Cubital Tunnel Syndrome with First Dorsal Interosseous Weakness and Decreased Ulnar Nerve Conduction Velocity
Clinical Scenario
This protocol addresses patients with cubital tunnel syndrome who present with first dorsal interosseous muscle weakness or intrinsic hand muscle atrophy, alongside decreased ulnar nerve conduction velocity across the elbow confirmed on electrodiagnostic studies.
Key Findings in This Presentation
- First dorsal interosseous muscle weakness or intrinsic hand muscle atrophy on examination
- Decreased 2-point discrimination and reduced grip or apposition pinch strength
- Decreased ulnar nerve conduction velocity across the elbow on electrodiagnostic (EDX) testing — a moderate electrodiagnostic finding
Treatment Approach
Management in this setting involves a surgical revision procedure targeting the ulnar nerve at the elbow. The approach focuses on repositioning the nerve to address the underlying compression.
Full procedure details, sequencing, and decision criteria are in the complete protocol →
References
DOI: 10.1016/j.jhsg.2022.07.008
Moderate findings of EDX include decreased conduction velocity.
Decreased 2-point discrimination, weakness on strength testing (grip and apposition pinch).
The most common revision surgery is submuscular transposition of the ulnar nerve (75%).
In the revision setting, we recommend anterior submuscular transposition.
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