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.

Imaging of TFCC Injury of the Wrist

about dynamic cone-beam ct imaging of TFCC wrist injury

It’s always difficult to combine clinical aspects and diagnostic imaging, approaching wrist joint pathology; in many circumstances the orthopaedic surgeon needs to directly visualize what’s happened during the joint motion, especially in a complex region such as the wrist.

I show you an example in which a complex tear of the triangular fibrocartilage complex (TFCC) is evident, togheter with a positive ulnar variance. TFCC is a complex of a fibrocartilaginous disk in association with several ligamentous structures, acting as a  stabilizers of the distal radioulnar joint, and transmitting axial loading from carpus to the ulna.

TFC Injury

Coronal T1w (left) and 3D SHARC (right) Mri scans (0.3 Tesla).

The dedicated Mri examination (0.3 Tesla), depicts the pathologic picture; the ulnar plus defines the reduction of the quadrilateral ulno-carpal space, and the consequent complex tear of the TFCC at its ulnar attachment; but what happens during the active movements? I usually perform also the dynamic evaluation, both with ultrasound and Mri exams. In this case the Cone-beam CT (CBCT) dynamic acquisitions give the answer.

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.

Patellar Tendon Tear

about dynamic ultrasound and mri evaluation of partial patellar tendon tear

Today I show you the case of a partial tear at proximal insertion of the patellar tendon in a professional football player. The patient refears pain during flexion-extension at inferior patellar pole; hystory of repetitive trauma as usual in football players.

Patellar Tendon Tear

Sagittal Xbone T1w (left) and T1w TSE (right) Mri scan (o.3 Tesla)

The Mri exam shows a partial tear of the patellar tendon proximal insertion. In these kind of injury I always need a dynamic ultrasound exam, both in clino and orthostatic position.

The partial tear is better depicted with the dynamic ultrasound evaluation; the dynamic Mri is also useful to appreciate the tendon relationship with the patella.

Dorsal Scapholunate Ligament Tear

about dynamic mri and ultrasound examination of carpal instability

In my previous post Dynamic Evaluation of Dorsal Scapholunate Ligament I showed the usefulness of both ultrasound and Mri dynamic evaluation in the study of this important ligament structure. Today I want to show you the dorsal scapholunate ligament (SL) tear in a patient that came to my observation after a regular healing of post-traumatic scaphoid fracture.

SL Tear

Coronal Stir (left) and T1w (right)  Mri scans (0.3 Tesla): correct visualization with no artifacts of post-surgical treatment with scaphoid screw. Tear of the dorsal scapholunate ligament is evident (red arrow).

For the appropriate treatment is crucial to see also the dynamic behaviour of this kind of injuries. I always perform both ultrasound and Mri dynamic evaluation in these cases.

The dynamic ultrasound exam shows the post-traumatic carpal instability; dorsal SL tear is evident, togheter with the scapholunate dissociation and DISI picture.

For the correct ultrasound scanning please see my previous post Dynamic Evaluation of Dorsal Scapholunate Ligament.

The Dynamic Mri evaluation (0.3 Tesla) during flexion-extension and ulnar-radial deviation confirms the clinical picture, better defining all the pathologic findings. The radiology technician plays a crucial role for this kind of examination, explaining to the patient the correct wrist movement during the Mri acquisitions.