Hand Clin 23 (2007) 283–289

Ulnar Nerve Anatomy

Daniel B. Polatsch, MD*, Charles P. Melone, Jr, MD,
Steven Beldner, MD, Angelo Incorvaia, MD
Department of Orthopaedic Surgery, Albert Einstein College of Medicine,
Beth Israel Medical Center, Hand Surgery Center, 321 East 34th Street, New York, NY 10016, USA

The ulnar nerve originates from the ventral
rami of the C8 and T1 nerve roots, which unite to
form the lower trunk of the brachial plexus. The
lower trunk then divides into an anterior and
posterior division with the fibers of the ulnar nerve
in the anterior division, which becomes the medial
cord. The cords are named according to their
position relative to the axillary artery. The ulnar
nerve exits the brachial plexus as a terminal branch
of the medial cord and travels from the axilla into
the medial aspect of the anterior compartment of
the upper arm. The ulnar nerve is a mixed nerve
containing both motor and sensory axons.
Anatomy of ulnar nerve at elbow
In the upper arm, the ulnar nerve lies poster-
omedial to the brachial artery. It then traverses the
medial intermuscular septum posteriorly, passing
through the arcade of Struthers approximately 8
cm proximal to the medial epicondyle (Fig. 1) [1].
This arcade comprises a band of deep brachial fas-
cia that attaches to the intermuscular septum, has
a V-shaped opening, and covers the ulnar nerve
for an average length of 5.7 cm [2]. As shown
both anatomically and electrophysiologically, the
arcade of Struthers is a well-recognized potential
site of compression of the ulnar nerve [3].
As the nerve descends the lower arm, it re-
mains posterior to the intermuscular septum and
anterior to the medial head of the triceps muscle.
The medial intermuscular septum is a continuous
* Corresponding author.
E-mail address: dpolatsch@chpnet.org (D.B. Polatsch).
0749-0712/07/$ - see front matter ! 2007 Elsevier Inc. All rights reserved.
doi:10.1016/j.hcl.2007.05.001
structure that thickens and flares out distally as it
inserts onto the medial epicondyle of the distal
humerus. The intermuscular septum is a potential
site of compression of the ulnar nerve after
anterior transposition or in a patient with a con-
genitally unstable ulnar nerve that subluxes over
the medial epicondyle [4]. Thus, a consensus exists
that this septum should routinely be excised after
anterior transposition of the ulnar nerve. Several
thin-walled veins lie on the dorsal surface of the
septum, just proximal to its insertion on the me-
dial epicondyle. During nerve decompression,
the veins must be recognized and carefully coagu-
lated. Proximal to the medial epicondyle, the
ulnar nerve is superficial and often palpable. It is
in that location that a prominent medial head of
the triceps and an anomalous anconeus epitro-
chlearis muscle have been identified as causes of
ulnar nerve compression [5,6]. The anconeus
epitrochlearis muscle originates on the medial
border of the olecranon and adjacent triceps,
and it inserts onto the medial epicondyle. This
anomalous muscle has been shown to be present
in 3% to 28% of cadaver specimens [7–9].
Subcutaneously, at the level of the elbow, lies
the medial antebrachial cutaneous (MABC) nerve.
This nerve is a direct branch of the medial cord
(C8 and T1) and descends in the arm anterior and
medial to the brachial artery. The MABC nerve
emerges from under the brachial fascia adjacent to
the basilic vein (Fig. 2). The nerve usually divides
into several branches above the elbow as it courses
toward the medial epicondyle and olecranon to
innervate the skin of the anterior and medial sur-
face of the forearm. The principal nerve branches
might pass either proximal or distal to the epicon-
dyle. One study found the posterior branches of
hand.theclinics.com

Descargado para Anonymous User (n/a) en National Autonomous University of Mexico de ClinicalKey.es por Elsevier en octubre 02, 2019.
Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2019. Elsevier Inc. Todos los derechos reservados.
