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Musculoskeletal and Sports Medicine

Beyond Decompression: EMG and Ultrasound-Guided Management of Recurrent Ulnar Neuropathy

Thursday, October 23, 2025
12:45 PM - 2:15 PM MT
Location: Kiosk 3

    Poster Presenter(s)

  • Sophia Artamendi, Other

    Medical Student
    Florida International University Herbert Wertheim College of Medicine
    Fort Lauderdale, Florida

    • Co-Author(s)

  • DC

    David Collins, Other

    Medical Student
    FIU Herbert Wertheim College of Medicine
    Miami, Florida

  • CB

    Cody Barbari, DO

    PGY-4 Resident Physician
    Memorial Healthcare System (Hollywood) PM&R Program
    Hollywood, Florida

  • GN

    Giorgio Negron, MD

    Sports Medicine Physician
    Memorial Healthcare System
    Fort Lauderdale, Florida

  • RK

    Robert Klecz, MD

    Physiatrist
    Department of Physical Medicine and Rehabilitation, Memorial Health System
    Hollywood, Florida

Disclosure(s):
Sophia Artamendi, Other: No financial relationships to disclose
Case Diagnosis: Recurrent ulnar neuropathy following cubital tunnel decompression with suspected left thumb carpometacarpal subluxation.

Case Description or Program Description: A 38-year-old female with hypertension presented with worsening right ulnar nerve dysfunction five months post-cubital tunnel decompression. She displayed significant intrinsic right hand weakness, decreased sensation in ulnar nerve distribution, and a positive Tinel’s sign at the cubital tunnel. She also reported left thumb pain and CMC instability, attributed to compensating overuse.

Setting: Outpatient musculoskeletal and electrodiagnostic medicine clinic

Assessment/Results: Electrodiagnostic studies showed right ulnar nerve axonal loss with conduction slowing across the elbow and conduction block at the wrist. Chronic denervation in the ulnar-innervated muscles was noted along with acute membrane instability in the first dorsal interosseous, suggesting ongoing injury. Ultrasound identified pathology of the right ulnar nerve at the distal ulnar humerus and the entrance at the flexor carpi ulnar heads. Focal nerve swelling with angulated kinking was shown as the ulnar nerve passes the superficial fascia. Additionally, signs of fibrosis were noted superficial to the ulnar nerve at Guyon’s canal without mass effect.

Discussion (relevance): While decompression is typically effective, this case demonstrates the need for continued monitoring when symptoms persist. The integration of EMG and ultrasound played a crucial role in guiding comprehensive management strategies for persistent ulnar nerve dysfunction despite prior surgical intervention. Additionally, left thumb CMC instability highlights compensatory mechanisms contributing to secondary pathologies, requiring rehabilitation. Diagnostic findings influenced the decision for revision decompression, anterior subcutaneous transposition, Guyon’s canal decompression, and AIN-to-ulnar motor nerve transfer.

Conclusions: Recognizing persistent nerve dysfunction and compensatory musculoskeletal injuries is essential for optimizing functional outcomes. This case underscores the value of EMG and ultrasound in diagnosing and managing recurrent ulnar neuropathy post-decompression. Integrating diagnostics with surgical and rehabilitative strategies was instrumental to enhancing recovery.