Presentation
Ring and little finger numbness.
Patient Data
Cubital valgus alignment suspected. Large elbow joint effusion. Generalized severe elbow osteoarthritis, most prominent at the posteromedial ulnotrochlear compartment with marginal osteophytes protruding into the cubital tunnel. A few intra-articular bodies, largest at the lateral aspect of the radiocapitellar compartment.
Ulnar nerve is thickened and very high T2 signal proximal to the cubital tunnel and is markedly flattened in the carpal tunnel secondary to joint effusion/synovial thickening with posteromedial osteophytes mildly compressing more proximally in the cubital tunnel. Distally in the proximal forearm the ulnar nerve remains high T2 signal.
No denervation pattern of muscle belly edema in the proximal forearm.
Common extensor tendon origin as a deep chronic partial tear. Common flexor tendon origin is intact. Biceps and triceps tendons insertions are intact with mild enthesopathy of the latter.
Case Discussion
MRI findings of thickened high T2 signal ulnar nerve are relatively non-specific for ulnar neuropathy, however, in this case there is marked flattening from effusion and osteophytes, which support the clinical diagnosis of cubital tunnel syndrome.
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