves should be resected proximal to gross pathological change [24]. Vascular injuries occur in 13% of patients with peripheral nerve suture [24].

Other Considerations: Careful history, detailed examination, and adequate testing are required prior to surgery for entrapment neuropathy to rule out non-compressive etiologies that may be adversely affected by surgery [6].

Recovery

Light activity (weeks): Evidence does not provide specific week ranges for light activity or desk work return. Surgical intervention is generally indicated for compressive ulnar neuropathies at the elbow if symptoms persist or muscle weakness develops [1]. For radial nerve palsy, treatment is usually non-operative with satisfactory results, reserving surgery for cases of nerve transection or lack of improvement after conservative treatment [8].

Full activity (months): Specific month ranges for full activity return are not provided in the evidence base. However, outcomes vary by pathology and intervention. Surgical decompression leads to nearly 90% symptom resolution for median and ulnar neuropathies following shoulder surgery, where symptoms are often refractory to conservative management [2]. Delayed ulnar neuropathy in children associated with elbow dislocation and medial epicondyle fracture appears to be associated with complete recovery if promptly treated [12]. Symptoms including sensory dysfunction and weakness improved over a 1-year follow-up period in a case of cubital tunnel syndrome associated with previous ganglion cyst excision [15].

Complete recovery / outcome plateau (months): Specific month ranges for outcome plateau are not provided. A shorter time to presentation led to improved sensory recovery in combat-sustained peripheral nerve injuries [59]. Patients with motor abnormalities have more favorable results from carpal tunnel surgery than those with only sensory abnormalities [5]. Nerve-conduction studies can be used as a prognostic factor for surgical treatment of carpal tunnel syndrome [5]. Laboratory studies support early release of a nerve with evidence of constant static compression in a subacute setting, whereas there is no evidence in favor of early decompression of a physiologically altered nerve that has experienced slow chronic subclinical compression [26].

Rehabilitation protocol: Specific rehabilitation protocols, including PT phasing or immobilisation duration, are not detailed in the evidence. Careful history, detailed examination, and adequate testing are required prior to surgery for entrapment neuropathy to rule out non-compressive etiologies that may be adversely affected by surgery [6].

Functional milestones: Specific validated PROM trajectories are not provided. The Discovery Elbow System resulted in improved function, reduced pain, and high patient satisfaction [17]. Patients with combined nerve compressions follow similar postoperative trajectories as those with isolated cubital tunnel syndrome [25]. Cross-palm nerve grafting may be a useful adjunct to enhance sensory recovery in severe ulnar neuropathy [19]. A patient with epithelioid sarcoma arising from the perineural sheath of the median nerve returned to his original vocation and had continuous disease-free status at 3.5-year follow-up [57].

Other Considerations: The choice of surgical procedure for compressive ulnar neuropathies depends on the severity of the neuropathy and patient factors [1].

