December 2017

A 55 Year Old Male Mechanic with Right Hand Weakness

A 50-year-old right-hand dominant male mechanic presents with a 9-month history of progressive difficulty with performing his job due to weakness in the right hand. He states that he has been dropping objects with his dominant hand and has started performing tasks with his left hand more frequently since he does not have any symptoms on the left. He does endorse long-standing neck pain and waking at night due to hand numbness. He also describes an aching sensation in his forearm. He denies any trauma.

Cranial nerves II-XII are intact
DTRs – 2+ upper and lower extremities
Strength- 5/5 upper extremities except for 4/5 right hand intrinsic muscles
Decreased sensation to pinprick in the right fifth digit

Figure 1

1. What is the most common symptom associated with cubital tunnel syndrome?
2. What is the current “gold standard” treatment of cubital tunnel syndrome?
3. What finding is associated with ulnar nerve entrapment at the wrist, and not with ulnar nerve entrapment at the elbow?
4. Which of the following describes you?
5. I practice in one of the following locations.

Please submit your answers to see the case explanation.


  • Bartels RH, Verhagen WI, van der Wilt GJ, Meulstee J, van Rossum LG, Grotenhuis JA. Prospective randomized controlled study comparing simple decompression versus anterior subcutaneous transposition for idiopathic neuropathy of the ulnar nerve at the elbow: Part 1. Neurosurgery. Mar 2005;56(3):522-530; discussion 522-530.
  • Biggs M, Curtis JA. Randomized, prospective study comparing ulnar neurolysis in situ with submuscular transposition. Neurosurgery 2006; 58:296.
  • Gervasio O, Gambardella G, Zaccone C, Branca D. Simple decompression versus anterior submuscular transposition of the ulnar nerve in severe cubital tunnel syndrome: a prospective randomized study. Neurosurgery 2005; 56:108.
  • Macadam SA, Gandhi R, Bezuhly M, Lefaivre KA. Simple decompression versus anterior subcutaneous and submuscular transposition of the ulnar nerve for cubital tunnel syndrome: a meta-analysis. The Journal of hand surgery. Oct 2008;33(8):1314 e1311-1312.
  • Caliandro P, La Torre G, Padua R, Giannini F, Padua L. Treatment for ulnar neuropathy at the elbow. Cochrane Database Syst Rev. 2012;7:CD006839.

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