To the Editor.—
The letter by John F. Aita, MD, concerning ulnar neuropathy occurring after cardiac surgery (1981;245:2295) attracted our attention. We have also recently noticed two cases of ulnar neuropathy at the elbow occurring after coronary bypass surgery. One of these patients underwent ulnar nerve transposition and has shown remarkable improvement, both in sensation and in strength of the abductor digiti quinti muscle.We must take issue, however, with the suggestion that this neuropathy is exclusively compressive in nature. At our institution, we have scrupulously padded the elbow in patients undergoing surgery of any sort in the supine position. Furthermore, we are careful not to tape the arm on an arm board in such a fashion as to produce pressure in the cubital tunnel, either from the edge of the arm board or from adjacent tubing. Despite these precautions, we have noted the occurrence of postcardiotomy ulnar nerve palsy.