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Ulnar Nerve Compression From Ganglion Cyst
 

Author: Bradlee Sako, MD
Senior Editor: Nicholas Moore, MD

Clinical Vignette: An 86-year-old male with a past medical history of coronary artery disease, polymyalgia rheumatica, idiopathic gout involving the foot, CKD stage 3B, and pulmonary hypertension presented with complaints of persistent numbness and tingling in his left 4th and 5th fingers ongoing for the prior two months. He also complained of feeling a small bump at the ulnar aspect of his left forearm slightly distal to his humeroulnar joint.

Type of Probe Used: Linear setting on multi-purpose point of care ultrasound device.



Unlabeled short axis view of the left cubital tunnel.


Unlabeled long axis view of the left cubital tunnel.


Unlabeled long axis view of the ulnar nerve with Doppler
View Video

Short Axis Cine of the left cubital tunnel from proximal to distal. As the transducer tracks the ulnar nerve, a prominent, well-circumscribed, anechoic structure becomes evident, particularly from the 0:11 mark onward. This finding is highly consistent with a large ganglion cyst. The cyst creates a significant mass effect, visibly displacing and compressing the ulnar nerve within the restricted space of the tunnel.
View Video

Long Axis Cine of the left cubital tunnel from medial to lateral and back further characterizing the prominent ganglion cyst identified in the previous short-axis sweep. The large, anechoic fluid collection is clearly visualized exerting a substantial mass effect on the surrounding structures. The ulnar nerve can be seen running longitudinally, with its normal fascicular architecture visibly displaced, stretched, and bowed over the cyst.
View Video

Long Axis Cine of the left cubital tunnel from the cyst proximally and then distally, utilizing color Doppler imaging to further evaluate the prominent anechoic structure compressing the ulnar nerve. Throughout the dynamic sweep, the large fluid collection exhibits a complete absence of internal color flow within the Doppler box. This critical finding definitively rules out a vascular etiology, such as an aneurysm or prominent vein, confirming that the mass is indeed an avascular structure. This solidifies the diagnosis of a ganglion cyst acting as a space-occupying lesion and causing mechanical compression of the ulnar nerve.


Labeled short axis view of the left cubital tunnel with ganglion cyst and ulnar nerve visible.


Labeled long axis view of the left cubital tunnel with ganglion cyst visible and evidence of ulnar nerve compression.


Labeled long axis view of the ulnar nerve with Doppler with visible proximal swelling of the ulnar nerve with compression distally as it traverses ganglion cyst.

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

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