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Nerve & Neurological

Elbow nerve disorders: ulnar neuropathy, PIN palsy, radial nerve compression, brachial plexus injuries, and neuralgic amyotrophy diagnosis & management.

Overview

Nerve and neurological management in orthopaedics spans diverse pathologies, from peripheral palsies to complex plexus injuries. Nonsurgical management of posterior interosseous and ulnar nerve motor palsies following minimally displaced radial neck fractures results in excellent functional recovery [1]. In contrast, most major peripheral nerve injuries after elbow arthroscopy show only partial or no functional recovery, necessitating patient counseling on this risk [23]. Neurologic complications encountered in a series of 2759 elbow surgery cases are well within the limits of earlier reports, showing that elbow surgery is a relatively safe procedure to perform for a wide variety of indications [24].

Indications and timing dictate surgical intervention across various sites. Management of intra-articular peroneal nerve incarceration following multi-ligament knee injury depends on timing and type of nerve injury, with controversy existing regarding the best surgical treatment for complete transection [2]. Indications for peroneal nerve decompression in patients with multiple hereditary exostoses include neurologic symptoms and pain [20]. For recalcitrant cubital tunnel syndrome, no surgical treatment procedure has shown superiority over another; individualized treatment is emphasized to improve symptoms and maximize nerve recovery potential [10]. Radiological and electrodiagnostic insights into suprascapular nerve dysfunction serve as a key predictor of poor functional outcomes in shoulder hemiarthroplasty, highlighting the importance of perioperative nerve preservation strategies and postoperative neurological assessments [22].

Advanced reconstructive techniques offer new paradigms for nerve repair. Nerve transfers are replacing other techniques as the gold standard for brachial plexus and other proximal peripheral nerve injuries, offering functional outcomes surpassing those obtained from traditional nerve repair or tendon transfers [51]. Nerve transfers appear reasonable to optimize recovery even 12 to 18 months after the onset of symptoms of muscle weakness in cervical spondylotic amyotrophy, though greater patient numbers are required to confirm efficacy [18]. Distal nerve transfers are indicated for late presentation, isolated nerve deficits, and absence of proximal roots in birth-related brachial plexus injuries, though their role as a primary strategy for Erb's palsy remains unknown [42]. The results of a series on C5 root grafting to the musculocutaneous nerve using pedicled, vascularized ulnar nerve grafts do not support strong recommendations to use vascularized nerve grafts in the reconstruction of large nerve defects [47]. When managed appropriately, nerve recovery and clinical outcomes for the paediatric population with nerve injuries associated with supracondylar fractures of the humerus are extremely favourable [21].

Anatomy & Pathophysiology

Osseous & Joint Kinematics

Joint congruence of healthy elbows increases significantly when changing from supination to pronation [83]. The humeral trochlea protrudes into the cubital tunnel during elbow flexion, causing dynamic morphologic changes in the ulnar nerve [85]. Grip strength assessment requires nuance; Medical Research Council grade 4/5 includes both very weak and very strong strength, and grade 3/5 strength may be much weaker than generally assumed [95].

Ligamentous & Dynamic Stability

The proximal and distal ligaments of the anterior bundle of the medial collateral ligament act as checkreins that function only at the limits of elbow motion [98]. Pitching 100 balls induces a significant reduction in the dynamic stabilizing ability of medial elbow structures against valgus laxity [87]. Gripping does not change ulnohumeral joint space width or medial elbow tissue stiffness during valgus stress testing [55].

Vascular & Neural

Elbow surgery is associated with neurologic complications, though the incidence is within limits of earlier reports and the procedure is considered relatively safe [24]. The ulnar nerve moves medially and is flattened with the elbow flexed between 90 and 120 degrees [91]. With elbow flexion, the ulnar nerve does not move appreciably in the distal-proximal direction directly at the cubital tunnel, but maximal excursion occurs in the fatty region proximal to the elbow [84]. Shoulder position changes the ulnar nerve strain around the elbow in living patients with cubital tunnel syndrome [101].

Elbow flexion is the most effective way to decrease radial and median nerve tension distal to reverse shoulder arthroplasty, while elbow extension should be avoided during humeral component implantation [77]. Understanding the dynamic nature of the axillary and radial nerves in relation to the latissimus dorsi tendon across variable shoulder positions is critical to avoid complications [100]. Elbow arthroscopy can be safely performed with proper knowledge of anatomy around the elbow, including at-risk areas beyond the capsule when working within the joint [93].

Clinical Pathophysiology & Management

Modern patient-specific management of adult traumatic brachial plexus injuries can often permit consistent restoration of elbow flexion and shoulder stability with potential for hand prehension [96]. Preoperative dynamic electromyography findings in the biceps brachii appear to predict incapacitated force production and may guide targeted surgical procedures for elbow spasticity [90]. Ultrasonography is useful in identifying the pathogenesis of snapping elbow associated with congenital radioulnar synostosis [99].

