Surgical Treatment of Snapping of Ulnar Nerve along the Medial Distal Part of Triceps


Haim Katsevman Daniel Dreyfuss Dan Hutt
Unit of Hand Surgery, Rambam Health Care Campus, Israel

Snapping of the ulnar nerve is an uncommon condition usually associated with pain and symptoms of neuropathy, whereas cubital tunnel syndrome is the second most common neuropathy after median nerve entrapment at the carpal tunnel, with an incidence of 25 cases per 100 000 men and 19 cases per 100 000 women each year.

In some cases there is subluxation not only of the nerve but also the medial part of the triceps over the medial epicondyle. This is a rare pathology described only in isolated cases caused by either abnormal attachment of the distal medial triceps or varus deformity of the elbow.

Among the first who described this pathology were Israeli surgeons, Dr Dreyfuss and Dr Kessler. They published an article in JBJS in 1978 titled "Surgical treatment of Snapping of Ulnar Nerve along the Medial distal part of Triceps"

Spinner and Goldner described 17 such cases, and only 6 of them underwent surgical treatment. Two patients underwent surgery for anterior transposition of the nerve symptoms, but slipping over epicondylar structures remained and was later diagnosed with pathology of the medial triceps with subsequent re-operation. The diagnosis was made clinically, but all patients underwent CT, MRI and ultrasound before surgery.

Robert and other authors in their work warned that operative release and anterior transposition of the ulnar nerve, which includes removal of the distal portion of the intramuscular septum, may lead to instability of the medial triceps.

I will be happy to present a clinical case of anterior medial triceps snapping over the medial epicondyle. My report will be accompanied by intraoperative images and videos.

During surgery, abnormal attachment of the medial aspect of the triceps was revealed, which caused anterior snapping. Partial resection of medial distal triceps with lateralization after ulnar nerve transposition was performed. One year after the operation the patient is asymptomatic.