Ulnar neuropathy at the elbow (UNE) is commonly encountered in clinical practice. It results from either static or dynamic compression of the ulnar nerve. While the retroepicondylar groove and its surrounding structures are quite superficial, the use of ultrasound (US) imaging is associated with the following advantages: (1) an excellent spatial resolution allows a detailed morphological assessment of the ulnar nerve and adjacent structures, (2) dynamic imaging represents the gold standard for assessing the ulnar nerve stability in the retroepicondylar groove during flexion/extension, and (3) US guidance bears the capability of increasing the accuracy and safety of injections. This review aims to illustrate the ulnar nerve's detailed anatomy at the elbow using cadaveric images to understand better both static and dynamic imaging of the ulnar nerve around the elbow. Pathologies covering ulnar nerve instability, idiopathic cubital tunnel syndrome, space-occupying lesions (e.g., ganglion, heterotopic ossification, aberrant veins, and anconeus epitrochlearis muscle) are presented. Additionally, the authors also exemplify the scientific evidence from the literature supporting the proposition that US guidance is beneficial in injection therapy of UNE. The non-surgical management description covers activity modifications, splinting, neuromobilization/gliding exercise, and physical agents. In the operative treatment description, an emphasis is put on two commonly used approaches-in situ decompression and anterior transpositions.

Department of Neurosurgery and Neurooncology 1st Faculty of Medicine Charles University and Military University Hospital Prague Prague Czechia

Department of Radiology 1st Faculty of Medicine Charles University and General University Hospital Prague Czechia

Department of Rehabilitation and Sports Medicine 2nd Faculty of Medicine Charles University and University Hospital Motol Prague Czechia

Department of Rehabilitation Medicine 1st Faculty of Medicine Charles University and General University Hospital Prague Czechia

Institute of Anatomy 1st Faculty of Medicine Charles University Prague Czechia

Zobrazit více v PubMed

Staples JR, Calfee R. Cubital tunnel syndrome: current concepts. J Am Acad Orthop Surg. (2017) 25:e215–e24. 10.5435/JAAOS-D-15-00261 PubMed DOI

Wu C-H, Chang K-V, Özçakar L, Hsiao M-Y, Hung C-Y, Shyu S-G, Wang T-G, et al. Sonographic tracking of the upper limb peripheral nerves: a pictorial essay and video demonstration. Am J Phys Med Rehabil. (2015) 94:740–7. 10.1097/PHM.0000000000000344 PubMed DOI

Kara M, Gürçay E, Ekiz T, Sekizkardeş M, Yorulmaz E, Ata AM, et al. EURO-MUSCULUS/USPRM global report on musculoskeletal ultrasound publications. Am J Phys Med Rehabil. (2020) 99:847–52. 10.1097/PHM.0000000000001390 PubMed DOI

Ricci V, Özçakar L. Ultrasonographic examination: the “X-Factor” in physiatry. Am J Phys Med Rehabil. (2020) 99:e131–e2. 10.1097/PHM.0000000000001372 PubMed DOI

Mezian K, Steyeorova P, Vacek J, Navratil L. Introduction to neuromuscular ultrasound. Cesk Slov Neurol N. (2016) 79:656–61. 10.14735/amcsnn2016656 DOI

Contreras MG, Warner MA, Charboneau WJ, Cahill DR. Anatomy of the ulnar nerve at the elbow: potential relationship of acute ulnar neuropathy to gender differences. Clin Anat. (1998) 11:372–8. 10.1002/(SICI)1098-2353(1998)11:6<372::AID-CA2>3.0.CO;2-R PubMed DOI

Standring S. Gray's Anatomy. The Anatomical Basis of Clinical Practice. 41st ed. Edinburgh: Churchill Livingstone/Elsevier; (2015).

