title: [Ulnar nerve neuropathy in the elbow region: surgical findings and conclusions about the etiologic mechanism and indications for surgery].
abstract: The operative findings of 191 cases of so-called tardy ulnar neuritis are demonstrated. They may be divided into 2 groups, neuropathies associated with (67 cases) and without dislocation or subluxation of the nerve (124 cases). Cases of ulnar neuritis associated with dislocation of the nerve showing no other pathologic changes indicate that dislocation of the nerve alone may account for clinical signs. The next step is the formation of adhesions followed at a later date by formation of a pseudoneuroma. As this condition is mostly of congenital origin an additional factor is needed for including clinical manifestations such as direct or chronic professional trauma. Not enough importance has been attached to the strong triceps, with large muscle mass reaching far down to the olecranon, which might cause irritation of the nerve by pressing it against the wall of the sulcus or dislocating it over the epicondyle. In cases of neuropathy without dislocation/subluxation there is always a pathological finding even when there is no pseudoneuroma. The m. epitrochleoanconaeus is found in this category (14 cases, 11%). The cubital tunnel syndrom of OSBORNE in a very large sense (all possible causes of compression distal to the sulcus) has been found 28 times. Therapeutic measures aim at taking the nerve away from the causative irritation (anterior transposition) or at erradicating the cause (resection of the epicondyle, section of the arcus tendineus, excision of a tumor etc.). OSBORNE's operation has been performed only thrice. Subluxation or dislocation of the nerve may follow this procedure or the nerve is left more exposed to pressure than before. Deep submuscular transposition is preferred in patients less than 50 years old but other factors may determine the choice between deep and subcutaneous transposition such as the cause of the neuropathy, arthritis of the elbow joint, strength of the flexor muscle mass etc.
mesh_terms: D000328:Adult; D004550:Elbow / Q000601:surgery; D006801:Humans; D008722:Methods; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000150:complications; D009443:Neuritis / Q000209:etiology; D009463:Neuroma / Q000150:complications / Q000151:congenital; D010523:Peripheral Nervous System Diseases / Q000209:etiology* / Q000601:surgery; D000267:Tissue Adhesions; D014459:Ulnar Nerve / Q000601:surgery
vernacular_title: Neuropathie des N. ulnaris im Ellenbogenbereich: Operations-befunde und Folgerungen für den Entstehungs-mechanismus und die Operationsindikation