Presentation
Right 4th and 5th finger weakness for the last few days. Ultrasound for the ulnar nerve evaluation.
Patient Data
The distal arm and elbow regions show the ulnar nerve thickening due to compression at the cubital tunnel. No neural or intratunnel lesion. An accessory muscle covering the cubital tunnel - anconeus epitrochlearis. A normal ulnar nerve in the forearm and wrist. The underlying joint shows capsular thickening and marginal osteophytes. A thin-walled, anechoic ganglion cyst is present under the humeral head of the flexor carpi ulnaris muscle and possibly arising from the humeroulnar joint. However, the cyst is away from the ulnar nerve. The abnormal contour of the radial head. No joint effusion.
Short-axis cine-loop runs from the distal arm to the proximal forearm.
Old non-united fracture of the lateral condyle of the humerus. Marginal osteophytes. Radial head altered contour. Cubitus valgus. No bone lesion.
The first photo shows the ulnar nerve after dissection. The second photo shows the transposition of the ulnar nerve.
Case Discussion
The patient developed right 4th and 5th finger weakness without recent injury. He had right elbow trauma in childhood resulting in the cubitus valgus.
The ultrasound shows features of cubital tunnel syndrome due to underlying joint abnormality with the anconeus epitrochlearis being an additional factor.
The radiograph revealed a non-united fracture of the distal humerus with secondary bony changes.
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