Mizia E, Zarzecki MP, Pekala JR, Baginski A, Kaythampillai LN, Golebiowska M, et al. An anatomical investigation of rare upper limb neuropathies due to the Struthers' ligament or arcade: a meta-analysis. Folia Morphol. (2020). 10.5603/FM.a2020.0050. [Epub ahead of print]. PubMed DOI

Tubbs RS, Deep A, Shoja MM, Mortazavi MM, Loukas M, Cohen-Gadol AA. The arcade of struthers: an anatomical study with potential neurosurgical significance. Surg Neurol Int. (2011) 2:184. 10.4103/2152-7806.91139 PubMed DOI PMC

Spinner M, Kaplan EB. The relationship of the ulnar nerve to the medial intermuscular septum in the arm and its clinical significance. Hand. (1976) 8:239–42. 10.1016/0072-968X(76)90008-5 PubMed DOI

Michelin P, Leleup G, Ould-Slimane M, Merlet MC, Dubourg B, Duparc F. Ultrasound biomechanical anatomy of the soft structures in relation to the ulnar nerve in the cubital tunnel of the elbow. Surg Radiol Anat. (2017) 39:1215–21. 10.1007/s00276-017-1879-y PubMed DOI

O'Driscoll SW, Horii E, Carmichael SW, Morrey BF. The cubital tunnel and ulnar neuropathy. J Bone Joint Surg Br. (1991) 73:613–7. 10.1302/0301-620X.73B4.2071645 PubMed DOI

Jacobson JA, Fessell DP, Lobo LDG, Yang LJ-S. Entrapment neuropathies I: upper limb (carpal tunnel excluded). Semin Musculoskelet Radiol. (2010) 14:473–86. 10.1055/s-0030-1268068 PubMed DOI

Mahan MA, Gasco J, Mokhtee DB, Brown JM. Anatomical considerations of fascial release in ulnar nerve transposition: a concept revisited. J Neurosurg. (2015) 123:1216–22. 10.3171/2014.10.JNS141379 PubMed DOI

Won H-S, Liu H-F, Kim J-H, Kwak D-S, Chung I-H, Kim I-B. Intermuscular aponeuroses between the flexor muscles of the forearm and their relationships with the ulnar nerve. Surg Radiol Anat. (2016) 38:1183–9. 10.1007/s00276-016-1695-9 PubMed DOI

An TW, Evanoff BA, Boyer MI, Osei DA. The prevalence of cubital tunnel syndrome: a cross-sectional study in a U.S. Metropolitan Cohort. J Bone Joint Surg Am. (2017) 99:408–16. 10.2106/JBJS.15.01162 PubMed DOI PMC

Frost P, Johnsen B, Fuglsang-Frederiksen A, Svendsen SW. Lifestyle risk factors for ulnar neuropathy and ulnar neuropathy-like symptoms. Muscle Nerve. (2013) 48:507–15. 10.1002/mus.23820 PubMed DOI

Uzunkulaoglu A, Ikbali Afsar S, Karataş M. Association between gender, body mass index, and ulnar nerve entrapment at the elbow: a retrospective study. J Clin Neurophysiol. (2016) 33:545–8. 10.1097/WNP.0000000000000288 PubMed DOI

Jačisko J, Sobotová K, Mezian K. The utility of ultrasound examination in cubital tunnel syndrome caused by heterotopic ossification. Med Ultrason. (2020) 22:117–8. 10.11152/mu-2419 PubMed DOI

Ashworth NL, Huang C, Chan KM. Laterality and risk factors for ulnar neuropathy at the elbow. Muscle Nerve. (2020) 61:101–4. 10.1002/mus.26737 PubMed DOI

Dawson DM. Entrapment neuropathies of the upper extremities. N Engl J Med. (1993) 329:2013–8. 10.1056/NEJM199312303292707 PubMed DOI

Van Den Berg PJ, Pompe SM, Beekman R, Visser LH. Sonographic incidence of ulnar nerve (sub)luxation and its associated clinical and electrodiagnostic characteristics. Muscle Nerve. (2013) 47:849–55. 10.1002/mus.23715 PubMed DOI

