Abstract:A 24-year-old, right-handed male patient presented with a 1-month history of continuous tingling paresthesia involving left medial hand and fingers accompanied by clumsiness of left hand and fingers. Thepain onset was sudden and marked by a severe aching pain in the medial elbow and medial scapular areas, without any prior cause. Two weeks of excruciating pain led to clumsiness of the left hand and fingers gradually occurred. Magnetic resonance imaging (MRI) of the left elbow revealed a swollen ulnar nerve wit… Show more
“…Transposition of the ulnar nerve is controversial and usually depends on surgeon’s choice. 42 Figure 4.(a) Axial fat saturated STIR images show focal thickening and edema of the ulnar nerve posterior to the elbow (white arrow). (b) More distal T1-weighted image showing overlying accessory anconeus epitrochlearis muscle causing focal compression (black arrow).…”
The ulnar nerve is the second most commonly entrapped nerve after the median nerve. Although clinical evaluation and electrodiagnostic studies remain widely used for the evaluation of ulnar neuropathy, advancements in imaging have led to increased utilization of these newer / better imaging techniques in the overall management of ulnar neuropathy. Specifically, high-resolution ultrasonography of peripheral nerves as well as MRI has become quite useful in evaluating the ulnar nerve in order to better guide treatment. The caliber and fascicular pattern identified in the normal ulnar nerves are important distinguishing features from ulnar nerve pathology. The cubital tunnel within the elbow and Guyon’s canal within the wrist are important sites to evaluate with respect to ulnar nerve compression. Both acute and chronic conditions resulting in deformity, trauma as well as inflammatory conditions may predispose certain patients to ulnar neuropathy. Granulomatous diseases as well as both neurogenic and non-neurogenic tumors can also potentially result in ulnar neuropathy. Tumors around the ulnar nerve can also lead to mass effect on the nerve, particularly in tight spaces like the aforementioned canals. Although high-resolution ultrasonography is a useful modality initially, particularly as it can be helpful for dynamic evaluation, MRI remains most reliable due to its higher resolution. Newer imaging techniques like sonoelastography and microneurography, as well as nerve-specific contrast agents, are currently being investigated for their usefulness and are not routinely being used currently.
“…Transposition of the ulnar nerve is controversial and usually depends on surgeon’s choice. 42 Figure 4.(a) Axial fat saturated STIR images show focal thickening and edema of the ulnar nerve posterior to the elbow (white arrow). (b) More distal T1-weighted image showing overlying accessory anconeus epitrochlearis muscle causing focal compression (black arrow).…”
The ulnar nerve is the second most commonly entrapped nerve after the median nerve. Although clinical evaluation and electrodiagnostic studies remain widely used for the evaluation of ulnar neuropathy, advancements in imaging have led to increased utilization of these newer / better imaging techniques in the overall management of ulnar neuropathy. Specifically, high-resolution ultrasonography of peripheral nerves as well as MRI has become quite useful in evaluating the ulnar nerve in order to better guide treatment. The caliber and fascicular pattern identified in the normal ulnar nerves are important distinguishing features from ulnar nerve pathology. The cubital tunnel within the elbow and Guyon’s canal within the wrist are important sites to evaluate with respect to ulnar nerve compression. Both acute and chronic conditions resulting in deformity, trauma as well as inflammatory conditions may predispose certain patients to ulnar neuropathy. Granulomatous diseases as well as both neurogenic and non-neurogenic tumors can also potentially result in ulnar neuropathy. Tumors around the ulnar nerve can also lead to mass effect on the nerve, particularly in tight spaces like the aforementioned canals. Although high-resolution ultrasonography is a useful modality initially, particularly as it can be helpful for dynamic evaluation, MRI remains most reliable due to its higher resolution. Newer imaging techniques like sonoelastography and microneurography, as well as nerve-specific contrast agents, are currently being investigated for their usefulness and are not routinely being used currently.
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