Selective decompression of the ulnar nerve at the arcade of Struthers: A case report

The arcade of Struthers is a known compression site in patients with ulnar neuropathy, but its presence has been debated and in case reports it has mainly been described as incidental finding during cubital tunnel surgery. In this article, we present a case of ulnar neuropathy caused by the arcade of Struthers only. A 27-year-old woman was referred with symptoms of ulnar neuropathy and weakness of intrinsic muscles, but with normal electrodiagnostic tests. On ultrasound (US) an arcade of Struthers was detected proximal to the medial epicondyl with focal indentation of the ulnar nerve and swelling of the nerve proximally and distally. A decompression of the ulnar nerve focused at this site was performed through a small incision in the mid-arm. One year after decompression her pain was almost completely relieved and strength had returned to normal. This case demonstrates the value of pre-operative US in ulnar neuropathy and the option of selective decompression of the arcade of Struthers.