Tardy ulnar nerve palsy after fracture non-union medial epicondyle of humerus – An unusual case

Thiyam, Rajesh; Lalchandani, Rajesh

doi:10.1016/j.jcot.2014.12.004

Cited by 14 publications

(10 citation statements)

References 6 publications

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“…Cubitus varus deformity in the setting of chronic distal supracondylar fractures may also account for a delayed onset of cubital tunnel syndrome. 49,50 Inflammatory Neuropathies: Parsonage-Turner Syndrome Parsonage-Turner syndrome, also called acute brachial neuritis, is an acute idiopathic neuritis characterized by an abrupt onset of severe shoulder pain followed by unilateral arm weakness. Clinical presentation also includes shoulder and arm paresthesias exacerbated by overhead activities.…”

Section: Traumatic Nerve Injurymentioning

confidence: 99%

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Imaging of Nerve Disorders in the Elbow

Gunio

Babaa

Bencardino

2022

Semin Musculoskelet Radiol

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Neuropathies of the elbow represent a spectrum of disorders that involve more frequently the ulnar, radial, and median nerves. Reported multiple pathogenic factors include mechanical compression, trauma, inflammatory conditions, infections, as well as tumor-like and neoplastic processes. A thorough understanding of the anatomy of these peripheral nerves is crucial because clinical symptoms and imaging findings depend on which components of the affected nerve are involved. Correlating clinical history with the imaging manifestations of these disorders requires familiarity across all diagnostic modalities. This understanding allows for a targeted imaging work-up that can lead to a prompt and accurate diagnosis.

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Section: Traumatic Nerve Injurymentioning

confidence: 99%

“…Cubitus varus deformity in the setting of chronic distal supracondylar fractures may also account for a delayed onset of cubital tunnel syndrome. 49 50…”

Section: Traumatic Nerve Injurymentioning

confidence: 99%

Imaging of Nerve Disorders in the Elbow

Gunio

Babaa

Bencardino

2022

Semin Musculoskelet Radiol

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“…It has a variety of etiological factors including callus of old healed fractures around the elbow, arthritis, effusions and synovial thickening of the elbow joint, congenital anomalies, adhesion, recurrent dislocation of the elbow, etc. Tardy nerve palsy can also result from cubitus varus deformity following old supracondylar fracture of humerus [ 45 , 46 ].…”

Section: Imaging Findings In a Wide Spectrum Of Ulnar Nerve Pathologimentioning

confidence: 99%

Imaging in the diagnosis of ulnar nerve pathologies—a neoteric approach

et al. 2019

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The ulnar nerve is a branch of the C8 and T1 nerve roots and arises from the medial cord of the brachial plexus. It supplies the intrinsic muscles of the hand and assists the median nerve in functioning of the flexors. Also known as the musician’s nerve, it is the second most common nerve involved in compressive neuropathy following the median nerve. Common sites of entrapment include cubital tunnel at the elbow, the ulnar groove in the humerus and the Guyon’s canal at the wrist. Patients present with altered sensation in the ulnar fourth and the fifth digit and the medial side of arm with loss of function of intrinsic muscles of the hand, the flexor carpi ulnaris and ulnar fibres of flexor digitorum superficialis in more severe cases. Diagnosis relies on clinical examination, electrodiagnostic studies and imaging findings. Plain radiographs are used to identify fracture sites, callus, or tumours as cause of compression. Technological advances in ultrasonography have allowed direct visualisation of the involved nerve with assessment of exact site, extent and type of injury. It yields unmatched information about anatomical details of the nerve. MR imaging adds to soft tissue details and helps in characterising the lesion. This pictorial review aims to illustrate a wide spectrum of causes of ulnar neuropathies as seen on ultrasound and MRI and emphasises upon the importance of imaging modalities in the diagnosis of neuropathies.

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“…Typically tardy ulnar nerve palsy is a late consequence of traumatic cubitus valgus deformity arising due to nonunion or malunion of fractures of the lateral humeral condyle sustained during childhood [1] . Cubitus valgus deformity which compels the nerve to take a longer route around the retrocondylar groove along with development of intraneural fibrosis, tension neuritis, adhesions and frank entrapment of the nerve in the fracture callus may all contribute to development of late onset ulnar neuropathy [1,2] . Surgical procedures described for the treatment of ulnar neuropathy at the elbow include in-situ decompression, endoscopic decompression, decompression with medial epicondylectomy and decompression along with anterior transposition (subcutaneous, submuscular, or intramuscular) [3] .…”

Section: Introductionmentioning

confidence: 99%

Severe tardy ulnar nerve palsy due to cubitus valgus deformity: Use of intramuscular anterior transposition

Kamble¹,

Keny²,

Mohanty³

et al. 2021

Int. J. Case Rep. Orthop.

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Tardy ulnar nerve palsy is a frequent late complication of post-traumatic cubitus valgus deformity arising due to nonunion lateral condyle humerus fracture. We present a case of a 30 year old homemaker who came with features of tardy ulnar nerve palsy (McGowan grade III) with difficulty in activities of daily living and reduced grip strength. Clinical examination revealed atrophy of hand muscles, claw hand deformity and other features suggestive of ulnar neuropathy. X-rays and CT scan confirmed the diagnosis as fracture lateral condyle humerus nonunion. Surgical intervention in the form of anterior intramuscular transfer of ulnar nerve with neurolysis without addressal of nonunion site was performed. The patient showed complete recovery of sensory and motor symptoms at six months post-op. Anterior transposition of ulnar nerve is a safe and reliable procedure which provides good functional outcomes in cases of tardy ulnar nerve palsy with low morbidity.

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Tardy ulnar nerve palsy after fracture non-union medial epicondyle of humerus – An unusual case

Abstract: We report a rare case of tardy ulnar nerve in an adult male with fracture non-union of medial epicondyle of humerus.

Cited by 14 publications

References 6 publications

Imaging of Nerve Disorders in the Elbow

Imaging of Nerve Disorders in the Elbow

Imaging in the diagnosis of ulnar nerve pathologies—a neoteric approach

Severe tardy ulnar nerve palsy due to cubitus valgus deformity: Use of intramuscular anterior transposition

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