Omejec G, Podnar S. Does ulnar nerve dislocation at the elbow cause neuropathy? Muscle Nerve. (2016) 53:255–9. 10.1002/mus.24786 PubMed DOI

Ochi K, Horiuchi Y, Tanabe A, Waseda M, Kaneko Y, Koyanagi T. Shoulder internal rotation elbow flexion test for diagnosing cubital tunnel syndrome. J Shoulder Elbow Surg. (2012) 21:777–81. 10.1016/j.jse.2011.10.015 PubMed DOI

Patel P, Norbury JW, Fang X. Sonographic measurements of the ulnar nerve at the elbow with different degrees of elbow flexion. PM R. (2014) 6:395–9. 10.1016/j.pmrj.2013.12.011 PubMed DOI

Rosenberg ZS, Beltran J, Cheung Y, Broker M. MR imaging of the elbow: normal variant and potential diagnostic pitfalls of the trochlear groove and cubital tunnel. AJR Am J Roentgenol. (1995) 164:415–8. 10.2214/ajr.164.2.7839980 PubMed DOI

Cornelson SM, Sclocco R, Kettner NW. Ulnar nerve instability in the cubital tunnel of asymptomatic volunteers. J Ultrasound. (2019) 22:337–44. 10.1007/s40477-019-00370-9 PubMed DOI PMC

Bordes SJ, Jenkins S, Bang K, Turgut M, Iwanaga J, Loukas M, et al. Ulnar nerve subluxation and dislocation: a review of the literature. Neurosurg Rev. (2020) 44:793–8. 10.1007/s10143-020-01286-3 PubMed DOI

Leis AA, Smith BE, Kosiorek HE, Omejec G, Podnar S. Complete dislocation of the ulnar nerve at the elbow: a protective effect against neuropathy? Muscle Nerve. (2017) 56:242–6. 10.1002/mus.25483 PubMed DOI

Mackinnon SE. Pathophysiology of nerve compression. Hand Clin. (2002) 18:231–41. 10.1016/S0749-0712(01)00012-9 PubMed DOI

Omejec G, Podnar S. Precise localization of ulnar neuropathy at the elbow. Clin Neurophysiol. (2015) 126:2390–6. 10.1016/j.clinph.2015.01.023 PubMed DOI

Bäumer T, Grimm A, Schelle T. [Diagnostic nerve ultrasonography]. Radiologe. (2017) 57:157–65. 10.1007/s00117-017-0218-y PubMed DOI

Wilson TJ, Tubbs RS, Yang LJS. The anconeus epitrochlearis muscle may protect against the development of cubital tunnel syndrome: a preliminary study. J Neurosurg. (2016) 125:1533–8. 10.3171/2015.10.JNS151668 PubMed DOI

Said J, Abboudi J, Gallant G, Jones C, Kirkpatrick W, Liss F, et al. Prospective evaluation of sleep improvement after cubital tunnel decompression surgery. J Shoulder Elbow Surg. (2019) 28:e144–e9. 10.1016/j.jse.2018.11.046 PubMed DOI

Hrehová L, Mezian K. Non-pharmacologic treatment of insomnia in primary care settings. Int J Clin Pract. (2021). 10.1111/ijcp.14084. [Epub ahead of print]. PubMed DOI

Hsu P-C, Chang K-V, Mezian K, Nanka O, Wu W-T, Yang Y-C, et al. Sonographic pearls for imaging the brachial plexus and its pathologies. Diagnostics. (2020) 10:324. 10.3390/diagnostics10050324 PubMed DOI PMC

McGOWAN AJ. The results of transposition of the ulnar nerve for traumatic ulnar neuritis. J Bone Joint Surg Br. (1950) 32-B:293–301. 10.1302/0301-620X.32B3.293 PubMed DOI

Ehler E, Nakladalova M, Urban P, Mazanec R, Fenclova Z, Matulova H, et al. Neurophysiological diagnosis of the ulnar nerve damage at the elbow. Cesk Slov Neurol N. (2012) 75:320–5.

