Post-Operative Ulnar Nerve Palsy

Perioperative ulnar nerve palsy is the most frequent peri-operative nerve palsy. It results from excessive flexion of the arm, and compression of the ulnar nerve within the tight band of the cubital groove as the nerve crosses the elbow.

There are many clinical reports highlighting the risk of ulnar nerve palsy from positioning of the arm, with flexion beyond 90º. Positioning of the arm across the chest during surgery places the ulnar nerve at risk of injury. Although this remains common practice, it is important to reiterate the message that this position is not acceptable and will result in successful negligence claims.