REVIEW ARTICLE| Volume 102, ISSUE 11, P2231-2238, November 2021

Is There an Association Between Ulnar Nerve Hypermobility and Neuropathy at the Elbow?

Published:March 11, 2021DOI:



      To systematically review the association between ulnar nerve hypermobility (UNH) at the elbow and ulnar neuropathy (UNE).

      Data Sources

      Cumulative Index to Nursing and Allied Health, MEDLINE, and Embase databases were searched for English language studies published up to July 4, 2020.

      Study Selection

      We included case-control, cohort, and randomized controlled studies that established the presence or absence of UNH and UNE. Twenty out of 654 studies identified met the inclusion criteria.

      Data Extraction

      Two reviewers independently extracted data for analysis. Risk of bias and applicability were assessed with the QUADAS-2 tool.

      Data Synthesis

      We compared rates of UNH between patients diagnosed with and without UNE and found no significant difference. The meta-analysis pooled rate of UNH was 0.37 (95% confidence interval, 0.20-0.57) for those without UNE and 0.33 (95% confidence interval, 0.23-0.45) for those with UNE.


      The clinical finding of UNH is unhelpful when assessing for UNE, as the presence of UNH does not make the diagnosis of UNE more likely.


      List of abbreviations:

      CI (confidence interval), CSA (cross-sectional area), UND (ulnar nerve dislocation), UNE (ulnar neuropathy at the elbow), UNH (ulnar nerve hypermobility), UNS (ulnar nerve subluxation)
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        • Ashenhurst EM.
        Anatomical factors in the etiology of ulnar neuropathy.
        Canadian Medical Association journal. 1962; 87
        • Kang S
        • Yoon JS
        • Yang SN
        • Choi HS.
        Retrospective study on the impact of ulnar nerve dislocation on the pathophysiology of ulnar neuropathy at the elbow.
        PeerJ. 2019; 2019
        • Michelin P
        • Leleup G
        • Ould-Slimane M
        • Merlet MC
        • Dubourg B
        • Duparc F.
        Ultrasound biomechanical anatomy of the soft structures in relation to the ulnar nerve in the cubital tunnel of the elbow.
        Surgical and Radiologic Anatomy. 2017; 39
        • van den Berg PJ
        • Pompe SM
        • Beekman R
        • Visser LH.
        Sonographic incidence of ulnar nerve (sub)luxation and its associated clinical and electrodiagnostic characteristics.
        Muscle and Nerve. 2013; 47
        • Okamoto M
        • Abe M
        • Shirai H
        • Ueda N.
        Morphology and dynamics of the ulnar nerve in the cubital tunnel. Observation by ultrasonography.
        Journal of Hand Surgery. 2000; 25 B
        • Calfee RP
        • Manske PR
        • Gelberman RH
        • van Steyn MO
        • Steffen J
        • Goldfarb CA.
        Clinical assessment of the ulnar nerve at the elbow: Reliability of instability testing and the association of hypermobility with clinical symptoms.
        Journal of Bone and Joint Surgery - Series A. 2010; 92
        • Schertz M
        • Mutschler C
        • Masmejean E
        • Silvera J.
        High-resolution ultrasound in etiological evaluation of ulnar neuropathy at the elbow.
        European Journal of Radiology. 2017; 95
        • Cornelson SM
        • Sclocco R
        • Kettner NW.
        Ulnar nerve instability in the cubital tunnel of asymptomatic volunteers.
        Journal of Ultrasound. 2019; 22
        • Moher D
        • Liberati A
        • Tetzlaff J
        • et al.
        Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement.
        PLoS Medicine. 2009; 6
        • Stijnen T
        • Hamza TH
        • Özdemir P.
        Random effects meta-analysis of event outcome in the framework of the generalized linear mixed model with applications in sparse data.
        Statistics in Medicine. 2010; 29
        • Schwarzer G
        • Chemaitelly H
        • Abu-Raddad LJ
        • Rücker G.
        Seriously misleading results using inverse of Freeman-Tukey double arcsine transformation in meta-analysis of single proportions.
        Research Synthesis Methods. 2019; 10
        • Leis AA
        • Smith BE
        • Kosiorek HE
        • Omejec G
        • Podnar S.
