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Dynamic Ulnar Nerve Dislocation
 

Author: Steven Greenberg, MD, MS
Affiliation: Carolinas Medical Center Sports Medicine
Co Author(s): David Price, MD
Senior Editor: Wesley Troyer, DO
Editor: Laura Mattson, DO

Clinical Vignette: A 40-year-old male presented to clinic describing a shock-like sensation, numbness, pain and weakness in the left forearm with preacher curls. Numbness extended into the medial left hand. Symptomed were provoked with left hand hyperflexion and hyperextension.

Type of Probe Used: LA3-16AI Hockey-Stick transducer



Unlabeled Short Axis View of the Cubital Tunnel in 90 Degrees of Elbow Flexion


Labeled Short Axis View of the Cubital Tunnel in 90 Degrees of Flexion with the ulnar nerve at the level of the medial epicondyle. This image demonstrates the ulnar nerve (yellow), medial epicondyle (blue) and medial head of the triceps (red) in its usual configuration, with the nerve within the ulnar groove. In this region, there was focal enlargement of the ulnar nerve, with maximal cross sectional area of 15mm2 (normal <10mm2).


Unlabeled Short Axis View of the Cubital Tunnel in Max Elbow Flexion


Labeled Short Axis View of the Cubital Tunnel in Max Elbow Flexion with the ulnar nerve visible at the level of the medial epicondyle. The ulnar nerve is seen outside of the ulnar groove (dislocated), anterior to the medial epicondyle.
View Video

During dynamic ultrasound evaluation, the patient's elbow was flexed and the ulnar nerve was seen to dynamically dislocate out of the ulnar groove. With elbow extension, the nerve was seen to spontaneously reduce. During this assessment, the patient's typical symptoms were reproduced. In the attached video, we begin with the patient in a position of maximal elbow flexion, with the nerve already dislocated anterior to the medial epicondyle. With elbow extension, the nerve is then seen to relocate posterior to the medial epicondyle in its normal, anatomic position.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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