Presentation
Right 4th and 5th fingers flexion deformity with tingling for the last few days. No history of trauma. Referred for ultrasound evaluation of the ulnar nerve.
Patient Data
There are hypoechogenicity and edema of the ulnar nerve in the distal arm, medial elbow region, and proximal-most part of the forearm. The ulnar nerve shows the presence of a thin-walled anechoic cyst ( 27 x 7 x 5 mm ) within the ulnar nerve. The neck of the ganglion cyst could not be traced. There is no dislocation of nerve with restricted flexion of the elbow.
The ulnar nerve in the mid-distal forearm and at the wrist shows normal echopattern without any neural or perineural lesion.
There are marginal osteophytes from the radial head.
There is joint space reduction with marginal osteophytes formation. There is no fracture/ dislocation/ bone lesion.
Case Discussion
A patient developed signs of ulnar neuropathy during the last few days. He was referred for ultrasound evaluation of the ulnar nerve.
The ultrasound shows ulnar nerve hypoechogenicity, edema, and an intraneural ganglion cyst. The patient had restricted elbow movements before the development of ulnar neuropathy. The ultrasound shows the presence of radial head osteophyte formation. An elbow radiograph was done which showed degenerative joint disease. Unfortunately, there is no surgical follow up available in this case.
Ultrasound has become primary modality for evaluation of the upper extremity peripheral nerve1. Ultrasound has many advantages over MRI; higher soft tissue resolution, quick examination of whole limb nerve, comparison with the contralateral side being few of them1.
An intraneural ganglion cyst is a non-neoplastic gelatinous cyst. It is found within the epineurium of a peripheral nerve resulting in signs and symptoms of peripheral neuropathy3. Intraneural cysts commonly affect the peroneal nerve at the knee4. However, it can involve the other peripheral nerves4.
The medial elbow ganglia are strongly associated with osteoarthritis of the elbow. It can cause a relatively acute onset of cubital tunnel syndrome2.
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