AAEM . Practice parameter for electrodiagnostic studies in ulnar neuropathy at the elbow: summary statement. Muscle Nerve. (1999) 22:408–11. 10.1002/(SICI)1097-4598(199903)22:3<408::AID-MUS16>3.0.CO;2-7 PubMed DOI

Dimberg EL. Electrodiagnostic evaluation of ulnar neuropathy and other upper extremity mononeuropathies. Neurol Clin. (2012) 30:479–503. 10.1016/j.ncl.2011.12.003 PubMed DOI

Omejec G, Podnar S. Normative values for short-segment nerve conduction studies and ultrasonography of the ulnar nerve at the elbow. Muscle Nerve. (2015) 51:370–7. 10.1002/mus.24328 PubMed DOI

Martin SP, Schauer KT, Czyrny JJ, Ablove RH. Electrophysiological findings in common median-ulnar nerve interconnections and their clinical implications. J Hand Surg Am. (2019) 44:884–94. 10.1016/j.jhsa.2019.04.010 PubMed DOI

Ehler E, Ridzon P. Ulnar nerve. Cesk Slov Neurol N. (2017) 80:130–40. 10.14735/amcsnn2017130 DOI

Lee K-S, Oh C-S, Chung I-H, Sunwoo I-N. An anatomic study of the Martin-Gruber anastomosis: electrodiagnostic implications. Muscle Nerve. (2005) 31:95–7. 10.1002/mus.20141 PubMed DOI

Gans P, Van Alfen N. Nerve ultrasound showing Martin-Gruber anastomosis. Muscle Nerve. (2017) 56:E46–E7. 10.1002/mus.25746 PubMed DOI

Mezian K, Machač S, Zavareh A, Majerníková L, Vacek J, Navrátil L, et al. Positioning techniques to improve the ultrasound evaluation of the elbow. Ultrasound Q. (2019) 35:136–41. 10.1097/RUQ.0000000000000377 PubMed DOI

Özçakar L, Muynck MD. Musculoskeletal Ultrasound in Physical Rehabilitation Medicine. Italy: Edi Ermes; (2014).

Martinoli C, Bianchi S, Zamorani MP, Zunzunegui JL, Derchi LE. Ultrasound of the elbow. Eur J Ultrasound. (2001) 14:21–7. 10.1016/S0929-8266(01)00142-2 PubMed DOI

Cheng Y, Xu X, Chen W, Wang Y. Doppler sonography for ulnar neuropathy at the elbow. Muscle Nerve. (2016) 54:258–63. 10.1002/mus.25022 PubMed DOI

Chang K-V, Wu W-T, Han D-S, Özçakar L. Ulnar nerve cross-sectional area for the diagnosis of cubital tunnel syndrome: a meta-analysis of ultrasonographic measurements. Arch Phys Med Rehabil. (2018) 99:743–57. 10.1016/j.apmr.2017.08.467 PubMed DOI

Volpe A, Rossato G, Bottanelli M, Marchetta A, Caramaschi P, Bambara LM, et al. Ultrasound evaluation of ulnar neuropathy at the elbow: correlation with electrophysiological studies. Rheumatology. (2009) 48:1098–101. 10.1093/rheumatology/kep167 PubMed DOI

Chen I-J, Chang K-V, Wu W-T, Özçakar L. Ultrasound parameters other than the direct measurement of ulnar nerve size for diagnosing cubital tunnel syndrome: a systemic review and meta-analysis. Arch Phys Med Rehabil. (2019) 100:1114–30. 10.1016/j.apmr.2018.06.021 PubMed DOI

Grimm A, Rattay TW, Winter N, Axer H. Peripheral nerve ultrasound scoring systems: benchmarking and comparative analysis. J Neurol. (2017) 264:243–53. 10.1007/s00415-016-8305-y PubMed DOI

