Cubital tunnel syndrome

Case contributed by Dr Shailaja Muniraj

Presentation

Tingling sensation and numbness in the little and ring finger.

Patient Data

Age: 35 years
Gender: Male
mri

Anconeus epitrochlearis muscle with resultant:

  • narrowing of the cubital tunnel
  • reduction in perineural ulnar fat
  • prominent ulnar nerve with increased signal intensity

Small volume joint effusion in radio-capitellar joint space.  

The superficial radial and posterior interosseous nerves appear normal in size and signal intensity. No abnormal vascular loop.

The median nerve shows normal signal intensity. It shows a normal course between the pronator teres and brachialis muscle. Also, it shows normal contact with the brachial vessels.

No medial epicondyle osteophytic spur, no thickening of the posterior bundle fibers of the ulnar collateral ligament, no atrophy of the flexor carpi ulnaris or flexor digitorum profundus muscles.

Case Discussion

Ulnar neuropathy assessment can be challenging imaging wise.

However, the radiologist should evaluate the ulnar nerve in the following anatomical regions:

  • medial intermuscular septum - arcade of Struthers
  • medial epicondyle - osteophytic spur or bony growth
  • cubital tunnel
  • flexor-pronator aponeurosis between the heads of the flexor carpi ulnaris

If the above four regions show no compression features, look for ulnar nerve subluxation, humerus fracture, ganglion cyst, synovitis, locoregional infection or tumor and nerve intrinsic causes (like tumors).

Also, a clinical history of overuse (repetitive elbow flexion) should also be ruled out.

Special thanks: Dr HT Gururaj.

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