1612 - When “Better Late Than Never” is Not Better: A Case Report on Tardy Ulnar Nerve Palsy

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

DM

Daniel S. Marte, MD

Resident Physician
Icahn School of Medicine at Mount Sinai
New York City, New York, United States

Co-Author(s)

AT

Aruna Thyagaraj, MD

Assistant Professor
NYC Health + Hospitals/Elmhurst
Elmhurst, New York, United States

Submitter(s)

DM

Daniel S. Marte, MD

Icahn School of Medicine at Mount Sinai
New York City, New York, United States

Case Diagnosis: Tardy Ulnar Nerve Palsy

Case Description: A 48-year-old man with a prior childhood left elbow fracture treated non-operatively presented for an electromyography (EMG) and nerve conduction study (NCS) for left-hand weakness, numbness, and tingling. Symptoms began four years ago without an inciting injury, initially presenting as paresthesia over the left medial epicondyle radiating distally to the dorsal and plantar surfaces of his 4th and 5th digits. Three months ago, he developed progressive weakness and muscle wasting without a clear trigger. Elbow x-ray showed post-traumatic degenerative changes. Physical exam revealed hypothenar and intrinsic hand muscle atrophy, sensory loss in the ulnar distribution, weak finger flexion of the 4th and 5th digits, absent abductor digiti minimi (ADM) strength, and ulnar claw hand. NCS revealed absent responses in the left ulnar motor and ulnar sensory nerves at the wrist. EMG demonstrated denervation and impaired recruitment in the left ADM, first dorsal interosseous, flexor digitorum profundus, and flexor carpi ulnaris.

Discussions: This patient’s electrodiagnostic studies were consistent with severe combined motor and sensory ulnar neuropathy. His presentation suggests tardy ulnar nerve palsy secondary to prior elbow fracture, which likely altered the patient’s anatomy and predisposed him to nerve irritation along the nerve tract. His delay in treatment led to worsening neuropathy and ulnar nerve palsy. Given the severity of his symptoms, the patient was referred to occupational therapy and surgery for possible nerve decompression or tendon transfer.

Conclusions:

Tardy ulnar nerve palsy is a debilitating condition that can present years to decades after an elbow injury. It should be considered in the differential for acute ulnar neuropathies of unclear etiology in patients with a history of elbow trauma. EMG and NCS are essential for diagnosis.