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Case Reports
. 2021 May 6;14(5):e242773.
doi: 10.1136/bcr-2021-242773.

Primary elbow osteoarthritis presenting as ulnar nerve palsy with claw hand

Stanzin Spalkit  1 , Anindita Sinha  2 , Mahesh Prakash  1 , Satyaswarup Tripathy  3
Affiliations
Case Reports

Primary elbow osteoarthritis presenting as ulnar nerve palsy with claw hand

Stanzin Spalkit et al. BMJ Case Rep. .

Abstract

A 59-year-old woman was referred with weakness, paraesthesia, numbness and clawing of the little and ring fingers for the last 2 years. MRI of the cervical spine was normal and nerve conduction velocity revealed abnormality of the ulnar nerve. Ultrasound and MRI showed medial osteophytes and effusion of the elbow joint with stretched and thinned ulnar nerve in the cubital tunnel. The patient underwent release and anterior transposition of the ulnar nerve with significant relief of symptoms.

Keywords: musculoskeletal and joint disorders; peripheral nerve disease; plastic and reconstructive surgery.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Ultrasound of the cubital tunnel showing the UN in transverse section (large arrow). Ulnotrochlear portion of the elbow joint shows multiple bony spurs (small arrows) and joint effusion (arrowhead). The ulnar nerve is flattened, thickened and superficially displaced by the effusion. UN, ulnar nerve.
Figure 2
Figure 2
Ultrasound of the ulnar nerve in the longitudinal axis in the cubital tunnel shows mild displacement and bowing (arrow) of the nerve. Synovial thickening (arrowhead) with adjacent joint effusion is seen.
Figure 3
Figure 3
Plain radiograph anteroposterior view of the elbow joint showing reduction in joint space (arrow) predominantly in the ulnotrochlear joint, subchondral sclerosis and large medially projecting osteophyte formation (arrowhead).
Figure 4
Figure 4
Axial proton density-weighted non-fat suppressed image reveals large marginal osteophytes arising from the ulnotrochlear joint (arrow) with minimal joint effusion (*) and synovits(arrowhead) within elbow joint. There is obliteration of fat in the cubital tunnel. The ulnar nerve (empty arrow) appears hyperintense and is displaced laterally.
Figure 5
Figure 5
Axial T2-weighted fat suppressed image reveals large marginal osteophytes arising from ulnotrochlear joint (arrow) with minimal joint effusion (*) and synovits(arrowhead) within elbow joint. There is obliteration of fat in the cubital tunnel. The ulnar nerve (empty arrow) appears hyperintense and is displaced laterally.
Figure 6
Figure 6
MR neurography (PSIF-reverse TRUFISP) sagittal sequence of the elbow joint shows the course of the ulnar nerve (small arrows) with focal thickening and hyperintensity in the cubital tunnel (large arrow). TRUFISP, True Fast Imaging with Steady-state free Precession.
Figure 7
Figure 7
Intraoperative image after ulnar nerve decompression shows the focally thickened ulnar nerve (arrow) at the cubital tunnel.
See this image and copyright information in PMC

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