The patient was admitted to Shmaisani hospital complaining of pain of the right elbow for 2 years and numbness of the ulnar division of the the right hand with progressing weakness of the right hand for 1 year.

ECS and EMG done 1 week ago confirming the presence of severe entrapment of the right ulnar nerve at the cubital tunnel.

On examination, the patient has atrophy of the interosseus muscle and the hypothenar with sensory impairment including the dorsal branch of the ulnar nerve with beginning  clawing of the Vth finger.

Projectional incision over the right cubital tunnel. The ulnar nerve was exposed and it was severely compressed by the surrounding tissues. The nerve was dissected down to its peripheral branching and up through a small separate incision at the medial intramuscular septum. Inspection of the tunnel revealed a ganglion arising from the joint, which was removed and the elevated bony spur from the joint was drilled off  to provide a good depth of tunnel with good bony elevations of the medial condyle and the olecranon prominence. The nerve was put back to its previous course.

Routine closure of the wound. Smooth postoperative recovery.

The patient has repetitive trauma to the nerve due to ganglion and bony prominence irritating the ulnar nerve at cubital tunnel.

For more than 18 years, I abandoned the anterior transfer of the ulnar nerve. Instead, correction of the problem locally with deepening of the floor of the tunnel to prevent future mechanical trauma to the nerve was performed in more than 40 cases with good results.

During anterior transposition, even if not to sacrifices several branches to make the transposition, these branches will be stretched and neuralgia take place after surgery.