Cubital tunnel syndrome

Case contributed by Dr Shailaja Muniraj

Presentation

Tingling sensation and numbness in the little and ring finger.

Patient Data

Age: 35
Gender: Male
MRI

Anconeus epitrochlearis muscle with resultant:

  • Narrowing of 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 normal course between the pronator teres and brachialis muscle. Also, it shows normal contact with the brachial vessels.

No medial epicondyle osteophytic spur noted.  No thickening of the posterior bundle fibers of 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:

  1. Medial intermuscular septum - arcade of Struthers.
  2. Medial epicondyle - osteophytic spur or bony growth.
  3. Cubital tunnel.
  4. Flexor-pronator aponeurosis between the heads of the flexor carpi ulnaris.

If the above four regions shows 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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Case information

rID: 66489
Published: 22nd Feb 2019
Last edited: 28th Feb 2019
Inclusion in quiz mode: Included
Institution: Prima diagnostics india

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