Ulnar Neuropathy at Elbow after Flap to Graft Conversion Method for Osmidrosis Axillae

Jung, Sung No; Lim, Jee Hyun; Kwon, Ho; Chung, Sang Hun

Abstract

Ulnar neuropathy at elbow is the second most common entrapment neuropathy following carpal tunnel syndrome. However, ulnar neuropathy secondary to abnormal strain of the ulnar nerve over the sulcus due to an postoperative osmidrosis axillae position is one of rare causes of ulnar neuropathy at the elbow. Following the operation of osmidrosis axillae, a patient's arm movements were restricted with elbow flexion in order to prevent hematoma from developing at the operation site. In this case presented here, the patient developed ulnar neuropathy 7 day post osmidrosis axillae operation. He had weakness in flexion of the fourth and fifth metacarpophalangeal joints on the right hand, and also weakness in finger straddling, in particular, abduction of the 5th finger on the left hand. Additionally, there was tingling sensation of the fourth and fifth finger and the hypothenar eminence on the left hand. Motor and sensory nerve conduction studies of the left ulnar nerve showed delayed conduction velocities over the left ulnar sulcus. Ulnar neuropathy at the elbow was diagnosed based upon the clinical presentation electrophysiological findings. The patient had been advised to avoid the posture with prolonged flexion of the elbow. The symptoms had been completely resolved spontaneously in 5 months without any surgical intervention. This case has shown that postoperative osmidrosis axillae positon could cause ulnar neuropathy associated with excessive strain of the ulnar nerve during prolonged flexion of the elbow.