Classification

Electrodiagnostic Testing: Used to identify and grade associated neuropathy based on severity for clinical diagnoses such as carpal or cubital tunnel syndromes [9].

Suprascapular Triad Topography: A new classification of the suprascapular triad topography and quantitative analysis of the space available for the path of the suprascapular nerve are important for understanding morphological conditions that may promote suprascapular nerve entrapment, especially those with a type III arrangement [39].

Yang Classification: The study adds Type IV for the biceps and Type III for the brachialis to the Yang classification regarding innervation patterns to the accessory biceps head [80].

Posterolateral Corner Injury Classification: The authors present a classification system for injuries to all individual structures constituting the posterolateral corner in multiligament knee injuries [81].

Radial Nerve Palsy Classification: A proposed new classification system based on intraoperative findings for radial nerve palsy after humeral shaft fractures can better guide treatment and prognosis [82].

Gartland Classification: The incidence of vascular and nerve complications positively correlates with the progression of fracture according to the Gartland classification in pediatric supracondylar humerus fractures [86].

Clinical Presentation

Nerve compression syndromes are a common cause of pain, sensory disturbance, and motor weakness [35]. Peripheral nerve injuries can dramatically affect a patient's life [13]. In cases of peripheral nerve localization where a clear cleavage plane is absent, simple nerve decompression followed by biopsy is the correct management [6]. To avoid nerve palsy completely, the etiopathogenesis of compressive neuropathy should be identified [7].

History and Assessment: Patients presenting with median nerve symptoms must be assessed both at the wrist and proximally to exclude compression elsewhere [5]. A diagnosis of ulnar nerve compression merits a comprehensive workup by the treating surgeon and a high suspicion for concomitant median nerve compression [36]. There is a lack of consensus on defining and diagnosing different types of ulnar nerve dysfunction [16]. Neuropathy symptoms following shoulder surgery are often refractory to conservative management [3].

Diagnostic Modalities: Electrodiagnostic testing is used to confirm the presence or absence of neuropathophysiology associated with clinical diagnoses such as carpal tunnel or cubital tunnel syndromes [9]. Electrodiagnostic testing is used to identify and grade associated neuropathy based on severity [9]. Electrodiagnostic tests provide significantly more information than ultrasonography regarding the condition and function of the nerve in carpal tunnel syndrome [37]. Ultrasound and magnetic resonance neurography (MRN) are the most far-reaching modalities for peripheral nerve imaging, often providing complimentary information [11].

Prognostic Indicators: Nerve-conduction studies can be used as a prognostic factor, with patients having motor abnormalities appearing to have more favorable results than those with only sensory abnormalities [8]. Adequate clinical diagnosis through predominantly motor symptoms and electroneuromyography alterations can allow for early decompression with good postoperative functional outcomes in isolated compression of the recurrent motor branch of the median nerve [17].

Management Implications: The location and mechanism of nerve injury are the most important factors guiding management, requiring different treatment strategies depending on the specific location and type of nerve injury [12]. Management of peroneal nerve palsy varies based on etiology; many patients benefit from nonsurgical measures, while surgical decompression is considered for refractory cases and typically yields favorable results [14]. Posterior interosseous and ulnar nerve motor palsies can occur after a minimally displaced radial neck fracture [1]. The main sequels of obstetrical palsy are attributed to incorrect treatment or devastating early nerve surgery rather than the injury itself [15].

Investigations

Plain radiography: Plain radiography is indicated when findings suggest a metal fragment is the cause of nerve injury, necessitating exposure and removal of the fragment [66]. In young athletes with spondylolysis, magnetic resonance imaging is a useful tool to clarify the pathologic changes inducing radiculopathy [59].

MRI: Magnetic resonance imaging (MRI) and magnetic resonance neurography (MRN) are the most far-reaching modalities for peripheral nerve imaging, often providing complimentary information [11]. High-resolution ultrasonography and MRN have emerged as useful diagnostic modalities in the evaluation of traumatic peripheral nerve and brachial plexus injuries [48]. MRI is probably the diagnostic modality of choice when a lesion of the sciatic nerve is suspected [71]. Preoperative imaging (USS or MRI) is beneficial in cases of anomalous muscles contributing to nerve entrapment, particularly after previously failed decompression [74]. MRI performed early after traction injury to the brachial plexus provides useful additional information towards establishing the level of the lesion and information about injury to the plexus outside the spinal canal [78]. In high-level athletes with suspected dynamic nerve compression where initial history and physical examination do not reveal an etiology, dynamic MRI is warranted [65]. Only a small number of individuals with MRI evidence of an anconeus epitrochlearis muscle (AEM) had clinical evidence of ulnar neuropathy [68].

CT: MRI and postmyelography CT are the mainstays of diagnosis for problems involving the brachial plexus [73].