284
Fig. 1. Anatomy of the ulnar nerve at the elbow. a., artery; FCU, flexor carpi ulnaris; n., nerve; m., muscle; Med. epi.,
medial epicondyle; olec., olecranon.
the MABC nerve to pass posterior to the ulnar
nerve at or proximal to the epicondyle in 90%
of cases [10]. Another recent anatomic study found
the posterior branches of the MABC nerve to cross
at or proximal to the medial epicondyle in 61% of
cases at an average distance of 1.8 cm from the epi-
condyle [11]. The most proximal branch often runs
with the previously mentioned medial intermuscu-
lar septum. These reports indicate that this nerve
and its branches are in a highly vulnerable surgical
zone at the medial aspect of the elbow. Thus, in all
cases, these cutaneous nerves must be carefully
identified and protected when performing ulnar
nerve decompression with or without transposition
in an effort to avoid potentially troublesome iatro-
genic injury [12].
Approaching the elbow, the ulnar nerve con-
tinues posterior to the medial epicondyle and
therefore posterior to the axis of rotation of the
elbow and enters the cubital tunnel proper. The
roof of the cubital tunnel consists of the cubital
tunnel retinaculum (CTR), also termed ‘‘Os-
borne’s ligament,’’ and the deep layer of the
aponeurosis of the two heads of the flexor carpi
ulnaris (FCU) muscle. The CTR is the proximal-
most roof of the tunnel and serves to prevent
Descargado para Anonymous User (n/a) en National Autonomous University of Mexico de ClinicalKey.es por Elsevier en octubre 02, 2019.
Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2019. Elsevier Inc. Todos los derechos reservados.
POLATSCH et al
anterior subluxation of the nerve with elbow
flexion [13]. The deep layer of the aponeurosis of
the two heads of the FCU muscle, so-called ‘‘Os-
borne’s fascia,’’ forms the distal roof of the tunnel
and is a frequent site of ulnar nerve compression.
The floor of the cubital tunnel consists of the el-
bow capsule and the posterior and transverse por-
tions of the medial collateral ligament.
Compression of the ulnar nerve in the cubital
tunnel might be caused by various conditions.
Lesions compromising the dimensions of the
cubital tunnel can lead to nerve compression
within the tunnel and include ganglia, fractures,
arthritic osteophytes, traumatic hemorrhage, soft-
tissue masses, infections, osteochondromas, and
synovitis from the adjacent elbow joint [14].
Dynamic but physiological compression of the
ulnar nerve is apt to occur whenever the elbow is
flexed because of a reduction in the volume of the
cubital tunnel [15,16]. Pressures within the cubital
tunnel have been shown to increase 20-fold with
elbow flexion and simultaneous FCU muscle
contraction [17]. Ulnar nerve compression is
thus prone to result from activities that lead to
prolonged periods of elbow flexion and direct
pressure on the medial elbow. The activities
 ULNAR NERVE ANATOMY 285

Fig. 2. Superficial anatomy of the medial aspect of the elbow. Med. epi., medial epicondyle; n., nerve; olec., olecranon;
v., vein.

include sleeping with the elbow flexed, weightlift-
ing, airplane travel, driving, excessive typing,
and repetitive use of phones.
Compression of the ulnar nerve also might be
the consequence of congenital laxity of the CTR
with resultant ulnar nerve hypermobility. With
this not infrequent condition, the nerve repeti-
tively subluxes and even dislocates anteriorly
when the elbow assumes a position of flexion.
This hypermobility predisposes the nerve to be-
come inflamed from constant friction while resting
over the medial epicondyle [14]. In this position,
the nerve is more superficial than when in its nor-
mal state and is thus also vulnerable to external
pressures. It is important to remember that
approximately 20% of the population has this
condition and that it often is bilateral and asymp-
tomatic [18].
Other unusual instances of nerve anomalies,
such as hypertrophic neuropathy [19] or nerve tu-
mors, might be the cause of compression neurop-
athy because of a relative compromise of cubital
tunnel dimensions.
