How to Find the Ulnar Nerve at the Elbow

about the correct ultrasound scanning techinchs to find the ulnar erve at the sulcus ulnaris

Have you seen my recent post “Subluxating Ulnar Nerve at the Elbow”? If yes, you may find also interesting how to locate the ulnar nerve at the sulcus ulnaris and the specific ultrasound scans. Use your own elbow to practice or try to ask to a friend or collegue to “share” their anatomy; in other words… Practice is the mother of skills!

In the video below you can find everything needed for your training, so enjoy the video and if you have any questions don’t hesitate to contact me.

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Subluxating Ulnar Nerve at the Elbow

about ultrasound findings of post-traumatic ulnar nerve subluxation

This is the case of a direct blow to a flexed elbow. The X-ray and Mri exams show a condylar fracture of the humerus, with a partial cortical bone detachment; a gross joint capsule distension is also evident.

Elbow Mri-xray

Coronal Xbone-T1w Mri scan (0.3 Tesla) and Plain Radiography.

Condylar Fracture

Coronal Stir (left) and T1w (right) Mri scans of the same patient (0.3 Tesla).

Why ultrasound in this case? Because after 1 month the patient feels pain on the posterior-medial aspect of the elbow, especially during the flexion-extension active movement, with distal pain irradiation to the forearm.

The dynamic ultrasound exam better depicts the clinical picture of a post-traumatic ulnar nerve subluxation at the sulcus ulnaris, togheter with a gross joint synovitis.

Ulnar Nerve Inflammation

Axial T2w (left) and Stir (right) Mri scans of the same patient (0.3 Tesla).

Medial Gastrocnemius Rupture

about ultrasound findings of complete detachment of medial gastrocnemius

In case of major traumas in the calf region, a reminder of its intrinsic anatomy is necessary; I suggest you to read an interesting paper in which all of the tirceps surae anatomical structures are perfectly depicted. https://www.ncbi.nlm.nih.gov/pubmed/25456712

Today I show you the case of a complete detachment of the medial gastrocnemius, togheter with the total rupture of the the so-called intramuscular aponeurosis of the soleus.

Axial Mri

Axial T2w (left) and Stir (right) Mri scans (0.3 Tesla)

The Mri images show a gross fluid collection in the aponeurotic space between medial gastrocnemius and soleus muscle; I always perform the ultrasound dynamic examination, both in the acute phase and especially during resting period. The elastosonography study is also useful in the monitoring of the fluid collection evolution.

The elastosonography study is also useful in the monitoring of the fluid collection evolution.

Bipartite Hallux Sesamoid Injury

about dynamic ultrasound and MRi findings of post-traumatic injury of a medial bipartite hallux sesamoid bone

Today I show you the injury of a medial bipartite hallux sesamoid bone in a professional football player; extremely painful after trauma, it takes time to heal.

Sesamoid

Standard X-Ray exam after trauma.

Medial Bipartite Sesamoid MRI

Sagittal (left) and Coronal (right) Ge-Stir Mri sequences (0.3 Tesla); bone marrow edema of the medial sesamoid is evident.

I always perform also the dynamic evaluation, both with ultrasound and Mri exams.

 

Dynamic MSK Imaging of Metacarpal Fracture

About dynamic msk imaging modalities in the study of post-traumatic metacarpal fracture

4th metacarpal fracture

Acute 4th metacarpal spiroid fracture of a professional football goalkeeper; first diagnosis was made directly on pitch with an ultrasound examination. Plain radiographs and Mri exam were performed just one hour after trauma.

One month after surgical fixation the fracture is studied with dynamic US, Mri and Cone-Beam CT imaging. The US and MR dynamic evaluations, show a regular tendon sliding over the fixation devices.

No metal-induced artifacts were seen, allowing a perfect visualization of the implanted devices.

CBCT Reconstruction

Cone-Beam CT Sagittal (left) and Coronal (right) reconstructions.

The study was completed with dynamic Mri (0.3 Tesla) and Cone-Beam CT scans, performed with active flexion-extension of carpal-metacarpal joint structures.

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.

Peroneal Fracture Monitoring

about ultrasound monitoring of peroneal fracture

Two months after a peroneal fracture the x-rays show a regular healing but the patient feels pain: why?

Peroneal Fracture Healing

I suggest you to always use both ultrasound and Mri imaging to better evaluate the correct healing of the fracture.

In this professional football player is also evident a gross perilesional edema involving the peroneal muscles togheter with the peroneal neurovascular bundle.

Peroneal Fracture Mri

Axial T2w (left) and Stir (right) mri sequences of the same patient (0.3 Tesla).

Peroneal Fracture Mri2

Sagittal Stir (left) and T2w (right) Mri sequences (0.3 Tesla); the perilesional edema along the course of peroneal neurovascular bundle is evident.

The dynamic ultrasound exam allows to better appreciate all the structures involved in this pathological picture; just a little reminder: high sensibility but 0% specificity of the ultrasound imaging in the study of cortical bone.