Key Evidence

  • [L5] If symptoms persist or muscle weakness develops, surgery is usually indicated, with the choice of procedure depending on the severity of the neuropathy and patient factors. (10.5435/00124635-199809000-00004)
  • [L4] Neuropathy symptoms were often refractory to conservative management, while surgical decompression led to nearly 90% symptom resolution. (10.1016/j.jseint.2024.05.011)
  • [L5] By reviewing the current literature within the spectrum of median nerve entrapment neuropathies, this review aimed to enhance and summarize the current understanding by consolidating the existing knowledge for improved patient outcomes. (10.1016/j.xrrt.2024.10.001)
  • [L5] Peripheral nerve injuries can dramatically affect a patient's life. (10.1016/j.hcl.2015.01.007)
  • [L4] Nerve-conduction studies can be used as a prognostic factor, with patients having motor abnormalities appearing to have more favorable results than those with only sensory abnormalities. (10.2106/00004623-197961010-00017)
  • [L5] Prior to committing an individual to surgery for entrapment neuropathy, careful history, detailed examination, and adequate testing should be carried out to ascertain that there are no non-compressive etiologies for the presentation, some of which may be adversely affected by surgery. (10.1177/1558944719898801)
  • [L4] It also emphasizes the importance of clinical findings because imaging and nerve conduction studies failed to provide a definitive answer. (10.1111/j.1758-5740.2010.00051.x)
  • [L5] Treatment is usually non-operative with satisfactory results, though surgery is indicated for nerve transection or lack of improvement after conservative treatment. (10.1302/2058-5241.1.000028)
  • [L5] Nontraumatic neuropathies of the upper limb are rare in children, and high-quality evidence regarding diagnostics and treatment remains limited. (10.1016/j.jhsa.2020.04.028)
  • [L4] Dynamic compressive neuropathies around the elbow are rare entities that present unique diagnostic challenges, often requiring dynamic nerve conduction studies for diagnosis. (10.1177/2325967118807131)
  • [L3] Ulnar and radial neuropathies were less common, with ulnar neuropathies more frequent in men and radial neuropathies being rare. (10.1177/1753193419886741)
  • [L4] The delayed neuropathy of the ulnar nerve appears to be associated with a complete recovery in children, as long as it is promptly treated. (10.1016/j.jse.2012.11.009)
  • [Case_report] Physicians treating peripheral nerve disorders in individuals from endemic regions should consider leprosy when confronted with a mass in or near the ulnar nerve associated with peripheral neuropathy. (10.2106/00004623-197961040-00028)
  • [L5] Ulnar nerve entrapment is the second most common nerve entrapment syndrome of the upper extremity, most commonly occurring in the cubital tunnel. (10.5435/00124635-200711000-00006)
  • [Case_report] The patient's symptoms including sensory dysfunction and weakness improved over the 1-year follow-up period. (10.5397/cise.2022.01102)
  • [L4] The Discovery Elbow System resulted in improved function, reduced pain, and high patient satisfaction. (10.1016/j.jse.2014.08.013)
  • [L3] A diagnosis of ulnar nerve compression merits a comprehensive workup by the treating surgeon and a high suspicion for concomitant median nerve compression. (10.1177/1558944718813669)
  • [L4] Cross-palm nerve grafting may be a useful adjunct to enhance sensory recovery in severe ulnar neuropathy. (10.1177/1558944718822851)
  • [L5] A comprehensive and individualized treatment plan is crucial for optimizing patient outcomes with painful neuromas. (10.5435/jaaos-d-24-00581)
  • [L5] This manuscript focuses on the historical aspects of treatments for compressive ulnar neuropathy, including in situ decompression, subcutaneous transposition, submuscular transposition, and endoscopic release, alongside current understanding of their efficacy. (10.1016/j.jhsa.2017.03.027)
  • [L5] Surgical decompression of the median nerve or the AIN in the forearm is rarely indicated; a prolonged nonsurgical approach is warranted in most cases. (10.5435/jaaos-d-16-00010)
  • [L5] The majority of compression neuropathies in cyclists resolve after appropriate rest and conservative treatment; however, should symptoms persist, nerve decompression may be indicated. (10.1016/j.hcl.2016.08.015)
  • [L4] Patients with combined nerve compressions follow similar trajectories in the postoperative period as those with isolated CuTS. (10.1177/15589447211028921)
  • [L5] The study provides laboratory support for early release of a nerve with evidence of constant static compression in a subacute setting but does not provide evidence in favor of early decompression of a physiologically altered nerve that has experienced slow chronic subclinical compression. (10.2106/jbjs.n.00213)