Just before entering the cubital tunnel, the
ulnar nerve gives off its first branch, which is
thought to provide articular proprioception to the
elbow. After passing through the cubital tunnel,
the ulnar nerve travels deep to Osborne’s fascia
between the ulnar and humeral heads of the FCU
muscle. Distally, this fascia invests the FCU in
two layers, the deeper of which continues for
approximately 3 to 5 cm to the end of the cubital
tunnel [13]. The ulnar nerve then penetrates the
fascia to lie between the FCU and flexor digito-
rum profundus muscle bellies. This relatively rigid
Osborne’s fascia poses a frequent source of com-
pression and must always be incised at the time
of nerve decompression [20].
While still in the cubital tunnel, the ulnar nerve
gives off multiple motor branches to the FCU and
the ulnar half of the flexor digitorum profundus.
In a recent anatomic study, a mean of 3.4 motor
branches to the FCU muscles was observed, with
the majority branching on the ulnar side [21].
Anatomy of the ulnar nerve in the forearm
The ulnar nerve descends down the arm, deep
to the FCU on the surface of the flexor digitorum
profundus. At the junction of the middle and
distal third of the forearm, the ulnar nerve passes

Descargado para Anonymous User (n/a) en National Autonomous University of Mexico de ClinicalKey.es por Elsevier en octubre 02, 2019.
Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2019. Elsevier Inc. Todos los derechos reservados.
286
ulnar to the ulnar artery and both lie subjacent to
the FCU. The palmar cutaneous branch of the
ulnar nerve, also termed the ‘‘nerve of Henle,’’ is
referenced sparingly in most anatomic textbooks
(Fig. 3) [22]. McCabe and Kleinert [23] described
the nerve of Henle most typically to originate
16 cm proximal to the ulnar styloid and innervate
the distal ulnar flexor surface of the forearm in
a variable distribution. In atypical cases, it was
found to originate only 8 cm from the ulnar sty-
loid. The authors speculated that this nerve con-
tributes to the sympathetic innervation of the
ulnar artery, and this was later confirmed by the
use of immunohistochemistry staining [24].
In the distal third of the forearm, the dorsal
cutaneous branch of the ulnar nerve separates
from the main trunk and passes ulnar to the FCU
(see Fig. 3). The dorsal cutaneous branch then
pierces the fascia of the FCU muscle to enter the
dorsal ulnar aspect of the forearm. Despite fre-
quent variability, the nerve usually pierces the fas-
cia between 3 and 5 cm proximal to the ulnar
Fig. 3. Anatomy of the ulnar nerve and palmar cutane-
ous branch of the ulnar nerve (nerve of Henle) in the
forearm. a., artery; FCR, flexor carpi radialis; FDS,
flexor digitorum superficialis; m., muscle; n., nerve.
Descargado para Anonymous User (n/a) en National Autonomous University of Mexico de ClinicalKey.es por Elsevier en octubre 02, 2019.
Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2019. Elsevier Inc. Todos los derechos reservados.
POLATSCH et al
head. The dorsal cutaneous branch then divides
into a radial and ulnar branch, providing sensa-
tion to the dorso-ulnar aspect of the hand and
dorsum of the small and ring fingers and commu-
nicating with the radial sensory nerve. Many ana-
tomic variations in the dorsal cutaneous nerve
have been reported, the most common being
termed ‘‘Kaplan’s accessory branch’’ [25–28].
Kaplan [25] described an aberrant branch of the
dorsal cutaneous nerve arising proximal to the ul-
nar styloid process and coursing ulnar to the pisi-
form to rejoin the proximal volar sensory branch
of the ulnar nerve.
Also in the distal third of the forearm, a clin-
ically significant change in internal ulnar nerve
anatomy occurs. At that level, the principal motor
fascicles begin a change in course from an ulnar
and relatively volar location within the major
nerve trunk to a radial and dorsal positiond
a reorientation of motor bundles that is well
established as the nerve approaches the wrist.
