Case study: Cubital tunnel syndrome – Injection

December 21, 2023

A 65-year-old orthopedic surgeon presents with pain along the ulnar aspect of the right forearm and hand, lasting for one year. The patient does not report any weakness in these areas and has no comorbidities. He previously underwent an ulnar nerve hydrodissection, a procedure to relieve pressure around the nerve, which reduced the pain by 80%. However, due to persistent occasional pain along the ulnar border of the forearm, he presented for further treatment.

Physical examination

Pain was not associated with any activity and there were no relieving factors
No redness or wasting of the forearm
No hypothenar wasting
No evidence of ulnar claw hand
Tinel sign: Positive
Sensation: Light touch and 2-point discrimination were normal Froment’s sign: Negative

Ultrasound findings

MRI imaging revealed an ulnar nerve entrapment at the level of the medial epicondyle. The reference value for a swollen nerve is set at ≥ 10 mm2, according to the meta-analysis by Chang et al. (2018).

Transverse view of the elbow in a neutral position at the level of the edial epicondyle. Here, the ulnar nerve measured 5.9 x 1.6 mm. UCL, ulnar collateral ligament. m

Transverse view of the elbow in a flexed position at the level of the medial epicondyle. Here, the ulnar nerve measured 3.1 x 6.8 mm.

Diagnosis

The patient was diagnosed with cubital tunnel syndrome, which is caused by the compression of the ulnar nerve at the elbow. The ulnar nerve entrapment leads to numbness and pain in the forearm and specific fingers. It is the second most common neuropathy of the arm after carpal tunnel syndrome.

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