Qi HT, Wang XM, Li SY, Wang GB, Wang DH, Wang ZT, et al. The role of ultrasonography and MRI in patients with non-traumatic nerve fascicle torsion of the upper extremity. Clin Radiol. (2013) 68:e479–83. 10.1016/j.crad.2013.03.021 PubMed DOI

Childress HM. Recurrent ulnar-nerve dislocation at the elbow. Clin Orthop Relat Res. (1975) 108:168–73. 10.1097/00003086-197505000-00027 PubMed DOI

Calfee RP, Manske PR, Gelberman RH, Van Steyn MO, Steffen J, Goldfarb CA. Clinical assessment of the ulnar nerve at the elbow: reliability of instability testing and the association of hypermobility with clinical symptoms. J Bone Joint Surg Am. (2010) 92:2801–8. 10.2106/JBJS.J.00097 PubMed DOI PMC

Kiliç E, Ozçakar L. Ulnar nerve compression possibly due to aberrant veins: sonography is elucidatory for idiopathic cubital tunnel syndrome. Rheumatol Int. (2011) 31:139–40. 10.1007/s00296-009-1352-2 PubMed DOI

Chuang H-J, Hsiao M-Y, Wu C-H, Özçakar L. Dynamic ultrasound imaging for ulnar nerve subluxation and snapping triceps syndrome. Am J Phys Med Rehabil. (2016) 95:e113–4. 10.1097/PHM.0000000000000466 PubMed DOI

Shin R, Ring D. The ulnar nerve in elbow trauma. J Bone Joint Surg Am. (2007) 89:1108–16. 10.2106/JBJS.F.00594 PubMed DOI

Omejec G, Podnar S. Long-term outcomes in patients with ulnar neuropathy at the elbow treated according to the presumed aetiology. Clin Neurophysiol. (2018) 129:1763–9. 10.1016/j.clinph.2018.04.753 PubMed DOI

Kooner S, Cinats D, Kwong C, Matthewson G, Dhaliwal G. Conservative treatment of cubital tunnel syndrome: a systematic review. Orthop Rev. (2019) 11:7955. 10.4081/or.2019.7955 PubMed DOI PMC

Caliandro P, La Torre G, Padua R, Giannini F, Padua L. Treatment for ulnar neuropathy at the elbow. Cochrane Database Syst Rev. (2016) 11:CD006839. 10.1002/14651858.CD006839.pub4 PubMed DOI PMC

Svernlöv B, Larsson M, Rehn K, Adolfsson L. Conservative treatment of the cubital tunnel syndrome. J Hand Surg. (2009) 34:201–7. 10.1177/1753193408098480 PubMed DOI

Vinitpairot C, Jianmongkol S, Thammaroj T, Wattanakamolchai S. Ulnar nerve strain in functional elbow and shoulder motions. J Hand Surg. (2019) 24:323–8. 10.1142/S2424835519500413 PubMed DOI

Gelberman RH, Yamaguchi K, Hollstien SB, Winn SS, Heidenreich FP, Bindra RR, et al. Changes in interstitial pressure and cross-sectional area of the cubital tunnel and of the ulnar nerve with flexion of the elbow. An experimental study in human cadavera. J Bone Joint Surg Am. (1998) 80:492–501. 10.2106/00004623-199804000-00005 PubMed DOI

Hong CZ, Long HA, Kanakamedala RV, Chang YM, Yates L. Splinting and local steroid injection for the treatment of ulnar neuropathy at the elbow: clinical and electrophysiological evaluation. Arch Phys Med Rehabil. (1996) 77:573–7. 10.1016/S0003-9993(96)90297-X PubMed DOI

Assmus H, Antoniadis G, Bischoff C, Hoffmann R, Martini A-K, Preissler P, et al. Cubital tunnel syndrome - a review and management guidelines. Cent Eur Neurosurg. (2011) 72:90–8. 10.1055/s-0031-1271800 PubMed DOI