Recognition of this change in topographical
anatomy is essential to an accurate neurorrhaphy
when ulnar nerve transection occurs at this
frequent site of trauma.
Anatomy of the ulnar nerve at the wrist and hand
The main or volar trunk of the ulnar nerve
continues subjacent to the FCU and becomes
relatively superficial, covered by fascia and skin.
The ulnar nerve and artery enter Guyon’s canal,
which is a fibro-osseous tunnel formed between
the pisiform and hamate hook (Fig. 4). The floor
of the canal is formed by the pisohamate ligament,
and the roof is the superficial volar carpal liga-
ment. Within Guyon’s canal, the ulnar nerve bi-
furcates into superficial and deep branches. The
ulnar artery lies radial to the ulnar nerve.
The branches of the ulnar nerve continue into
the hand with the superficial branch classically
described as innervating the palmaris brevis mus-
cle and continuing distally as a pure sensory nerve
over the hypothenar muscles and dividing into the
fourth common digital nerve and the ulnar proper
digital nerve to the small finger. Variations and
overlap of this ‘‘typical’’ description exist and
have been described in the literature [29–31]. The
inconsistencies might lead to confusion and delay
in diagnosis of certain compressive neuropathies
and traumatic injuries. The presence of communi-
cation between the ulnar fourth common digital
nerve and the median third common digital nerve
 ULNAR NERVE ANATOMY 287

Fig. 4. Anatomy of the ulnar nerve at Guyon canal. a., artery; Ham., hamate; lig., ligament; mm., muscles; n., nerve.

should be considered when the digital sensory pre-
sentation is atypical. The ramus communicans has
been described in the literature as being present in
4% to 100% of patients [26,30].
The deep or motor branch of the ulnar nerve,
accompanied by the deep branch of the ulnar
artery, then passes between the abductor digiti
minimi and the flexor digiti minimi brevis. This
typically occurs just distal to the pisohamate
ligament, which serves as an important landmark
when isolating the motor branch. The motor
branch then perforates the opponens digiti minimi
and courses radially and deep to curve around the
hook of the hamate. It then follows the course of
the deep palmar arch beneath the flexor tendons.
At its origin, it supplies the hypothenar muscles.
As it crosses the deep part of the hand, it supplies
all the interosseous muscles and the third and
fourth lumbricals. It ends by supplying the
adductor pollicis and the medial head of the flexor
pollicis brevis. It also sends articular branches to
the adjacent carpal joints.
Several clinical presentations of ulnar nerve
dysfunction can occur because of compression at
the level of the wrist and hand. The presentations
might involve isolated sensory loss, isolated motor
weakness, or a combination of both [32–34]. The
clinical presentation is dictated by the anatomic
site of compression. Guyon’s canal often is di-
vided into three zones, with zone 1 being the
area proximal to the bifurcation of the ulnar
nerve. Compression in zone 1 leads to a combined
motor and sensory loss. Zone 2 includes the deep
or motor branch after it has bifurcated. Compres-
sion in zone 2 leads to isolated loss of motor func-
tion of the ulnar innervated muscles. Zone 3
encompasses the superficial or sensory branch of
the ulnar nerve, and injury at the zone 3 level leads
to sensory loss of the hypothenar eminence, small
finger, and part of the ring finger; however, it does
not lead to motor weakness.
Ulnar tunnel syndrome has been well described
in the literature and might be the result of various
causes, including ganglia [33–36], fractures or dis-
locations of the ulnar side of the wrist [34,37,38],
anomalous muscle bellies or fibrous bands
[36,39,40], hemangiomas [41], bipartite hamate
[42], giant cell tumors [43], thrombosis of the
ulnar artery [34,36,44], osteoarthritis of the distal
radioulnar joint and carpal joints [45,46], rheuma-
toid tenosynovitis [47], and bicycle racing and
other activities that require either prolonged wrist

Descargado para Anonymous User (n/a) en National Autonomous University of Mexico de ClinicalKey.es por Elsevier en octubre 02, 2019.
Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2019. Elsevier Inc. Todos los derechos reservados.
288
hyperextension or continuous pressure on the
hypothenar eminence [41].
Ulnar nerve anastomoses
Two commonly mentioned nerve variations
must be recognized because they are apt to
confuse the diagnosis of ulnar nerve dysfunction,
resulting in delayed or erroneous treatment. The
first is the Martin-Gruber anastomosis in the
forearm. With this anomaly, there is a communi-
cation between the ulnar nerve and the median
nerve in the forearm. The point of connection can
be anywhere from 3 to 10 cm distal to the medial
epicondyle [48]. With a typical Martin-Gruber
anastomosis, the motor nerves that ultimately in-
nervate the ulnar intrinsic muscles are carried
in the anterior interosseous nerve (AIN) branch
of the median nerve. In the middle of the forearm,
the motor fibers leave the AIN to join the ulnar
nerve. Thus, with this condition, functioning in-
trinsics are present despite a complete ulnar nerve
injury proximal to this connection.
The second variation is the Riche-Cannieu
anastomosis, by which the median and ulnar
nerves cross-connect in the palm. In such cases,
the motor fibers that typically are part of the
median nerve might be carried in the ulnar nerve
to the level of the hand and cross over in the palm.
With this anomaly, a patient with advanced carpal
tunnel syndrome resulting in a markedly compro-
mised median nerve might have near normal
thenar function, both clinically and electrophysi-
ologically [49].
Summary
The anatomy of the ulnar nerve in the upper
extremity is complex because of its passage
through various confined spaces. Knowledge of
the local, often variable, anatomy is essential for
accurate diagnosis and successful treatment of
ulnar nerve dysfunction. Surgical management
requires a thorough exploration and complete
release of all potential sites of compression when
treating neuropathies of the upper extremity.
Particular attention should be directed toward
identifying and addressing anomalous structures
and space-occupying lesions. A more proximal
site of pathology, systemic peripheral neuropa-
thies, and the possibility of peripheral nerve
anastomosis should be considered when the
Descargado para Anonymous User (n/a) en National Autonomous University of Mexico de ClinicalKey.es por Elsevier en octubre 02, 2019.
Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2019. Elsevier Inc. Todos los derechos reservados.
POLATSCH et al
clinical picture does not match the expected
physical findings.
Acknowledgment
The authors thank Jill K. Gregory, MFA,
CMI, medical illustrator, and Dori Kelly, MA,
senior editor.
References
[1] Spinner M. Injuries to the major branches of periph-
eral nerves of the forearm. Philadelphia: WB Saun-
ders; 1978.
[2] von Schroeder HP, Scheker LR. Redefining the
‘‘arcade of Struthers’’. J Hand Surg [Am] 2003;
28(6):1018–21.
[3] Ochiai N, Hayashi T, Ninomiya S. High ulnar nerve
palsy caused by the arcade of Struthers. J Hand Surg
[Br] 1992;17(6):629–31.
[4] Polatsch DB, Bong MR, Rokito AS. Severe ulnar
neuropathy after subcutaneous transposition in
a collegiate tennis player. Am J Orthop 2002;
31(11):643–6.
[5] Matsuura S, Kojima T, Kinoshita Y. Cubital tunnel
syndrome caused by abnormal insertion of triceps
brachii muscle. J Hand Surg [Br] 1994;19(1):38–9.
[6] O’Hara JJ, Stone JH. Ulnar nerve compression at
the elbow caused by a prominent medial head of
the triceps and an anconeus epitrochlearis muscle.
J Hand Surg [Br] 1996;21(1):133–5.
[7] Clemens HJ. Zur morpholigie des ligamentum
epitrochleoanconaeus. Anat Anz 1957;104(17–20):
343–4 [in German].
