Ulnar neuropathies

Historical note and nomenclature
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By Aparajitha K Verma MD and Mazen M Dimachkie MD

Ulnar neuropathy is also known as or subsumes Guyon canal neuropathy and Ulnar neuropathy at the wrist. -ed

Surgery to achieve ulnar nerve decompression at the elbow has been performed for nearly 2 centuries. Several methods have been developed, some of which have been abandoned. Historical insight improves understanding of current techniques and provides the basis for the development of new methods. A systematic chronological overview of the surgical treatment of ulnar nerve compression at the elbow is presented in one article, with special attention to people who described a treatment method for the first time (Bartels 2001).

Weir Mitchell, in an overlooked contribution, mentions a case of ulnar neuropathy at the elbow developing 29 years after an injury in his 1872 book entitled, Injuries to Nerves and Their Consequences (Sunderland 1978). In 1878, Panas described the operative treatment of an ulnar neuropathy at the elbow that developed 12 years after an elbow fracture (Panas 1878). Broca and Mouchet applied the term "tardy" to this syndrome in 1899. The appellation "tardy ulnar palsy" eventually came to be applied to almost any ulnar neuropathy at the elbow, assumed that previous trauma had been forgotten. Physicians even began to use that line of reasoning to apply to median neuropathies, and the term "tardy median palsy" was used to refer to progressive thenar atrophy until 1947, when Lord Brain described the entity of carpal tunnel syndrome (Brain et al 1947). In 1922, Buzzard and Sargent reported a case of ulnar neuropathy at the elbow where "the nerve passed beneath a dense fibrous archway which constricted it." This is clearly a description of entrapment by the humeroulnar aponeurotic arcade (the bridging aponeurosis that connects the 2 heads of origin of the flexor carpi ulnaris) at what later came to be known as the "cubital tunnel" (Buzzard 1922). In 1957, Osborne rediscovered the humeroulnar aponeurotic arcade, also known as “Osborne band,” as a compression site (Osborne 1957). In 1958, Feindel and Stratford affirmed Osborne's observations and coined the term "cubital tunnel syndrome" to refer to entrapment by the humeroulnar aponeurotic arcade (Feindel and Stratford 1958).

In 1861, Guyon described the anatomical details of the ulnar nerve at the wrist and pointed out the potential for entrapment (Mackinnon and Dellon 1988). The clinical descriptions of ulnar nerve entrapment in the wrist and hand largely originate from Ramsey Hunt in the early 20th century, and these conditions, especially the deep palmar branch neuropathy, are sometimes referred to as Ramsey Hunt syndrome (several syndromes bear his name) (Hunt 1908).