Management of ulnar nerve entrapment at the elbow

Ulnar nerve entrapment at the elbow is the second most common upper extremity nerve entrapment. The choice of treatment is based on the presumed cause of compression, after obtaining a history and physical examination and ancillary tests. Treatment is conservative for mild cases and those related to repetitive stress disorder and surgical for patients who fail to respond to conservative management. Surgical decompression requires attention to various anatomical points of nerve compression. Of the five surgical operations for ulnar nerve compression at the elbow, the simplest is an in situ decompression. A medial epicondylectomy is especially useful when there is an anatomical deformity. The ulnar nerve can be transposed to the antecubital fossa using one of three techniques. Adherence to basic surgical technique has resulted in a satisfactory outcome in up to 95% of patients regardless of the procedure chosen. Incomplete decompression or creation of a new site of compression, neuroma formation, and subluxation can result in surgical failure.