  • [L4] The diagnostic process to differentiate pronator syndrome from carpal tunnel syndrome remains a challenge due to overlapping symptoms and limited reliable information in the literature; this review provides a comprehensive clinical comparison to aid in establishing appropriate diagnosis and treatment. (10.3390/diagnostics12102433)
  • [L4] Carpal tunnel syndrome in the pediatric population is rare and may be a forerunner of systemic illness; diagnosis requires awareness, detailed physical examination, and electrodiagnostic studies. (10.2106/00004623-198769060-00021)
  • [L4] The authors conclude that neurolysis, if performed by a surgeon skilled in microsurgery, is a safe and effective procedure for severe carpal-tunnel syndrome. (10.2106/00004623-198567020-00011)
  • [L5] The review summarizes current knowledge, clinical assessment, and treatment of tardy ulnar nerve palsy, noting that treatment consists of ulnar nerve decompression with or without corrective osteotomy, with overall successful results usually achieved. (10.5435/jaaos-d-18-00138)
  • [L1] Recent literature supports the AAOS guideline but demonstrates a trend towards recommending early surgery for CTS cases with or without median nerve denervation. (10.2147/ijgm.s7682)
  • [L4] Nerve transfers are replacing other techniques as the gold standard for brachial plexus and other proximal peripheral nerve injuries, offering functional outcomes surpassing those obtained from traditional nerve repair or tendon transfers. (10.1016/j.injury.2020.04.015)
  • [L5] Pitching 100 balls induces a significant reduction in dynamic stabilizing ability against elbow valgus laxity. (10.1016/j.jse.2023.11.001)
  • [L5] Tearing of the UCL significantly increased elbow valgus laxity, which in turn elongated the ulnar nerve during simulated throwing motion. (10.1016/j.jse.2019.02.009)
  • [L4] All patients treated surgically had an excellent result regarding carpal-tunnel symptoms, whereas only three of the conservatively treated group showed improvement. (10.2106/00004623-196749060-00011)
  • [L5] Experts agree that intermittent paraesthesia should be primarily managed non-operatively with avoidance of flexion and ergonomic advice. (10.1177/17531934241238942)
  • [L2] Musculoskeletal ultrasound has emerged as a reasonable alternative to electrodiagnostic studies in the diagnostic work-up of carpal tunnel syndrome, cubital tunnel syndrome, and other peripheral nerve compression syndromes. (10.1016/j.jhsa.2024.11.009)
  • [L5] Nonsurgical management is appropriate for a distal compression lesion caused by repetitive activity, but surgical decompression is indicated if symptoms persist or worsen over 2 to 4 months. (10.5435/jaaos-22-11-699)
  • [L4] Once the diagnosis of thoracic-outlet syndrome has been made, the possibility of an additional distal compression neuropathy should be investigated. (10.2106/00004623-199072010-00014)
  • [L3] Increased elbow flexion in patients with CuTS influences the intraneural blood flow of the ulnar nerve. (10.1016/j.jhsa.2021.06.024)
  • [L4] Ulnar nerve gliding was most severe during passive wrist movement in elbow flexion and forearm supination. (10.5397/cise.2024.00934)
  • [L5] The study could not detect a definitive effect of elbow deformity on ulnar nerve strain or demonstrate the extent of acceptable clinical elbow deformity. (10.1186/s12891-022-05786-9)
  • [L5] Compression of the ulnar nerve proximal to Guyon's canal from a tortuous artery is rare, but when clinical signs suggest this possibility, nerve conduction studies and MRI are useful diagnostic investigations. (10.1177/17531934251329861)
  • [L3] Ulnar nerve instability does not appear to be associated with elbow symptoms in the general population. (10.1016/j.jseint.2021.05.005)
  • [L3] There was no significant difference in the motor nerve conduction velocity of the ulnar nerve across the elbow between different angles of flexion in patients with ulnar nerve entrapment or in healthy controls. (10.1177/1753193415582145)
  • [L5] A distally based tendon graft reconstruction of the annular ligament of the elbow using the tendon of the superficial head of the brachialis muscle would be feasible in most patients, based on this anatomic study. (10.1016/j.jhsa.2013.04.008)
  • [L4] The patient returned to his original vocation and was alive with continuous disease-free status at 3.5-year follow-up. (10.1155/2009/595391)
  • [L4] Although timely referral does not occur for most CSPNIs, a shorter time to presentation also led to improved sensory recovery. (10.1016/j.jhsa.2020.08.004)

