Postoperative ulnar neuropathy after kidney transplantation.

Postoperative ulnar neuropathy as a result of mechanical trauma at the elbow was observed in eight patients undergoing renal transplantation. In five cases this occurred on arms that were adducted during the operation and in which an arteriovenous shunt was present. In four cases (one patient had the lesion bilaterally) the other, abducted arm was affected. Analysis of possible causes revealed no single factor responsible for the condition. Factors that most likely contributed were: pressure on the adducted arm by the combined weights of patient and surgeon, blood pressure monitoring with a cuff compressing the cubital fossa, venous congestion by the arteriovenous shunt, and subclinical uraemic polyneuropathy. Although no single factor could be identified protection of the adducted arms with a hard plastic cover and placement of the blood pressure cuff as proximally as possible on the abducted arms provided a successful solution to the problem.