        Complete dislocation of the ulnar nerve at the elbow: a protective effect against neuropathy?.
        Muscle and Nerve. 2017; 56
        • Zeng X
        • Zhang Y
        • Kwong JSW
        • et al.
        The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta-analysis, and clinical practice guideline: A systematic review.
        Journal of Evidence-Based Medicine. 2015; 8
        • Whiting PF
        • Rutjes AWS
        • Westwood ME
        • et al.
        Quadas-2: A revised tool for the quality assessment of diagnostic accuracy studies.
        Annals of Internal Medicine. 2011; 155
        • Viera AJ
        • Garrett JM.
        Understanding interobserver agreement: The kappa statistic.
        Family Medicine. 2005; 37
        • CHILDRESS HM
        Recurrent ulnar-nerve dislocation at the elbow.
        The Journal of bone and joint surgery American volume. 1956; 38-A
        • Filippou G
        • Mondelli M
        • Greco G
        • et al.
        Ulnar neuropathy at the elbow: How frequent is the idiopathic form? An ultrasonographic study in a cohort of patients.
        Clinical and Experimental Rheumatology. 2010; 28
        • Granata G
        • Padua L
        • Celletti C
        • Castori M
        • Saraceni VM
        • Camerota F.
        Entrapment neuropathies and polyneuropathies in joint hypermobility syndrome/Ehlers-Danlos syndrome.
        Clinical Neurophysiology. 2013; 124
        • Kim BJ
        • Koh SB
        • Park KW
        • Kim SJ
        • Yoon JS.
        Pearls & Oy-sters: False positives in short-segment nerve conduction studies due to ulnar nerve dislocation.
        Neurology. 2008; 70
        • Kim BJ
        • Date ES
        • Lee SH
        • Yoon JS
        • Hur SY
        • Kim SJ.
        Distance measure error induced by displacement of the ulnar nerve when the elbow is flexed.
        Archives of Physical Medicine and Rehabilitation. 2005; 86
        • Kang JH
        • Joo BE
        • Kim KH
        • Park BK
        • Cha J
        • Kim DH.
        Ultrasonographic and Electrophysiological Evaluation of Ulnar Nerve Instability and Snapping of the Triceps Medial Head in Healthy Subjects.
        American Journal of Physical Medicine and Rehabilitation. 2017; 96
        • Matev B.
        Cubital tunnel syndrome.
        Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand. 2003; 8
        • Michael AE
        • Young P.
        Is triceps hypertrophy associated with ulnar nerve luxation?.
        Muscle and Nerve. 2018; 58
        • Omejec G
        • Podnar S.
        Does ulnar nerve dislocation at the elbow cause neuropathy?.
        Muscle and Nerve. 2016; 53
        • Ozturk E
        • Sonmez G
        • Çolak A
        • et al.
        Sonographic appearances of the normal ulnar nerve in the cubital tunnel.
        Journal of Clinical Ultrasound. 2008; 36
        • Pelosi L
        • Mulroy E.
        Diagnostic sensitivity of electrophysiology and ultrasonography in ulnar neuropathies of different severity.
        Clinical Neurophysiology. 2019; 130
        • Pelosi L
        • Tse DMY
        • Mulroy E
        • Chancellor AM
        • Boland MR.
        Ulnar neuropathy with abnormal non-localizing electrophysiology: Clinical, electrophysiological and ultrasound findings.
        Clinical Neurophysiology. 2018; 129
        • Terlemez R
        • Yilmaz F
        • Dogu B
        • Kuran B.
        Comparison of Ultrasonography and Short-Segment Nerve Conduction Study in Ulnar Neuropathy at the Elbow.
        Archives of Physical Medicine and Rehabilitation. 2018; 99
        • Campbell WW.
        Guidelines in electrodiagnostic medicine. Practice parameter for electrodiagnostic studies in ulnar neuropathy at the elbow.
        Muscle & nerve Supplement. 1999; 8
        • Bayrak AO
        • Bayrak IK
        • Turker H
        • Elmali M
        • Nural MS.
        Ultrasonography in patients with ulnar neuropathy at the elbow: Comparison of cross-sectional area and swelling ratio with electrophysiological severity.
        Muscle and Nerve. 2010; 41
        • Iba K
        • Wada T
        • Aoki M
        • Tsuji H
        • Oda T
        • Yamashita T.
        Intraoperative Measurement of Pressure Adjacent to the Ulnar Nerve in Patients With Cubital Tunnel Syndrome.
        Journal of Hand Surgery. 2006; 31