Ultrasound: Ultrasound is one of the most far-reaching modalities for peripheral nerve imaging, often providing complimentary information to MRN [11]. High-resolution ultrasonography is useful in the evaluation of traumatic peripheral nerve and brachial plexus injuries [48]. Preoperative imaging (USS or MRI) is beneficial in cases of anomalous muscles contributing to nerve entrapment, particularly after previously failed decompression [74]. If radiographic and ultrasonographic findings suggest a metal fragment is the cause of nerve injury, the nerve should be exposed and the metal fragment removed [66].

Electrodiagnostic Studies: Imaging and electrodiagnostic studies form an essential part of the evaluation of the patient with traumatic brachial plexopathy [72]. These studies enable clarification of surgical options, prognostication of outcome, and formulation of postoperative management in traumatic brachial plexopathy [72]. Adequate clinical diagnosis through predominantly motor symptoms and electroneuromyography alterations can allow for early decompression with good postoperative functional outcomes in isolated compression of the recurrent motor branch of the median nerve [17]. In cases of suspected dynamic nerve compression in a high-level athlete where initial history and physical examination do not reveal an etiology, additional diagnostic modalities such as dynamic nerve studies with inching technique are warranted [65].

Other Considerations: Neuropathy symptoms following shoulder surgery are often refractory to conservative management [3]. Surgical decompression leads to nearly 90% symptom resolution for neuropathies following shoulder surgery [3]. Patients presenting with median nerve symptoms must be assessed at the wrist and proximally to exclude compression elsewhere [5]. Identifying the etiopathogenesis of compressive neuropathy is necessary to avoid nerve palsy completely [7]. When a clear cleavage plane is absent during peripheral nerve localization, the correct management is simple nerve decompression followed by biopsy and adequate, prolonged follow-up [6]. Early diagnosis, careful preoperative imaging assessment, and complete decompression can be expected to result in favorable rehabilitation outcomes for ulnar nerve double crush by entrapment of a peri-cubital tunnel ganglion cyst and cubital tunnel [49]. The demographics of patients with various compressive neuropathies were not homogeneous, suggesting different etiologies [29]. Tumors of the nerve sheath should be included in the differential diagnosis of neurogenic pain in the lower extremity [71]. Recent improvements in technology allow for routine reliable visualization of nerve roots to differentiate preganglionic injuries from postganglionic lesions [73]. Clear inferences regarding imaging, timing of surgery, nerve transfers, and physiotherapy in brachial plexus birth injury are difficult due to many variables and uncertainties [79].

Treatment

Non-Operative Management

Nonsurgical management is the primary intervention for many nerve palsies and neuropathies, often yielding excellent or complete recovery. Nonsurgical management of posterior interosseous and ulnar nerve motor palsies following minimally displaced radial neck fractures results in excellent functional recovery [1]. Nonsurgical treatment is successful in most patients with mild cubital tunnel syndrome [38]. Chitosan phonophoresis demonstrates significant improvements in nerve conduction, pain reduction, and enhancement of hand function for mild to moderate cubital tunnel syndrome [43]. Nonoperative management for isolated musculocutaneous nerve injury results in a successful clinical outcome [45]. Initial treatment for saphenous neuritis includes nonsurgical symptomatic care and injections, with surgical decompression and neurectomy reserved for recalcitrant cases [50]. Distal peripheral neuropathy after open and arthroscopic shoulder surgery often resolves with nonoperative management [62].

A prolonged trial of non-operative treatment is recommended for peroneal nerve injuries to allow for assessment of nerve recovery and patient outcome before considering surgical treatments [40]. Operative decompression for meralgia paresthetica in children is reserved for patients who have not responded to non-operative treatment [60]. An isolated anterior interosseous nerve injury may not by itself be an indication for urgent surgery [58]. Anterior interosseous nerve palsy after open capsular release for elbow stiffness recovers completely with conservative management [61]. In the absence of a surgical solution for scapular winging due to rhomboid muscle paralysis, conservative treatment is fundamental and requires management in a rehabilitation center with intervention by a multidisciplinary team [54].

Operative Management

Indications: Surgical intervention is indicated when conservative measures fail or when specific anatomical pathologies require mechanical correction. Surgical decompression of median and ulnar neuropathies following shoulder surgery leads to nearly 90% symptom resolution, as symptoms are often refractory to conservative management [3]. Surgical decompression is considered for refractory peroneal nerve palsy and typically yields favorable results [14]. Surgical decompression is an effective treatment option for distal peripheral neuropathy in refractory cases [62]. Indications for peroneal nerve decompression in patients with multiple hereditary exostoses include neurologic symptoms and pain [20]. Bony encasement of the ulnar nerve secondary to heterotopic ossification of the elbow is treated with an approach that leads to superior range of motion, improved or resolved ulnar neuropathy, and good to excellent long-term functional outcomes [41].