See Also

References

[1] Compressive Ulnar Neuropathies at the Elbow: II. Treatment. Journal of the American Academy of Orthopaedic Surgeons. 1998. DOI: 10.5435/00124635-199809000-00004

[2] The incidence and decompression rates of median and ulnar neuropathies following shoulder surgery. JSES International. 2024. DOI: 10.1016/j.jseint.2024.05.011

[3] Median nerve entrapment neuropathy: a review on the pronator syndrome. JSES Reviews, Reports, and Techniques. 2025. DOI: 10.1016/j.xrrt.2024.10.001

[4] Management and Complications of Traumatic Peripheral Nerve Injuries. Hand Clinics. 2015. DOI: 10.1016/j.hcl.2015.01.007

[5] The surgical treatment of the carpal-tunnel syndrome correlated with preoperative nerve-conduction studies.. The Journal of Bone & Joint Surgery. 1979. DOI: 10.2106/00004623-197961010-00017

[6] Neuromuscular Mimics of Entrapment Neuropathies of Upper Extremities. HAND. 2020. DOI: 10.1177/1558944719898801

[7] Median Nerve Compression Secondary to a High Insertion of Pronator Teres. Shoulder & Elbow. 2010. DOI: 10.1111/j.1758-5740.2010.00051.x

[8] Radial nerve palsy. EFORT Open Reviews. 2016. DOI: 10.1302/2058-5241.1.000028

[9] Peripheral Nerve Compression Syndromes in Children. The Journal of Hand Surgery. 2020. DOI: 10.1016/j.jhsa.2020.04.028

[10] Etiology, Diagnosis, and Treatment of Dynamic Nerve Compression Syndromes of the Elbow Among High-Level Pitchers: A Review of 7 Cases. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967118807131

[11] Incidence and operations of median, ulnar and radial entrapment neuropathies in Finland: a nationwide register study. Journal of Hand Surgery (European Volume). 2019. DOI: 10.1177/1753193419886741

[12] A rare case of elbow dislocation associated with unrecognized fracture of medial epicondyle and delayed ulnar neuropathy in pediatric age. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2012.11.009

[13] Calcified abscess in the ulnar nerve in a patient with leprosy. A case report.. The Journal of Bone & Joint Surgery. 1979. DOI: 10.2106/00004623-197961040-00028

[14] Entrapment Neuropathy of the Ulnar Nerve. Journal of the American Academy of Orthopaedic Surgeons. 2007. DOI: 10.5435/00124635-200711000-00006

[15] Cubital tunnel syndrome associated with previous ganglion cyst excision in the elbow: a case report. Clinics in Shoulder and Elbow. 2024. DOI: 10.5397/cise.2022.01102

[17] Total elbow arthroplasty: a prospective clinical outcome study of Discovery Elbow System with a 4-year mean follow-up. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2014.08.013

[18] The Association Between Concomitant Ulnar Nerve Compression at the Elbow and Carpal Tunnel Syndrome. HAND. 2018. DOI: 10.1177/1558944718813669

[19] Cross-Palm Nerve Grafts to Enhance Sensory Recovery in Severe Ulnar Neuropathy. HAND. 2019. DOI: 10.1177/1558944718822851

[20] Current Concepts of the Management of Painful Traumatic Peripheral Nerve Neuromas. Journal of the American Academy of Orthopaedic Surgeons. 2024. DOI: 10.5435/jaaos-d-24-00581

[21] Compressive Neuropathy of the Ulnar Nerve: A Perspective on History and Current Controversies. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.03.027

[22] Ulnar Tunnel Syndrome, Radial Tunnel Syndrome, Anterior Interosseous Nerve Syndrome, and Pronator Syndrome. Journal of the American Academy of Orthopaedic Surgeons. 2017. DOI: 10.5435/jaaos-d-16-00010

[23] Ulnar Neuropathy in Cyclists. Hand Clinics. 2017. DOI: 10.1016/j.hcl.2016.08.015

[24] Peripheral Movidas: Cannibalizing Galicia. 2018.