Butler D. The Sensitive Nervous System. Adelaide, SA: Noigroup Publications; (2000). 10.1016/B978-012529650-2/50026-3 DOI

Myers RR, Murakami H, Powell HC. Reduced nerve blood flow in edematous neuropathies: a biomechanical mechanism. Microvasc Res. (1986) 32:145–51. 10.1016/0026-2862(86)90050-6 PubMed DOI

Rozmaryn LM, Dovelle S, Rothman ER, Gorman K, Olvey KM, Bartko JJ. Nerve and tendon gliding exercises and the conservative management of carpal tunnel syndrome. J Hand Ther. (1998) 11:171–9. 10.1016/S0894-1130(98)80035-5 PubMed DOI

Burke FD, Ellis J, McKenna H, Bradley MJ. Primary care management of carpal tunnel syndrome. Postgrad Med J. (2003) 79:433–7. 10.1136/pmj.79.934.433 PubMed DOI PMC

Millesi H, Zöch G, Reihsner R. Mechanical properties of peripheral nerves. Clin Orthop Relat Res. (1995) 314:76–83. 10.1097/00003086-199505000-00011 PubMed DOI

Coppieters MW, Butler DS. Do “sliders” slide and “tensioners” tension? An analysis of neurodynamic techniques and considerations regarding their application. Man Ther. (2008) 13:213–21. 10.1016/j.math.2006.12.008 PubMed DOI

Basso JC, Suzuki WA. The effects of acute exercise on mood, cognition, neurophysiology, and neurochemical pathways: a review. Brain Plast. (2017) 2:127–52. 10.3233/BPL-160040 PubMed DOI PMC

Bilgin Badur N, Unlu Ozkan F, Aktas I. Efficacy of shortwave diathermy in ulnar nerve entrapment at the elbow: a double-blind randomized controlled clinical trial. Clin Rehabil. (2020) 34:1048–55. 10.1177/0269215520930062 PubMed DOI

Mense S, Hoheisel U. Shock wave treatment improves nerve regeneration in the rat. Muscle Nerve. (2013) 47:702–10. 10.1002/mus.23631 PubMed DOI

Hausner T, Pajer K, Halat G, Hopf R, Schmidhammer R, Redl H, et al. Improved rate of peripheral nerve regeneration induced by extracorporeal shock wave treatment in the rat. Exp Neurol. (2012) 236:363–70. 10.1016/j.expneurol.2012.04.019 PubMed DOI

Paoloni M, Tavernese E, Cacchio A, D'orazi V, Ioppolo F, Fini M, et al. Extracorporeal shock wave therapy and ultrasound therapy improve pain and function in patients with carpal tunnel syndrome. A randomized controlled trial. Eur J Phys Rehabil Med. (2015) 51:521–8. PubMed

Raissi GR, Ghazaei F, Forogh B, Madani SP, Daghaghzadeh A, Ahadi T. The effectiveness of radial extracorporeal shock waves for treatment of carpal tunnel syndrome: a randomized clinical trial. Ultrasound Med Biol. (2017) 43:453–60. 10.1016/j.ultrasmedbio.2016.08.022 PubMed DOI

Gesslbauer C, Mickel M, Schuhfried O, Huber D, Keilani M, Crevenna R. Effectiveness of focused extracorporeal shock wave therapy in the treatment of carpal tunnel syndrome : a randomized, placebo-controlled pilot study. Wien Klin Wochenschr. (2020). 10.1007/s00508-020-01785-9. [Epub ahead of print]. PubMed DOI PMC

Shen Y-P, Wu Y-Y, Chu H-Y, Li T-Y, Chen L-C, Yung-Tsan W. Extracorporeal shock wave therapy in cubital tunnel syndrome: a pilot study. Neurol Asia. (2018) 23:233–8.