Surgical Approach / Technique: Nerve transfers appear reasonable to optimize recovery in cervical spondylotic amyotrophy even 12 to 18 months after the onset of muscle weakness symptoms, though greater patient numbers are required to confirm efficacy [18]. The spinal accessory nerve should be explored if spontaneous recovery does not occur, and repair is recommended as long as denervation potentials are detectable on electromyography [26]. Decompression and/or external neurolysis are beneficial for nerve recovery in infraclavicular (Chuang Level IV) brachial plexus injuries, and vascularized nerve grafts or muscle transfers may improve prognoses for specific nerve reconstructions [44].

Other Considerations: Management of peroneal nerve incarceration following multi-ligament knee injury depends on timing and type of nerve injury, with controversy existing regarding the best surgical treatment for complete transection [2]. No surgical treatment procedure for recalcitrant cubital tunnel syndrome has shown superiority over another; however, individualized treatment is emphasized to improve symptoms and maximize nerve recovery potential [10]. Patients presenting with median nerve symptoms must be assessed both at the wrist and proximally to exclude compression elsewhere, such as from a high insertion of pronator teres [5]. There is no advantage of using a nerve stimulator in selecting fascicles before performing nerve transfer for restoring elbow flexion in brachial plexus injuries [53].

Complications

Nerve palsy: Nerve injuries can dramatically affect a patient's life [13]. In elbow arthroscopy, the minor nerve-related complication rate is 4.4%, while the incidence of major peripheral nerve injury is 0.9% [46]. Most major peripheral nerve injuries after elbow arthroscopy show only partial or no functional recovery [23]. Patient counseling regarding this risk is necessary [23]. In hip arthroscopy, pudendal nerve compression is influenced by traction force and hip abduction angle [7]. Identifying the etiopathogenesis of compressive neuropathy is necessary to avoid nerve palsy [7]. In reverse total shoulder arthroplasty (rTSA), permanent peripheral nerve injuries are uncommon but do occur with debilitating effects [56]. For long head of the biceps tenodesis, nerve injury occurs at a significantly higher rate with subpectoral techniques compared to other methods, yet all associated nerve injuries result in recovered nerve function [63].

Carpal tunnel syndrome: Nerve-conduction studies serve as a prognostic factor for surgery, with patients having motor abnormalities showing more favorable results than those with only sensory abnormalities [8].

Cubital tunnel syndrome: Open in situ release is safer and produces reliably good results compared to endoscopic release, pending more long-term data on endoscopic techniques [70]. Cubital tunnel syndrome associated with previous ganglion cyst excision in the elbow can improve over a 1-year follow-up period, including sensory dysfunction and weakness [28]. Demographics of patients with compressive neuropathies in the upper extremity are not homogeneous, suggesting different etiologies [29]. Careful history, detailed examination, and adequate testing are required before surgery for entrapment neuropathy to rule out non-compressive etiologies that may be adversely affected by surgery [92]. Early surgical decompression is supported for nerves with constant static compression in a subacute setting but is not supported for physiologically altered nerves with slow chronic subclinical compression [30].

Pediatric nerve injuries: Delayed ulnar neuropathy associated with elbow dislocation and medial epicondyle fracture in pediatric patients is associated with complete recovery if promptly treated [31]. Incorrect treatment or devastating early nerve surgery are the main causes of sequelae in obstetrical palsy, rather than the injury itself [15].

Other Considerations: Nonsurgical management of posterior interosseous and ulnar nerve motor palsies after minimally displaced radial neck fracture results in excellent functional recovery [1]. Compression of the radial nerve by the triceps muscle may result in no return of nerve function post-operatively [32]. Congenital radial head dislocation can lead to osteophyte formation causing proximal median nerve compression [94]. Routine intraoperative nerve monitoring has limited clinical utility due to a high incidence of false-positive nerve alerts and lack of correlation with persistent postoperative neurologic deficits [57]. FK506 (tacrolimus) treatment shows no evident improvement in sensory, motor, or functional recovery for nerve regeneration compared to expected results without treatment, though it has no observed undesirable side-effects [67].

Recovery

Light activity (weeks): Specific timelines for light activity are not defined in the current evidence base. However, early surgical release is supported for nerves with constant static compression in a subacute setting, whereas physiologically altered nerves with slow chronic subclinical compression do not benefit from this approach [30].

Full activity (months): Recovery trajectories vary significantly by pathology. Ninety-one percent of patients with traumatic nerve injury following humeral shaft fracture experience improvement in nerve function with a median time to recovery of 7-9 weeks [89]. Patients with carpal tunnel syndrome and preoperative motor abnormalities demonstrate more favorable surgical outcomes than those with only sensory abnormalities [8]. In pediatric cases, surgical timing impacts the time to recovery of complex nerve injuries in supracondylar humeral fractures [104], while delayed ulnar neuropathy in pediatric elbow dislocation is associated with complete recovery if promptly treated [31].

