Ulnar Nerve Synovial Impingement

about dynamic ultrasound findings of ulnar nerve synovial impingement

This is the case of a patient suffering for a post-traumatic olecranon bursitis with ulnar nerve entrapment symptoms, one month after an elbow contusion.

A standard plain radiograph was made immediatly after trauma, showing a small bony fragment of the olecranon cortical surface.

Elbow

Olecranon Bursitis

Sagittal T2w (left) and Axial T2w (right) Mri scans (0.3 Tesla).

The Mri exam shows a gross olecranon bursitis, but the inflammatory process involving the ulnar nerve is better appreciated with the dynamic ultrasound examination.

My suggestion is always tha same… Mri and Ultrasound exams complement each other succesfully, so use both togheter in your daily practice.

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Anatomy & Affinity

“Anatomy is to physiology as geography is to history; it describes the theatre of events.”
Jean Fernel

The anatomy is quite similar in the musculoskeletal apparatus. Just think at the correlations between shoulder and hip antomy; the gluteus medius and gluteus minimus externally rotate the thigh and a bursa separates the tendons from the surface of the trochanter over which they glide (that anatomy ring a bell with you?). Performing an ultrasound study at the trochanter site, you can find lots of similarities with the shoulder anatomy.

hip

Sagittal ultrasound scans of shoulder extra-rotator cuff (left) and gluetus medius-minumus tendons (right).

Don’t forget these similarities, regarding both to anatomy and function, because it will be helpful for your clinical and ultrasound evaluation.

Dynamic hip ultrasound exam; painful trochanteric bursitis in a professional football player.

hip3

Correlation between ultrasound and MRI images (coronal T2w Spair – 1.5T) in the same patient.

 

Bursitis

The fluid collection inside a bursa is usally seen as hypo-anechoic layer with B-mode ultrasound scan, right?…..Wrong!

The Wikipedia definition of a synovial bursa: “A bursa (plural bursae or bursas) is a small fluid-filled sac lined by synovial membrane with an inner capillary layer of viscous fluid (similar in consistency to that of a raw egg white). It provides a cushion between bones and tendons and/or muscles around a joint. This helps to reduce friction between the bones and allows free movement. Bursae are filled with synovial fluid and are found around most major joints of the body.”

The ultrasound appearance depends on the moment in wich you make the examination; especially in acute conditions, if a blood component is present within the bursa, it appears as an isoechoic layer.

bursitis

Superficial retrocalcaneal bursa of a professional football player – GE Stir sagittal Mri scan (0.3 T) – US sagittal scan. Note the different appearance of the fluid collection between Mri and ultrasound scan. The Mri also shows a small bone marrow edema of the calcaneal posterior process.

elasto.jpg

The Elastosonography evaluation in this case works like a “contrast agent”, well depicting the fluid collection within the bursa (red/soft).