0:00

At least I'm consistent of back again

0:02

with the short axis projection.

0:05

And the history on this one was a 68-year-old man.

0:10

It said evaluate, evaluate the ulnar nerves

0:14

and the left upper limb for radiculopathy.

0:17

Patient has had a cervical evaluation

0:20

and they've got pain over the hypo thenar eminence.

0:24

And this is an example of somebody that, that has a mass,

0:28

um, ion's canal when it's, uh, when it's uninterrupted,

0:33

is typically a triangular shaped structure or, or space.

0:38

And it's covered by the superficial ligamentum, uh,

0:42

palari ol has, has a bunch of other fancy names,

0:45

but basically it's a ulu.

0:48

And one thing I like to do, just

0:50

to get my bearings is I like to find the vein.

0:53

'cause the veins usually have slow flow. They're white.

0:56

And, and then I go about the process

0:58

of eliminating structure.

1:00

So now I've got the vein, which means

1:02

that the other tubular structure

1:04

that's gonna be bigger than a nerve,

1:06

'cause I know how big the ulnar nerves are,

1:07

is gonna be an artery.

1:09

So let's follow that artery.

1:10

Here it is, and I'm gonna make it even a little bigger.

1:13

So our, our viewing audience around the world can see it.

1:17

The T one isn't all that helpful

1:19

because everything just looks gray,

1:22

but certainly the T two is there's your artery.

1:24

And now let's continue following that artery.

1:26

And all of a sudden it looks a little bit bi lobed

1:29

and a little too big.

1:30

And as we come back a little bit,

1:31

there's some inflammatory tissue around it, which,

1:35

which has affected the ulnar nerve.

1:38

So here we've got the, the ulnar nerve.

1:40

Now one thing I like to do is find the common ulnar nerve.

1:44

So the first thing I do is I find the vein,

1:46

then I find the artery.

1:48

And here here's a little bit more artery right here.

1:50

And then anything that's left is the nerve.

1:52

Then as I track the nerve distally,

1:54

I can see the nerve bifurcating.

1:56

Let's see if I can, I can track that bifurcation.

1:58

There it is right there. So you've got,

2:02

and e embryologically

2:03

and evolutionary wise, you know,

2:06

I think it was more important

2:07

to have the motor nerves deep in your body

2:09

and the sensory nerves more superficial, so easy

2:12

to remember, s superficial sensory.

2:15

And, and, and the deep one is going to be, uh, motor.

2:19

And, uh, this patient did have ulnar nerve neuropathy,

2:23

had the syndrome of Dion's canal,

2:25

had an ulnar artery aneurysm.

2:27

Um, and that's kind of how I attack this vein to artery.

2:30

And then I look at the nerves last.

2:33

Any thoughts on this one? Yeah,

2:35

I really appreciate that approach.

2:37

I think that's a great way to, to identify, uh,

2:39

abnormalities in these cases.

2:41

So, uh, I like that I'm gonna start following that as well

2:44

And it kind of hope, hopes to dip, helps to dip back

2:46

and forth because you can see that sort of

2:49

concentric ring appearance of the artery,

2:51

which you don't get that, that much really in the nerve.

2:54

So that that helps you identify the artery as well.

2:57

Shall we move on?