[25] Evaluation of PROMIS Outcomes for Surgical Treatment of Cubital Tunnel Syndrome With and Without Carpal Tunnel Syndrome. HAND. 2021. DOI: 10.1177/15589447211028921

[26] Early Surgical Decompression: Too Early or Too Late?. Journal of Bone and Joint Surgery. 2014. DOI: 10.2106/jbjs.n.00213

[27] How to Differentiate Pronator Syndrome from Carpal Tunnel Syndrome: A Comprehensive Clinical Comparison. Diagnostics. 2022. DOI: 10.3390/diagnostics12102433

[28] Familial carpal-tunnel syndrome presenting in childhood. Report of two cases.. The Journal of Bone & Joint Surgery. 1987. DOI: 10.2106/00004623-198769060-00021

[30] Results of internal neurolysis of the median nerve for severe carpal-tunnel syndrome.. The Journal of Bone & Joint Surgery. 1985. DOI: 10.2106/00004623-198567020-00011

[31] Tardy Ulnar Nerve Palsy. Journal of the American Academy of Orthopaedic Surgeons. 2019. DOI: 10.5435/jaaos-d-18-00138

[32] Optimal management of carpal tunnel syndrome. International Journal of General Medicine. 2010. DOI: 10.2147/ijgm.s7682

[33] Nerve transfers in the upper extremity: A review. Injury. 2020. DOI: 10.1016/j.injury.2020.04.015

[34] Weakening and factors of medial elbow dynamic stabilizers against elbow valgus laxity after repetitive pitching in high school baseball players. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2023.11.001

[35] Ulnar collateral ligament insufficiency affects cubital tunnel syndrome during throwing motion: a cadaveric biomechanical study. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2019.02.009

[36] Carpal-Tunnel Syndrome Associated with Vasospasm. The Journal of Bone & Joint Surgery. 1967. DOI: 10.2106/00004623-196749060-00011

[37] Round table discussion: the management of idiopathic cubital tunnel syndrome. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934241238942

[38] The Use of Musculoskeletal Ultrasound for Diagnosis of Peripheral Nerve Compression Syndromes. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.11.009

[40] Ulnar Nerve Entrapment at the Wrist. Journal of the American Academy of Orthopaedic Surgeons. 2014. DOI: 10.5435/jaaos-22-11-699

[42] Double-crush nerve compression in thoracic-outlet syndrome.. The Journal of Bone & Joint Surgery. 1990. DOI: 10.2106/00004623-199072010-00014

[43] Dynamic Evaluation of Intraneural Microvascularity of the Ulnar Nerve Using Contrast-Enhanced Ultrasonography in Patients With Cubital Tunnel Syndrome. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2021.06.024

[44] Biomechanical analysis of ulnar nerve gliding and elongation: implications for nonsurgical ulnar nerve release in cubital tunnel syndrome. Clinics in Shoulder and Elbow. 2025. DOI: 10.5397/cise.2024.00934

[45] A cadaveric study of ulnar nerve strain at the elbow associated with cubitus valgus/varus deformity. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05786-9

[49] Compressive ulnar neuropathy owing to a tortuous ulnar artery proximal to Guyon’s canal. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251329861

[51] The ultrasonographic assessment of the morphologic changes in the ulnar nerve at the cubital tunnel in Japanese volunteers: relationship between dynamic ulnar nerve instability and clinical symptoms. JSES International. 2021. DOI: 10.1016/j.jseint.2021.05.005

[54] Does flexing the arm really affect ulnar motor conduction velocity across the elbow?. Journal of Hand Surgery (European Volume). 2015. DOI: 10.1177/1753193415582145

[56] Annular Ligament Reconstruction Using the Distal Tendon of the Superficial Head of the Brachialis Muscle: An Anatomical Feasibility Study. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.04.008

[57] Epithelioid Sarcoma of the Forearm Arising from Perineural Sheath of Median Nerve Mimicking Carpal Tunnel Syndrome. Sarcoma. 2009. DOI: 10.1155/2009/595391

[59] Combat-Sustained Peripheral Nerve Injuries in the United States Military. The Journal of Hand Surgery. 2021. DOI: 10.1016/j.jhsa.2020.08.004

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