Ozkan FU, Saygi EK, Senol S, Kapci S, Aydeniz B, Aktaş I, et al. New treatment alternatives in the ulnar neuropathy at the elbow: ultrasound and low-level laser therapy. Acta Neurol Belg. (2015) 115:355–60. 10.1007/s13760-014-0377-9 PubMed DOI

Anandkumar S, Manivasagam M. Effect of dry needling on cubital tunnel syndrome: three case reports. Physiother Theory Pract. (2019) 35:363–72. 10.1080/09593985.2018.1449275 PubMed DOI

Özçakar L, Kara M, Onat SS, Gürçay E. Don't touch my bone and don't run into my nerve. Am J Phys Med Rehabil. (2016) 95:e125–6. 10.1097/PHM.0000000000000493 PubMed DOI

Nwawka OK, Miller TT. Ultrasound-guided peripheral nerve injection techniques. AJR Am J Roentgenol. (2016) 207:507–16. 10.2214/AJR.16.16378 PubMed DOI

Ruiz A, Sala-Blanch X, Martinez-Ocón J, Carretero MJ, Sánchez-Etayo G, Hadzic A. Incidence of intraneural needle insertion in ultrasound-guided femoral nerve block: a comparison between the out-of-plane versus the in-plane approaches. Rev Esp Anestesiol Reanim. (2014) 61:73–7. 10.1016/j.redar.2013.09.023 PubMed DOI

Kim JM, Oh H-M, Kim M-W. Real-time visualization of ultrasonography guided cubital tunnel injection: a cadaveric study. Ann Rehabil Med. (2012) 36:496–500. 10.5535/arm.2012.36.4.496 PubMed DOI PMC

Choi CK, Lee HS, Kwon JY, Lee W-J. Clinical implications of real-time visualized ultrasound-guided injection for the treatment of ulnar neuropathy at the elbow: a pilot study. Ann Rehabil Med. (2015) 39:176–82. 10.5535/arm.2015.39.2.176 PubMed DOI PMC

Chen L-C, Ho T-Y, Shen Y-P, Su Y-C, Li T-Y, Tsai C-K, et al. Perineural dextrose and corticosteroid injections for ulnar neuropathy at the elbow: a randomized double-blind trial. Arch Phys Med Rehabil. (2020) 101:1296–303. 10.1016/j.apmr.2020.03.016 PubMed DOI

vanVeen KEB, Alblas KCL, Alons IME, Kerklaan JP, Siegersma MC, Wesstein M, et al. Corticosteroid injection in patients with ulnar neuropathy at the elbow: a randomized, double-blind, placebo-controlled trial. Muscle Nerve. (2015) 52:380–5. 10.1002/mus.24551 PubMed DOI

Kim JM. Comment on corticosteroid injection in patients with ulnar neuropathy at the elbow: a randomized, double-blind, placebo-controlled trial. Muscle Nerve. (2016) 53:494–5. 10.1002/mus.24938 PubMed DOI

Stoddard JM, Taylor CR, O'Connor FG. Ulnar nerve entrapment at the cubital tunnel successfully treated with ultrasound-guided peripheral nerve hydrodissection: a case report and further evidence for a developing treatment option. Curr Sports Med Rep. (2019) 18:382–6. 10.1249/JSR.0000000000000649 PubMed DOI

Rampen AJJ, Wirtz PW, Tavy DLJ. Ultrasound-guided steroid injection to treat mild ulnar neuropathy at the elbow. Muscle Nerve. (2011) 44:128–30. 10.1002/mus.22091 PubMed DOI

Alblas CL, van Kasteel V, Jellema K. Injection with corticosteroids (ultrasound guided) in patients with an ulnar neuropathy at the elbow, feasibility study. Eur J Neurol. (2012) 19:1582–4. 10.1111/j.1468-1331.2012.03676.x PubMed DOI

Osborne G. The surgical treatment of tardy ulnar neuritis. J Bone Joint Surg. (1957) 39B:782.

