Presentation
Right elbow medial side snapping.
Patient Data
The static image with complete elbow extension shows the normal position of the ulnar nerve and the triceps muscle. With 90-degree elbow flexion, both nerve, and muscle are located closer to the humeral medial epicondyle. An image with complete elbow flexion shows dislocated nerve and the muscle lying anterior to the medial epicondyle.
1st cine-loop is during gradual elbow flexion. Ulnar nerve dislocation is followed by triceps muscle dislocation over the humeral medial epicondyle.
2nd cine-loop is during gradual elbow extension. Triceps muscle relocation is followed by ulnar nerve relocation.
Elbow flexion results in dislocation of the ulnar nerve (indicated as N) and the medial head of the triceps muscle(indicated as M). Elbow extension shows relocation in the reverse order.
Case Discussion
The patient presented a history of medial elbow snapping for the last few years. There were intermittent neurological symptoms. However, sudden nerve snap was irritating while doing certain activities.
There was one audible snap during elbow flexion. Clinical examination revealed two palpable snaps during elbow flexion which were documented by the ultrasound as the ulnar nerve and the triceps medial head snapping.
Surgery revealed similar findings. Anterior transposition of the ulnar nerve was done after completely freeing it from elbow to arm. The tendinous edge of the snapping medial head of the triceps muscle was excised.
Surgical details: courtesy of operating surgeon Dr. Maulik Jariwala.
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