Cubital tunnel
Patient, man 45 years old, presenting with forearm pain mostly in the elbows, radiating distally and proximally, duration 4-5 months. Predominantly left arm, recently also right arm. Symptoms during light activity, certain movemens and lifting such as mobile phone use.
Electroneurography shows no signs of medial or ulnar nerve involvement. Electromyography shows normal findings contradicting cervical nerve root impact of C8-Th1 on the left side. The decision is made to do echoneurography, which is seen below.
Besides the ulnar nerve neuropathy, during dynamic ultrasound examination with flexion/extension of the elbow a subluxating ulnar nerve can be seen bilaterally. The nerve positions right on top of the medial epicondyle during elbowflexion >90 degrees wich is a riskfactor for direct trauma.
Short axis view image aquisition from medial epicondyle in distal direction past the level of intermuscular aponeurosis. In this case ulnar nerve swelling begins at distal cubital tunnel, reaches it’s maximum at the level of medial epicondyle with normalization proximally in the upper arm. Ulnar nerve CSA 14-15 mm2, measured at the level of medial epicondyle. Wich is equivalent to mild-moderate ulnar nerve neuropathy at the elbow.
Subluxation at the elbow.
Same patient, opposite arm. Normal findings. Ulnar nerve CSA 9 mm2, at the level of medial epicondyle. Normal <10 mm2.
Cubital tunnel
Patient, man 45 years old, presenting with forearm pain mostly in the elbows, radiating distally and proximally, duration 4-5 months. Predominantly left arm, recently also right arm. Symptoms during light activity, certain movemens and lifting such as mobile phone use.
Electroneurography shows no signs of medial or ulnar nerve involvement. Electromyography shows normal findings contradicting cervical nerve root impact of C8-Th1 on the left side. The decision is made to do echoneurography, which is seen below.
Besides the ulnar nerve neuropathy, during dynamic ultrasound examination with flexion/extension of the elbow a subluxating ulnar nerve can be seen bilaterally. The nerve positions right on top of the medial epicondyle during elbowflexion >90 degrees wich is a riskfactor for direct trauma.
Short axis view image aquisition from medial epicondyle in distal direction past the level of intermuscular aponeurosis. In this case ulnar nerve swelling begins at distal cubital tunnel, reaches it’s maximum at the level of medial epicondyle with normalization proximally in the upper arm. Ulnar nerve CSA 14-15 mm2, measured at the level of medial epicondyle. Wich is equivalent to mild-moderate ulnar nerve neuropathy at the elbow.
Subluxation at the elbow.
Same patient, opposite arm. Normal findings. Ulnar nerve CSA 9 mm2, at the level of medial epicondyle. Normal <10 mm2.