Adkinson JM, Zhong L, Aliu O, Chung KC. Surgical treatment of cubital tunnel syndrome: trends and the influence of patient and surgeon characteristics. J Hand Surg Am. (2015) 40:1824–31. 10.1016/j.jhsa.2015.05.009 PubMed DOI PMC

Kholinne E, Alsharidah MM, Almutair O, Aljasser S, Alhothali W, Kwak J-M, et al. Revision surgery for refractory cubital tunnel syndrome: a systematic review. Orthop Traumatol Surg Res. (2019) 105:867–76. 10.1016/j.otsr.2019.03.020 PubMed DOI

Wade RG, Griffiths TT, Flather R, Burr NE, Teo M, Bourke G. Safety and outcomes of different surgical techniques for cubital tunnel decompression: a systematic review and network meta-analysis. JAMA Netw Open. (2020) 3:e2024352. 10.1001/jamanetworkopen.2020.24352 PubMed DOI PMC

Krejčí T, Večera Z, Krejčí O, Šalounová D, Houdek M, Lipina R. Comparing endoscopic and open decompression of the ulnar nerve in cubital tunnel syndrome: a prospective randomized study. Acta Neurochir. (2018) 160:2011–17. 10.1007/s00701-018-3647-0 PubMed DOI

Kim KW, Lee HJ, Rhee SH, Baek GH. Minimal epicondylectomy improves neurologic deficits in moderate to severe cubital tunnel syndrome. Clin Orthop Relat Res. (2012) 470:1405–13. 10.1007/s11999-012-2263-1 PubMed DOI PMC

Liu C-H, Chen C-X, Xu J, Wang H-L, Ke X-B, Zhuang Z-Y, et al. Anterior subcutaneous versus submuscular transposition of the ulnar nerve for cubital tunnel syndrome: a systematic review and meta-analysis. PLoS ONE. (2015) 10:e0130843. 10.1371/journal.pone.0130843 PubMed DOI PMC

Chen H, Ou S, Liu G, Fei J, Zhao G, Wu L, et al. Clinical efficacy of simple decompression versus anterior transposition of the ulnar nerve for the treatment of cubital tunnel syndrome: a meta-analysis. Clin Neurol Neurosurg. (2014) 126:150–5. 10.1016/j.clineuro.2014.08.005 PubMed DOI

Said J, Van Nest D, Foltz C, Ilyas AM. Ulnar nerve PubMed DOI PMC

Vogel RB, Nossaman BC, Rayan GM. Revision anterior submuscular transposition of the ulnar nerve for failed subcutaneous transposition. Br J Plast Surg. (2004) 57:311–6. 10.1016/j.bjps.2004.02.027 PubMed DOI

Ruettermann M. Challenging the dogma: anterior transposition of the ulnar nerve is indicated in recurrent cubital tunnel syndrome. J Hand Surg. (2021) 46:45–9. 10.1177/1753193420970022 PubMed DOI

Byvaltsev VA, Stepanov IA, Kerimbayev TT. A systematic review and meta-analysis comparing open versus endoscopic PubMed DOI

Schmidt S, Kleist Welch-Guerra W, Matthes M, Baldauf J, Schminke U, Schroeder HWS. Endoscopic vs open decompression of the ulnar nerve in cubital tunnel syndrome: a prospective randomized double-blind study. Neurosurgery. (2015) 77:960–70; discussion 970–1. 10.1227/NEU.0000000000000981 PubMed DOI

Aldekhayel S, Govshievich A, Lee J, Tahiri Y, Luc M. Endoscopic versus open cubital tunnel release: a systematic review and meta-analysis. Hand. (2016) 11:36–44. 10.1177/1558944715616097 PubMed DOI PMC

Buchanan PJ, Chieng LO, Hubbard ZS, Law TY, Chim H. Endoscopic versus open PubMed DOI