Elbow workup: multiple pathologies

Case contributed by Brendan Cullinane

Presentation

Referral for aspiration of the swollen right olecranon bursa following trauma. The patient was a right-handed male plumber. Clinical assessment and questioning of the patient revealed a swollen but non-tender olecranon bursa, finger drop and radial deviation of the wrist on extension, pain on compression over the right arcade of Frohse but not the left and ulnar neuropathy. No previous imaging, so proceeded with a complete workup of his right elbow.

Patient Data

Age: 30
Gender: Male
Ultrasound

US right elbow

There were numerous findings as listed.

Case Discussion

Ultrasound revealed:

The PIN entrapment explains the finger drop and radial deviation of the wrist on extension. The dislocation of the ulnar nerve (a form of cubital tunnel syndrome) and being right-handed may explain the right-sided ulnar neuropathy.

The tricepsand biceps tendon insertions were unremarkable as were the anterior joints, median nerve and the anterior, posterior and oblique ulnar collateral ligaments.

In light of the posterior joint effusion (and trauma) an X-ray was performed. It was unremarkable aside from the swelling at the olecranon bursa.

The olecranon bursa was drained the following day and sent for pathology. The results showed that the fluid was blood. No fluid, leucocytes or organisms were detected.

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