The ulnar groove is a shallow groove on the posterior surface of the medial epicondyle of the humerus through which the ulnar nerve passes before entering the cubital tunnel. The groove is roofed by the cubital tunnel retinaculum (Osborne ligament) to form the cubital tunnel. The depth and shape of the groove varies; a shallow or absent groove predisposes to ulnar nerve subluxation.
The ulnar groove is the anatomical basis of the cubital tunnel and the primary site of ulnar nerve compression at the elbow (cubital tunnel syndrome). The nerve is palpable and compressible in the groove, and direct pressure produces tingling in the ring and little finger distributions (Tinel sign). A shallow groove may allow the ulnar nerve to sublux anteriorly over the medial epicondyle with elbow flexion, producing a snapping sensation. Surgical management of recalcitrant cubital tunnel syndrome includes simple decompression of the Osborne ligament or ulnar nerve transposition out of the groove to an anterior subcutaneous, intramuscular, or submuscular position.
A shallow ulnar groove allows the ulnar nerve to snap anteriorly over the medial epicondyle during elbow flexion, producing a painful snapping sensation and ulnar neuropathy from repeated friction trauma; anterior transposition moves the nerve out of the shallow groove into a protected anterior position.
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