0:01

This was a 39 year old man.

0:03

He had some paresthesias and weakness in the medial forearm and hand. Um,

0:08

he had had a direct blow to his medial elbow. Um,

0:12

and then kind of this abrupt onset of paresthesias. Uh,

0:17

so a little jumpy there. So just moving from, uh,

0:20

proximal to distal here.

0:25

And one more time, distal to proximal.

0:31

Okay. Hopefully it was enough of, uh, enough viewing there.

0:36

So this is question number five. This case demonstrates ulnar nerve entrapments,

0:41

and this is due to what anomalous structure and your choices are

0:46

an coia, spiro, gans muscle,

0:50

ancon muscle, or the flexor carpi ulis.

0:56

All right. And let's take a look at, uh,

1:00

this particular case over again. Uh,

1:03

the ancon atroli was the, oh, I'm sorry.

1:06

We gotta go back to our slides real quick and talk a little bit about that

1:08

muscle. Um, and talk a little bit more about ulnar nerve entrapment before we,

1:13

we review our imaging findings. So, um, this is a case, uh,

1:17

of kind of cubital tunnel syndrome, um, and potential ulnar nerve entrapment.

1:21

That was, that was kind of, um, made worse by the acute trauma.

1:26

So this is the second most common peripheral neuropathy.

1:29

Carpal tunnel is by and far the most common, uh,

1:32

and it can be caused by extrinsic compression.

1:35

And this an cornus atroli muscle is one to know about.

1:38

It's not seen infrequently. And if you're doing elbow imaging,

1:42

it should be part of your search pattern.

1:44

So present in about 11% of the population,

1:47

most people have injury of the ulnar nerve or cubital tunnel syndrome from kind

1:52

of chronic repetitive injury can be, um, caused by trauma of course.

1:57

And patients get this pretty characteristic clawing of the,

2:00

of the ring and the small finger. They can also have associated parasthesias,

2:05

uh, and weakness. So let's go back to our, our images there on our M R I.

2:10

Uh, this was, uh, just an elbow, m r i,

2:12

so we get a little bit better resolution of detail here and hopefully you can

2:16

see there's some signal abnormality in some of the muscle. I'm sorry,

2:19

these are off.

2:20

Let me get those lined up appropriately and that will hopefully help a little

2:24

bit. You can see that there's some signal abnormality of some of the ulnar sided

2:28

flexors in this case. And if you didn't see that, that's okay.

2:32

Hopefully you kind of picked on that.

2:33

This was a ulnar nerve case as the rest of our forearm, uh, uh,

2:36

flexors and extensors were normal. So remember that our ulnar nerve,

2:41

um,

2:42

is bordered by multiple different structures right here in this cubital tunnel.

2:46

So we have our, uh, ulnar collateral ligament that's deep,

2:50

and then we have osbourne's ligament, which makes up kind of the roof.

2:53

And this is really just, um,

2:54

a fascial plane between the two heads of our flexor carpi

2:59

Ulnar. Um,

3:00

this should be very thin and kind of have this more ligamentous appearance.

3:05

In this particular case,

3:07

we can see that it starts out that way and then really turns into muscular

3:10

signal abnormality. And this is an ancon atroli demonstrated here.

3:15

We're at the same level as our an cornus,

3:18

which is a normal structure on the other side of the elbow. So, uh,

3:22

traia on that one. Uh, but this is a anomalous muscle band.

3:26

It was thought that kind of the inciting trauma we may have resulted in some

3:30

older nerve swelling in this particular case and resulted in the patient's

3:34

symptoms.

3:34

So because those was acute traumatic event that resulted in a lot of these

3:38

findings, uh,

3:39

this patient actually recovered with just some conservative management. So,

3:44

okay. Case of Ancon Petroli.