Presentation
A patient had left wrist laceration on the palmar side about 2 months before the presentation. He presented with complaints of flexion deformity of 4th, 5th fingers and mild weakness of the thumb. He was referred for an evaluation of the ulnar nerve injury. On inspection, there were three scars involving wrist region; one on ulnar side, one on the radial side and another in midline.
Patient Data
Deep to the ulnar side scar of the wrist, about 11 mm long segment of the ulnar nerve shows hypoechoic thickening and loss of normal fascicular pattern. It represents a neuroma formation in the continuity of the nerve. This neuroma is located proximal to the Guyon's tunnel.
Overlying flexor carpi ulnas tendon also shows a focal area of thickening with loss of a normal fibrillary echopattern. However, tendon shows continuity. The overlying skin and subcutaneous tissue show a hypoechoic scar.
Deep to the midline scar of the wrist, palmaris longus tendon shows a focal area of thickening with loss of a normal fibrillary echopattern. The tendon shows continuity.
Deep to the radial side scar, the extensor pollicis brevis tendon shows a discontinuity. The proximal edge of the tendon is near the radial styloid process. The distal edge of the tendon is at the distal carpal bone level. The gap between the two edges of the tendon is about 35 mm.
The ulnar artery is patent without any injury.
The median nerve shows normal fascicular echo pattern.
Case Discussion
The patient had a laceration on the palmar side of the wrist. He presented with the main complaint of the 4th and 5th finger flexion deformity.
The patient was referred for ultrasound evaluation of the ulnar nerve. The ultrasound shows ulnar nerve injury as well as few tendons injuries.
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