Complete recovery / outcome plateau (months): Long-term outcomes show variability. Chronic pain and persistent functional deficits occur in almost one third of patients with neuralgic amyotrophy (Parsonage-Turner syndrome) after an average follow-up of greater than 6 years [88]. Conversely, compression of the ulnar nerve in Guyon’s canal by an angioleiomyoma results in complete recovery of motor conduction velocity at four months with no recurrence at 18 months [64]. Nonsurgical management of posterior interosseous and ulnar nerve motor palsies after minimally displaced radial neck fracture results in excellent functional recovery [1]. Cubital tunnel syndrome associated with previous ganglion cyst excision in the elbow improves over a 1-year follow-up period [28].

Rehabilitation protocol: Specific rehabilitation protocols are not detailed in the available evidence. However, perioperative nerve preservation strategies and postoperative neurological assessments are important predictors of functional outcomes in shoulder hemiarthroplasty [22]. Sleeve-shaped neurothekeoma of the ulnar nerve with absent clear cleavage plane is managed with simple nerve decompression followed by biopsy and prolonged follow-up [6].

Functional milestones: Nerve regeneration quality is slightly better in children than in adults, but this does not fully explain differences in clinical outcomes [19]. Patients with combined cubital and carpal tunnel syndrome follow similar postoperative recovery trajectories as those with isolated cubital tunnel syndrome [102]. Timely surgical decompression of postoperative median neuropathy (brachialis syndrome) results in full neurologic recovery, whereas delayed decompression leads to poor outcomes [103]. Compression of the radial nerve by the triceps muscle resulted in no return of nerve function at four months post-operatively in a patient with symptoms for at least three years [32].

Other Considerations: Iatrogenic spinal accessory nerve injury should be explored if spontaneous recovery does not occur, with repair recommended if denervation potentials are detectable on electromyography [26]. Peripheral nerve transfers for brachial plexus and peripheral nerve injuries must be assessed within the broader framework of neuroplasticity [25]. Nerve transfer surgery shows promising short- to midterm results for recovery of nerve and muscle function, particularly for restoration of elbow flexion in acute flaccid myelitis [69].