[8] Wachsmuth W, Wilhelm A. The musculus epi-
trochleoanconaeus and its clinical significance.
Monatsschr Unfalheilkd Versicher Versorg Ver-
kehrsmed 1968;71(1):1–22 [in German].
[9] Dellon AL. Musculotendinous variations about the
medial humeral epicondyle. J Hand Surg [Br] 1986;
11(2):175–81.
[10] Masear VR, Meyer RD, Pichora DR. Surgical anat-
omy of the medial antebrachial cutaneous nerve.
J Hand Surg [Am] 1989;14(2 Pt 1):267–71.
[11] Lowe JB III, Maggi SP, Mackinnon SE. The posi-
tion of crossing branches of the medial antebrachial
cutaneous nerve during cubital tunnel surgery in
humans. Plast Reconstr Surg 2004;114(3):692–6.
[12] Dellon AL, MacKinnon SE. Injury to the medial
antebrachial cutaneous nerve during cubital tunnel
surgery. J Hand Surg [Br] 1985;10(1):33–6.
[13] O’Driscoll SW, Horii E, Carmichael SW, et al. The
cubital tunnel and ulnar neuropathy. J Bone Joint
Surg Br 1991;73(4):613–7.
[14] Posner MA. Compressive ulnar neuropathies at the
elbow: I. etiology and diagnosis. J Am Acad Orthop
Surg 1998;6(5):282–8.
 ULNAR NERVE ANATOMY
[15] Feindel W, Stratford J. Cubital tunnel compression
in tardy ulnar palsy. Can Med Assoc J 1958;78(5):
351–3.
[16] Wadsworth TG. The external compression syn-
drome of the ulnar nerve at the cubital tunnel. Clin
Orthop Relat Res 1977;124:189–204.
[17] Werner CO, Ohlin P, Elmqvist D. Pressures
recorded in ulnar neuropathy. Acta Orthop Scand
1985;56(5):404–6.
[18] Childress HM. Recurrent ulnar-nerve dislocation at
the elbow. Clin Orthop Relat Res 1975;108:168–73.
[19] Taras J, Melone CP. Hypertrophic neuropathy pre-
senting with ulnar nerve compression: a case report.
J Hand Surg [Am] 1995;20(2):233–4.
[20] Amadio PC, Beckenbaugh RD. Entrapment of the
ulnar nerve by the deep flexor-pronator aponeurosis.
J Hand Surg [Am] 1986;11(1):83–7.
[21] Tubbs RS, Custis JW, Salter EG, et al. Quantitation
of and landmarks for the muscular branches of the
ulnar nerve to the forearm for application in periph-
eral nerve neurotization procedures. J Neurosurg
2006;104(5):800–3.
[22] Henle J. Handbuch der nervenlehre des menschen.
2nd edition. Braunschweig (Germany): Vieweg
Verlag; 1868. p. 540–3.
[23] McCabe SJ, Kleinert JM. The nerve of Henle.
J Hand Surg [Am] 1990;15(5):784–8.
[24] Balogh B, Valencak J, Vesely M, et al. The nerve
of Henle: an anatomic and immunohistochemical
study. J Hand Surg [Am] 1999;24(5):1103–8.
[25] Kaplan EB. Variation in the ulnar nerve at the wrist.
Bull Hosp Joint Dis 1963;24:85–8.
[26] McCarthy RE, Nalebuff EA. Anomalous volar
branch of the dorsal cutaneous nerve: a case report.
J Hand Surg [Am] 1980;5(1):19–20.
[27] Hoogbergen MM, Kauer JM. An unusual ulnar
nerve-median nerve communicating branch. J Anat
1992;181(Pt 3):513–6.
[28] Hankins CL, Flemming S. A variant of Kaplan’s ac-
cessory branch of the dorsal cutaneous branch of the
ulnar nerve: a case report and review of the litera-
ture. J Hand Surg [Am] 2005;30(6):1231–5.
