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Anatomy of the ulnar nerve at the elbow: Potential relationship of acute ulnar neuropathy to gender differences
Author(s) -
Contreras Michael G.,
Warner Mark A.,
Charboneau William J.,
Cahill Donald R.
Publication year - 1998
Publication title -
clinical anatomy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.667
H-Index - 71
eISSN - 1098-2353
pISSN - 0897-3806
DOI - 10.1002/(sici)1098-2353(1998)11:6<372::aid-ca2>3.0.co;2-r
Subject(s) - medicine , ulnar nerve , ulnar neuropathy , elbow , anatomy
Men develop perioperative ulnar neuropathies more frequently than women. To determine the role of anatomical gender differences in the development of these neuropathies, we performed several studies of the anatomy of the ulnar nerve, cubital tunnel, and elbow region. These studies included detailed dissection of male and female embalmed and unembalmed cadavers, ultrasound measurements of the tissue layers at the elbow, and measurement of various dimensions of the coronoid process of the ulna in multiple skeletal sets. No gross anatomical differences were found between genders regarding the course of the ulnar nerve through the upper limb. However, there was a strikingly larger (2–19 times greater) fat content on the medial aspect of the elbow in women compared to men, and the tubercle of the coronoid process was approximately 1.5 times larger in men ( P ≤ .002, rank sum test). Our finding suggest that the tubercle of the coronoid process is a likely area for external compression‐induced ischemia of the ulnar nerve because the nerve and its arterial supply (the posterior ulnar recurrent artery) are covered at the tubercle only by skin, subcutaneous fat, and a very thin aponeurosis of the flexor carpi ulnaris. Importantly, this tubercle is larger and the nerve and blood vessels passing by it are less protected by subcutaneous fat in men than in women. These two anatomical differences between men and women may contribute to the increased frequency of perioperative ulnar neuropathy induced by external pressure at the medial aspect of the elbow in men. Clin. Anat. 11:372–378, 1998. © 1998 Wiley‐Liss, Inc.