Key Evidence

  • [L4] With nonsurgical management, both nerves demonstrated excellent functional recovery. (10.1016/j.jhsa.2012.05.028)
  • [L4] Management depends on timing and type of nerve injury, with controversy existing regarding the best surgical treatment for complete transection. (10.1007/s00167-015-3626-4)
  • [L4] Neuropathy symptoms were often refractory to conservative management, while surgical decompression led to nearly 90% symptom resolution. (10.1016/j.jseint.2024.05.011)
  • [L4] The case demonstrates that patients presenting with median nerve symptoms must be assessed both at the wrist and proximally to exclude compression elsewhere. (10.1111/j.1758-5740.2010.00051.x)
  • [L4] In case of peripheral nerve localization and when a clear cleavage plane is absent, the correct management should be simple nerve decompression followed by biopsy, along with an adequate and prolonged follow-up period. (10.1177/1558944719828008)
  • [L5] To avoid nerve palsy completely, the etiopathogenesis of compressive neuropathy should be identified. (10.1016/j.arthro.2015.03.040)
  • [L4] Nerve-conduction studies can be used as a prognostic factor, with patients having motor abnormalities appearing to have more favorable results than those with only sensory abnormalities. (10.2106/00004623-197961010-00017)
  • [L5] No surgical treatment procedure has shown superiority over another; however, individualized treatment is emphasized to improve symptoms and maximize nerve recovery potential. (10.5435/jaaos-d-20-01381)
  • [L5] Ultrasound and magnetic resonance neurography (MRN) are the most far-reaching modalities for peripheral nerve imaging, often providing complimentary information. (10.1016/j.jhsa.2019.06.021)
  • [L4] The current literature shows that the location and mechanism of nerve injury are the most important factors guiding management, requiring different treatment strategies depending on the specific location and type of nerve injury. (10.1016/j.jse.2011.11.033)
  • [L5] Peripheral nerve injuries can dramatically affect a patient's life. (10.1016/j.hcl.2015.01.007)
  • [L5] Management of peroneal nerve palsy varies based on etiology; many patients benefit from nonsurgical measures, while surgical decompression is considered for refractory cases and typically yields favorable results. (10.5435/jaaos-d-16-00045)
  • [L4] The main sequels are attributed to incorrect treatment or devastating early nerve surgery rather than the injury itself. (10.1177/17531934211032032)
  • [L5] There is a lack of consensus on defining and diagnosing different types of ulnar nerve dysfunction, necessitating prospective studies with standardized definitions. (10.1016/j.jhsa.2011.11.023)
  • [Case_report] Adequate clinical diagnosis through predominantly motor symptoms and electroneuromyography alterations can allow for early decompression with good postoperative functional outcomes. (10.1177/1558944721990779)
  • [L4] Nerve transfers appear reasonable to optimize recovery even 12 to 18 months after the onset of symptoms of muscle weakness, though greater patient numbers are required to confirm efficacy. (10.1016/j.jhsa.2017.12.020)
  • [L3] Nerve regeneration is of a slightly better quality in children than in adults, but this alone cannot explain the difference in their clinical outcomes. (10.1054/jhsb.2000.0493)
  • [L3] Indications for peroneal nerve decompression included neurologic symptoms and pain. (10.2106/jbjs.23.01398)
  • [L4] When managed appropriately, nerve recovery and clinical outcomes for this paediatric population are extremely favourable. (10.1302/0301-620x.98b6.35686)
  • [L3] These findings highlight the importance of perioperative nerve preservation strategies and postoperative neurological assessments. (10.1016/j.jse.2025.07.001)
  • [L4] Most nerve injuries show only partial or no functional recovery, necessitating patient counseling on this risk. (10.1016/j.arthro.2015.11.023)
  • [L4] The neurologic complications encountered in this series are well within the limits of earlier reports and show that elbow surgery is a relatively safe procedure to perform for a wide variety of indications. (10.1016/j.jse.2015.07.033)
  • [L4] Peripheral nerve transfers must be assessed within the broader framework of neuroplasticity. (10.1177/17531934251398407)
  • [L4] The nerve should be explored if spontaneous recovery does not occur, and repair is recommended as long as denervation potentials are detectable on electromyography. (10.2106/00004623-199811000-00007)
  • [Case_report] The patient's symptoms including sensory dysfunction and weakness improved over the 1-year follow-up period. (10.5397/cise.2022.01102)
  • [L3] The demographics of patients with various compressive neuropathies were not homogeneous, suggesting different etiologies. (10.1177/15589447221107701)
  • [L5] The study provides laboratory support for early release of a nerve with evidence of constant static compression in a subacute setting but does not provide evidence in favor of early decompression of a physiologically altered nerve that has experienced slow chronic subclinical compression. (10.2106/jbjs.n.00213)
  • [L4] The delayed neuropathy of the ulnar nerve appears to be associated with a complete recovery in children, as long as it is promptly treated. (10.1016/j.jse.2012.11.009)
  • [L4] The patient had symptoms for at least three years prior to operation, and no return of nerve function was observed at four months post-operatively. (10.2106/00004623-197759060-00022)
  • [L5] Nerve compression syndromes are a common cause of pain, sensory disturbance, and motor weakness; while carpal tunnel syndrome is frequently treated surgically, other compression syndromes are less common and often best treated nonsurgically, though some, such as posterior interosseous nerve syndrome, are better treated by surgical intervention. (10.5435/00124635-199811000-00006)
  • [L3] A diagnosis of ulnar nerve compression merits a comprehensive workup by the treating surgeon and a high suspicion for concomitant median nerve compression. (10.1177/1558944718813669)
  • [L2] Electrodiagnostic tests provide significantly more information than ultrasonography regarding the condition and function of the nerve. (10.1177/1753193413489046)
  • [L4] Nonsurgical treatment is successful in most patients with mild nerve dysfunction. (10.5435/jaaos-d-15-00261)
