Tardy Ulnar Nerve Palsy by Neurofibroma

Tardy ulnar nerve palsy is ulnar neuropathy at or around elbow and commonly evaluated in the electromyography laboratory. However, ulnar neuropathy at the elbow due to neurofibroma is rare. Neurofibromas are tumors that arise within nerve fasciculi and anywhere along a nerve from dorsal root ganglion to the terminal nerve branch. We report one case of ulnar neuropathy at the elbow due to neurofibroma. Patient had paresthesia on the left 5th finger and there had been left hypothenar atrophy since 2 months ago. Tinel's sign was positive at left elbow. As a result of electromyography, there were suggestive of right ulnar neuropathy at or around elbow, referred to as tardy ulnar nerve palsy. Ultrasonography showed a diffuse tortuous thickening with multiple neurofibromas arising from individual fascicles of the ulnar nerve in cubital tunnel area. Surgery was then performed to release cubital tunnel of left elbow, then the patient's symptoms improved.

Tardy Ulnar Nerve Palsy due to Recurrent Dislocation of the Ulnar Nerve after Medial Epicondylar Fracture of the Humerus: A Case Report

Tardy ulnar nerve palsy might develop secondary to nonunion, malunion, or elbow deformity after medial epicondylar fracture of the humerus. We report a case of tardy ulnar nerve palsy following medial epicondylar fracture, treated with excision of bony fragment, neurolysis and relocation of the ulnar nerve.

Operative Treatment of Tardy Ulnar Nerve Palsy / 대한정형외과학회잡지

PURPOSE: To compare postoperative outcomes in tardy ulnar nerve palsy. MATERIALS AND METHODS: Between January 1997 and June 2000, 31 patients with the tardy ulnar nerve palsy, who have received operative treatment were divided into a traumatic group and an idiopathic group, and were analyzed with respect to preoperative factors, severity, nerve conduction velocity and postoperative result retrospectively. RESULTS: The traumatic group was composed of 17 cases and the idiopathic group of 14 cases. The average age was 35.7 years in the traumatic group, and 50.6 years in the idiopathic group, and this was statistically different (p=0.001). Other factors were not statistically different between the two groups. The improvement rate, which excluded mild degree patients, was 58.3% (7 in 12 cases) in the traumatic group and 90.9% (10 in 11cases) in the idiopathic group, and this was statistically different (p=0.048, ) and favorable in the idiopathic group. CONCLUSION: In cases of tardy ulnar nerve palsy of the elbow joint, the symptoms and the nerve conduction velocity were statistically no different between the two groups. The postoperative result in the traumatic elbow deformity patients was poorer than that in the idiopathic group.

Tardy Ulnar Nerve Palsy after Olecranon Fracture: 3 Cases Report / 대한정형외과학회잡지

There has not been reported that the tardy ulnar nerve palsy could be developed as a sequelae of the olecranon fracture. The purpose of this paper is to report our experience of diagnosis and treatment of tardy ulnar nerve palsy, developed in three patients who had managed for non-union and malunion of olecranon fractutre, with a review of the literature.

Tardy Ulnar Nerve Palsy Associated with Cubitus Varus Deformity

OBJECTIVES: Six cases of tardy ulnar neuropathy caused by cubitus varus deformity are presented. Clinical features and electrodiagnostic study of six cases were analysed to understand the mechanim of nerve palsy and the usefulness of electrodiagnostic study. METHODS: Electrodiagnostic study and elbow flexion test were performed and elbow varus angle, internal rotation angle of shoulder, biceps and brachioradialis muscle activities were measured in 6 patients RESULTS: Decreased ulnar nerve motor conduction velocities in the elbow segment was shown in 5 patients. Prolonged distal latency and reduced amplitude of ulnar sensory nerve action potentials were shown in one patient. Needle electromyography showed large amplitude motor unit action potentials in ulnar innervated forearm or hand muscles. The mean values of varus angle and internal rotation angle of humerus were 21degrees, and 28degrees, respectively. Brachioradialis showed relatively higher activity than biceps brachii in the early phase of elbow flexion. Three patients underwent surgery and showed immediate symptom relief. CONCLUSION: Tardy ulnar nerve palsy in cubitus varus thought to be caused by internal rotation of distal segment of humerus, stretching of ulnar nerve, snapping of the medial head of triceps on ulnar nerve and anterior transposition and compression of ulnar nerve. The three dimensional corrective osteotomy could be the most efficient treatment to restore the anatomic alignment of the elbow joint.

Surgical Treatment of Tardy Ulnar Nerve Palsy / 대한정형외과학회잡지

The report on compression neuropathy of the ulnar nerve at the elbow was first submitted by Panas in 1878. Therafter many authors have reported on etiology, pathoanatomy, method of treatment and prognosis of tardy ulnar nerve palsy. But there are some controversies about method of treatment and prognosis. We reviewed 15 patients of tardy ulnar nerve palsy resulted from the fracture of the lateral condyle of the humerus during the growing period. The result obtained are as follows. 1. All 15 patients with tardy ulnar nerve palsy were resulted from non-union of lateral condyle and cubitus valgus deformity. 2. Average carrying angle was 28 degrees. 3. Intial symptoms were pain and paresthesia of the hand in all 15 patients. Eight of them also had atrophy of intrinsic muscle and seven patients had clawing deformity of fingers. 4. Preoperative severity of ulnar neuritis according to Osborne's classification was Grade I; 1 case, Grade lI; 6 case, Grade III; 8 cases. 5. Submuscular transposition of ulnar nerve was performed in 11 and subcutaneous in the other 4 patients. 6. In all patient, pain was markedly improved within a few months after transposition of nerve. Improvement of hypothenar atrophy was obtained in 5 out of 8 and interosseous atropy in 3 out of 7 cases. Clawing was improved in 5 out of 8 cases. 7. Postoperative status of ulnar neuritis by Osborne's criteria was Normal; 1, Grade I; 4, Grade II; 7, Grade III; 3 cases. 8. Postoperative complications were decreased sensation in the medial aspect of forearm in 3 cases and recurrence of nerve compression symptom in 1 csse. 9. Internal neurolysis with anterior transposition of nerve would be recommandable in Grade III severe ulnar neuritis and in case of firm consistency of nerve at the operative field.