Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Oct 18, 2016; 7(10): 650-656
Published online Oct 18, 2016. doi: 10.5312/wjo.v7.i10.650
Treatment of the ulnar nerve for overhead throwing athletes undergoing ulnar collateral ligament reconstruction
Matthew S Conti, Christopher L Camp, Neal S Elattrache, David W Altchek, Joshua S Dines
Matthew S Conti, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY 10021, United States
Christopher L Camp, David W Altchek, Joshua S Dines, Shoulder and Sports Medicine Service, Hospital for Special Surgery, New York, NY 10021, United States
Neal S Elattrache, Kerlan-Jobe Orthopaedic Clinic, Los Angeles, CA 90045, United States
Author contributions: Conti MS, Camp CL and Dines JS wrote the paper; Elattrache NS and Altchek DW reviewed and revised the manuscript.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Joshua S Dines, MD, Shoulder and Sports Medicine Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United States.
Telephone: +1-516-4821037 Fax: +1-516-4829217
Received: April 23, 2016
Peer-review started: April 24, 2016
First decision: June 6, 2016
Revised: July 15, 2016
Accepted: August 6, 2016
Article in press: August 8, 2016
Published online: October 18, 2016

Ulnar nerve (UN) injuries are a common complaint amongst overhead athletes. The UN is strained during periods of extreme valgus stress at the elbow, especially in the late-cocking and early acceleration phases of throwing. Although early ulnar collateral ligament (UCL) reconstruction techniques frequently included routine submuscular UN transposition, this is becoming less common with more modern techniques. We review the recent literature on the sites of UN compression, techniques to evaluate the UN nerve, and treatment of UN pathology in the overhead athlete. We also discuss our preferred techniques for selective decompression and anterior transposition of the UN when indicated. More recent studies support the use of UN transpositions only when there are specific preoperative symptoms. Athletes with isolated ulnar neuropathy are increasingly being treated with subcutaneous anterior transposition of the nerve rather than submuscular transposition. When ulnar neuropathy occurs with UCL insufficiency, adoption of the muscle-splitting approach for UCL reconstructions, as well as using a subcutaneous UN transposition have led to fewer postoperative complications and improved outcomes. Prudent handling of the UN in addition to appropriate surgical technique can lead to a high percentage of athletes who return to competitive sports following surgery for ulnar neuropathy.

Keywords: Ulnar nerve, Neuropathy, Ulnar collateral ligament reconstruction, Management, Athletes

Core tip: Ulnar nerve (UN) injuries frequently plague overhead athletes due to the strain caused by extreme valgus stress across the elbow during throwing. In this paper, we review common locations of UN compression and keys to the evaluation. We also discuss the recent literature on treatment of injuries to the UN in overhead athletes and our preferred techniques for addressing UN symptomatology during concomitant UCL reconstruction. Athletes are increasingly being treated with subcutaneous anterior UN transpositions only when appreciable neurologic symptoms are present preoperatively.