[29] Stopford JS. The variation in distribution of the cu-
taneous nerves of the hand and digits. J Anat 1918;
53(Pt 1):14–25.
[30] Meals RA, Shaner M. Variations in the digital sen-
sory patterns: a study of the ulnar nerve-median
nerve palmar communicating branch. J Hand Surg
[Am] 1983;8(4):411–4.
[31] Ferrari GP, Gilbert A. The superficial anastomosis
on the palm of the hand between the ulnar and me-
dian nerves. J Hand Surg [Br] 1991;16(5):511–4.
Descargado para Anonymous User (n/a) en National Autonomous University of Mexico de ClinicalKey.es por Elsevier en octubre 02, 2019.
Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2019. Elsevier Inc. Todos los derechos reservados.
289
[32] Brooks DM. Nerve compression by simple ganglia.
J Bone Joint Surg Br 1952;34(3):391–400.
[33] Richmond DA. Carpal ganglion with ulnar nerve
compression. J Bone Joint Surg Br 1963;45:513–5.
[34] Dupont C, Cloutier GE, Prevost Y, et al. Ulnar-
tunnel syndrome at the wrist. J Bone Joint Surg
Am 1965;47:757–61.
[35] Seddon HJ. Carpal ganglion as a cause of paralysis
of the deep branch of the ulnar nerve. J Bone Joint
Surg Br 1952;34(3):386–90.
[36] Kleinert HE, Hayes JE. The ulnar tunnel syndrome.
Plast Reconstr Surg 1971;47(1):21–4.
[37] Howard FM. Ulnar-nerve palsy in wrist fractures.
J Bone Joint Surg Am 1961;43:1197–201.
[38] Nisenfield FG, Neviaser RJ. Fracture of hook of the
hamate: a diagnosis easily missed. J Trauma 1974;
14(7):612–6.
[39] Fahrer M, Millroy PJ. Ulnar compression neuropa-
thy due to an anomalous abductor digiti minimi:
clinical and anatomic study. J Hand Surg [Am]
1981;6(3):266–8.
[40] Failla JM. The hypothenar adductor muscle: an
anomalous intrinsic muscle compressing the ulnar
nerve. J Hand Surg [Am] 1996;21(3):366–8.
[41] Ogino T, Minami A, Kato H, et al. Ulnar nerve
neuropathy at the wrist. Handchir Mikrochir Plast
Chir 1990;22(6):304–8.
[42] Greene MH, Hadied AM. Bipartite hamulus with
ulnar tunnel syndrome: case report and literature
review. J Hand Surg [Am] 1981;6(6):605–9.
[43] Milberg P, Kleinert HE. Giant cell tumor compres-
sion of the deep branch of the ulnar nerve. Ann Plast
Surg 1980;4(5):426–9.
[44] Grundberg AB. Ulnar tunnel syndrome. J Hand
Surg [Br] 1984;9:72–4.
[45] Vanderpool DW, Chalmers J, Lamb DW, et al.
Peripheral compression lesions of the ulnar nerve.
J Bone Joint Surg Br 1968;50(4):792–803.
[46] Belliappa PP, Burke FD. Excision of the pisiform in
piso-triquetral osteoarthritis. J Hand Surg [Br] 1992;
17(2):133–6.
[47] Taylor AR. Ulnar nerve compression at the wrist in
rheumatoid arthritis: report of a case. J Bone Joint
Surg Br 1974;56:142–3.
[48] Uchida Y, Sugioka Y. Electrodiagnosis of Martin-
Gruber connection and its clinical importance in
peripheral nerve surgery. J Hand Surg [Am] 1992;
17(1):54–9.
[49] Refaeian M, King JC, Dumitru D, et al. Carpal tun-
nel syndrome and the Riche-Cannieu anastomosis:
electrophysiologic findings. Electromyogr Clin
Neurophysiol 2001;41(6):377–82.