![]() A better understanding of the relevant (sono)anatomy might help optimize clinical reasoning in patients presenting with UNE symptoms ( 5). It also provides a sort of “US-assisted physical examination,” e.g., “sono-Tinel” and “sono-palpation” ( 4). US imaging is an emerging tool in physicians' clinical practice across different specialties ( 3), as it allows an immediate correlation between imaging and clinical findings. The UN can be depicted using high-end US equipment with a high resolution in its course from the axilla to palm level ( 2). Ultrasound (US) imaging might provide better insight into the UN morphology, mainly if the diagnosis is in doubt. If not treated timely and adequately, UNE can progress to persistent impairment of sensation, pareses, and joint contracture ( 1). However, due to anatomic variations, a broad spectrum of differential diagnoses, and miscellaneous clinical presentations, the clinical diagnosis is often far from straightforward. The features suggesting a lesion of the ulnar nerve (UN) are based upon knowledge of the UN and its sensory and motor branch distribution. Ulnar neuropathy at the elbow (UNE) represents the second most common entrapment neuropathy in the upper extremity encountered in clinical practice. In the operative treatment description, an emphasis is put on two commonly used approaches- in situ decompression and anterior transpositions. The non-surgical management description covers activity modifications, splinting, neuromobilization/gliding exercise, and physical agents. Additionally, the authors also exemplify the scientific evidence from the literature supporting the proposition that US guidance is beneficial in injection therapy of UNE. Pathologies covering ulnar nerve instability, idiopathic cubital tunnel syndrome, space-occupying lesions (e.g., ganglion, heterotopic ossification, aberrant veins, and anconeus epitrochlearis muscle) are presented. This review aims to illustrate the ulnar nerve's detailed anatomy at the elbow using cadaveric images to understand better both static and dynamic imaging of the ulnar nerve around the elbow. While the retroepicondylar groove and its surrounding structures are quite superficial, the use of ultrasound (US) imaging is associated with the following advantages: (1) an excellent spatial resolution allows a detailed morphological assessment of the ulnar nerve and adjacent structures, (2) dynamic imaging represents the gold standard for assessing the ulnar nerve stability in the retroepicondylar groove during flexion/extension, and (3) US guidance bears the capability of increasing the accuracy and safety of injections. It results from either static or dynamic compression of the ulnar nerve. ![]() Ulnar neuropathy at the elbow (UNE) is commonly encountered in clinical practice. 5Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czechia.4Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia.3Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czechia.2Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia. ![]() 1Department of Rehabilitation Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia.Kamal Mezian 1 * Jakub Jačisko 2 Radek Kaiser 3 Stanislav Machač 2 Petra Steyerová 4 Karolína Sobotová 2 Yvona Angerová 1 Ondřej Naňka 5
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