  • [L4] The new classification of the suprascapular triad topography and quantitative analysis of the space available for the path of the suprascapular nerve are important for a better understanding of the possible morphological conditions that may promote suprascapular nerve entrapment, especially those with a type III arrangement. (10.1007/s00167-014-2937-1)
  • [L4] Thus, a prolonged trial of non-operative treatment is recommended for peroneal nerve injuries to allow for assessment of nerve recovery and patient outcome before entertaining surgical treatments. (10.1007/s00167-016-4417-2)
  • [L4] This treatment approach leads to superior range of motion, improved or resolved ulnar neuropathy, and good to excellent long-term functional outcomes. (10.1016/j.jse.2023.12.003)
  • [L5] Distal nerve transfers are indicated for late presentation, isolated nerve deficits, and absence of proximal roots, though their role as a primary strategy for Erb's palsy remains unknown. (10.1016/j.hcl.2015.12.006)
  • [L1] This approach demonstrated significant improvements in nerve conduction, pain reduction, and enhancement of hand function. (10.1016/j.jht.2024.02.006)
  • [L4] Decompression and/or external neurolysis were beneficial for nerve recovery, and vascularized nerve grafts or muscle transfers may improve prognoses for specific nerve reconstructions. (10.1177/1753193414553753)
  • [L5] Nonoperative management for isolated musculocutaneous nerve injury results in a successful clinical outcome. (10.1177/0363546508317966)
  • [L4] The minor nerve-related complication rate was 4.4%, with a 0.9% incidence of major peripheral nerve injury. (10.1016/j.arthro.2017.12.004)
  • [L4] The results of this series do not support the strong recommendations of other authors to use vascularized nerve grafts in the reconstruction of large nerve defects. (10.1016/j.jhsa.2009.08.004)
  • [L5] High-resolution ultrasonography and magnetic resonance neurography have emerged as useful diagnostic modalities in the evaluation of traumatic peripheral nerve and brachial plexus injuries. (10.5435/jaaos-d-24-00889)
  • [Case_report] Early diagnosis, careful preoperative imaging assessment, and complete decompression can be expected to result in favorable rehabilitation outcomes. (10.1186/s12891-025-08526-x)
  • [L5] Initial treatment includes nonsurgical symptomatic care and injections, with surgical decompression and neurectomy reserved for recalcitrant cases. (10.5435/00124635-200203000-00008)
  • [L4] Nerve transfers are replacing other techniques as the gold standard for brachial plexus and other proximal peripheral nerve injuries, offering functional outcomes surpassing those obtained from traditional nerve repair or tendon transfers. (10.1016/j.injury.2020.04.015)
  • [L3] There is no advantage of using a nerve stimulator in selecting fascicles before performing the nerve transfer. (10.1016/j.jhsa.2011.08.017)
  • [L4] In the absence of a surgical solution, conservative treatment is fundamental and requires management in a rehabilitation center with intervention by a multidisciplinary team. (10.1016/j.jse.2022.05.011)
  • [L4] Gripping does not change ulnohumeral joint space width or medial elbow tissue stiffness in the joint testing configuration and external loading conditions applied in this study. (10.1186/s12891-025-08343-2)
  • [L4] Although uncommon, permanent peripheral nerve injuries following rTSA do occur with debilitating effects. (10.1016/j.jse.2022.03.018)
  • [L2] However, the clinical utility of routine intraoperative nerve monitoring remains in question given the high incidence of false-positive nerve alerts and the lack of clinical correlation with persistent postoperative neurologic deficits. (10.1016/j.jse.2016.02.016)
  • [L4] An isolated anterior interosseous nerve injury may not by itself be an indication for urgent surgery. (10.2106/jbjs.n.00136)
  • [L4] Magnetic resonance imaging is a useful tool to clarify the pathologic changes inducing radiculopathy. (10.1177/0363546509348054)
  • [L4] Operative decompression, done as an outpatient procedure, produced a good or excellent result in patients who had not responded to non-operative treatment. (10.2106/00004623-199407000-00006)
  • [L4] The palsy in these patients recovered completely with conservative management. (10.1016/j.jhsa.2008.10.019)
  • [L4] When it occurs, DPN will often resolve with nonoperative management, and surgical decompression is an effective treatment option in refractory cases. (10.1016/j.jse.2014.08.007)
  • [L3] Nerve injury occurred at a significantly higher rate for subpectoral techniques, but all nerve function recovered. (10.1177/2325967117s00397)
  • [L4] The symptoms improved immediately after surgery, with complete recovery of motor conduction velocity at four months and no recurrence at 18 months. (10.1177/1753193410367701)
  • [L4] In cases of suspected dynamic nerve compression in a high-level athlete, additional diagnostic and imaging modalities, such as dynamic nerve studies with inching technique and dynamic MRI, are warranted if initial history and physical examination do not reveal an etiology. (10.1016/j.xrrt.2021.04.005)
  • [Case_report] If radiographic and ultrasonographic findings suggest a metal fragment is the cause of nerve injury, the nerve should be exposed and the metal fragment removed. (10.1016/j.jse.2024.05.048)
  • [L4] No undesirable side-effects were observed during or after FK506 treatment, but there was no evident improvement of sensory, motor or functional recovery at the end of the follow-up period compared to expected results without treatment. (10.1177/1753193411427826)
  • [L4] Only a small number of individuals with MRI evidence of an AEM had clinical evidence of ulnar neuropathy. (10.1016/j.jse.2018.03.021)
  • [L4] Nerve transfer surgery has shown promising short- to midterm results for recovery of nerve and muscle function, particularly for the restoration of elbow flexion. (10.1016/j.jhsa.2021.02.029)
  • [L4] Until more information regarding long-term results and the rate of nerve injury is available, open in situ release produces reliably good results with a similar sized incision and acceptable return to work time, and is safer. (10.1016/j.jhsa.2014.05.012)
  • [Case_report] Tumors of the nerve sheath should be included in the differential diagnosis of neurogenic pain in the lower extremity, and magnetic resonance imaging is probably the diagnostic modality of choice when a lesion of the sciatic nerve is suspected. (10.2106/00004623-199304000-00016)
  • [L5] Imaging and electrodiagnostic studies form an essential part of the evaluation of the patient with traumatic brachial plexopathy, enabling clarification of surgical options, prognostication of outcome and formulation of postoperative management. (10.1177/1753193411422313)
  • [L5] MRI and postmyelography CT are the mainstays of diagnosis for problems involving the brachial plexus, with recent improvements in technology allowing for the routine reliable visualization of nerve roots to differentiate preganglionic injuries from postganglionic lesions. (10.1016/j.hcl.2004.09.005)
  • [L4] Preoperative imaging (USS or MRI) has proved to be beneficial in cases of anomalous muscles contributing to nerve entrapment, particularly when assessing patients after previously failed decompression. (10.1177/1753193420943029)
  • [L5] Elbow flexion was the most effective way to decrease nerve tension, while elbow extension should be avoided when implanting the humeral component. (10.1016/j.jseint.2024.03.013)
  • [L4] MRI performed early after traction injury to the brachial plexus provides useful additional information towards establishing the level of the lesion and provides information about injury to the plexus outside the spinal canal. (10.1054/jhsb.1999.0234)
  • [L5] The article summarizes currently accepted views on imaging, timing of surgery, nerve transfers, and physiotherapy, noting that clear inferences are difficult due to many variables and uncertainties. (10.1177/17531934241231173)
  • [L4] The study describes specific innervation patterns to the accessory biceps head, adding Type IV for the biceps and Type III for the brachialis to the Yang classification. (10.1177/17531934221080952)
  • [L5] The authors state that while the prior study by Bottomley et al. noted potential nerve displacement, their own study is the first to explore the pattern and precise location of injury to all individual structures constituting the posterolateral corner and to present a classification system for these injuries. (10.1177/03635465211014498)
  • [L4] The proposed new classification system based on intraoperative findings can better guide treatment and prognosis. (10.1016/j.hcl.2017.09.011)
  • [L4] Joint congruence of healthy elbows on MRI increased significantly when changing from supination to pronation. (10.1177/03635465251330152)
  • [L5] With elbow flexion, the ulnar nerve did not move appreciably in the distal–proximal direction directly at the cubital tunnel, but maximal excursion was in the fatty region proximal to the elbow. (10.1016/j.jhsa.2012.03.016)
  • [L5] The humeral trochlea protrudes into the cubital tunnel during elbow flexion, causing dynamic morphologic changes in the ulnar nerve. (10.1016/j.jse.2022.05.026)
  • [L4] The incidence of vascular and nerve complications positively correlates with the progression of fracture according to Gartland classification. (10.1155/2017/2803790)
  • [L5] Pitching 100 balls induces a significant reduction in dynamic stabilizing ability against elbow valgus laxity. (10.1016/j.jse.2023.11.001)
  • [L5] Recent observational studies note the presence of chronic pain and persistent functional deficits in almost one third of affected patients after an average follow-up of greater than 6 years. (10.1016/j.jhsa.2010.09.010)
  • [L3] Ninety-one percent of patients experienced improvement in their nerve function with a median time to recovery of 7-9 weeks. (10.1016/j.jse.2021.04.025)
  • [L4] Preoperative dynamic electromyography findings in the biceps brachii appeared to predict incapacitated force production and may have promise for guiding more targeted surgical procedures to other elbow flexors. (10.1177/17531934251323078)
  • [L4] The ulnar nerve moves medially and is flattened with the elbow flexed between 90 and 120 degrees. (10.1016/j.jse.2014.01.039)
  • [L5] Prior to committing an individual to surgery for entrapment neuropathy, careful history, detailed examination, and adequate testing should be carried out to ascertain that there are no non-compressive etiologies for the presentation, some of which may be adversely affected by surgery. (10.1177/1558944719898801)
  • [L5] Elbow arthroscopy can be safely performed with proper knowledge and application of anatomy around the elbow when making portals and understanding at-risk areas beyond the capsule when working within the joint. (10.1016/j.arthro.2024.05.001)
  • [L4] This case highlights the importance of a careful, complete, symptom-driven history and physical examination when evaluating median nerve neuropathy, as congenital radial head dislocation can lead to osteophyte formation causing proximal compression. (10.1016/j.jhsa.2016.08.016)
  • [L4] For elbow flexion, grade 4/5 includes both the very weak and the very strong, and grade 3/5 strength may be much weaker than is generally assumed. (10.1016/j.jhsa.2006.10.020)
  • [L5] Modern patient-specific management can often permit consistent restoration of elbow flexion and shoulder stability with the potential of prehension of the hand. (10.5435/jaaos-d-18-00433)
  • [L5] The proximal and distal ligaments act as checkreins that work only at the limits of elbow motion. (10.1016/j.jse.2011.07.018)
  • [L4] Ultrasonography is useful in identifying the pathogenesis of snapping elbow. (10.1016/j.xrrt.2022.09.006)
  • [L5] Understanding the dynamic nature of these nerves related to different shoulder positions is critical to avoid complications. (10.1177/1758573218825476)
  • [L4] To the best of our knowledge, this is the first study showing that shoulder position changes the ulnar nerve strain around the elbow in living patients with CubTS. (10.1016/j.jse.2015.01.014)
  • [L4] Patients with combined nerve compressions follow similar trajectories in the postoperative period as those with isolated CuTS. (10.1177/15589447211028921)
  • [L4] Timely surgical decompression results in full neurologic recovery, whereas delayed decompression leads to poor outcomes. (10.1016/j.jse.2015.12.023)
  • [L3] Surgical timing impacts the time to recovery of complex nerve injuries. (10.2106/jbjs.24.00371)

See Also

References

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4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.