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Ulnar nerve neuropathy caused by pathologic ossification: a case report

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Surgical and Radiologic Anatomy Aims and scope Submit manuscript

Abstract

Purpose

Cubital tunnel syndrome is a well-described entity with many reported etiologies and anatomical compression sites. Accessory ossicles of either traumatic or congenital origin might occur around the elbow joint. Only one case reporting such ossicles compressing the ulnar nerve exists in previous literature. We aim to present this entity with a detailed description of the patient history and treatment.

Case report

We report a case of 30-year-old female presenting with classical signs of cubital tunnel syndrome—positive Wartenberg’s and Froment’s signs, hypoesthesia in the fourth and fifth finger with decreased finger duction strength but without gross hypotrophy of interosseous and hypothenar muscles. Tinel’s sign was positive over the ulnar sulcus and an accessory ossicle was found on the elbow radiograph within the ulnar sulcus. The first signs of calcification in this patient were reported 6 years prior in a follow-up after the dislocation of her elbow joint following a bike accident. The EMG confirmed ulnar nerve neuropathy in the elbow area. The ossicle was extirpated, the ulnar nerve was decompressed in the ulnar sulcus in a standard manner and the symptoms quickly resolved. The patient has been regularly visiting our outpatient clinic for the next 12 years without any complaints considering her elbow and the ulnar nerve.

Conclusion

This is a rare case of cubital tunnel syndrome caused by an accessory ossicle of traumatic origin. Simple bone extirpation with ulnar nerve release followed by anterior subcutaneous transposition is the recommended method of treatment. No report of congenital accessory bones causing ulnar nerve compression in the elbow exists in the literature.

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Data availability

Further data are available upon reasonable request to corresponding author.

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Funding

Funding was received from the Masaryk Hospital (Ústí nad Labem) grant agency (grant number IGA-KZ-2022-1-6).

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Authors and Affiliations

  1. Clinic of Trauma Surgery, Masaryk Hospital, Usti nad Labem, Czech Republic

    Kunc Vojtěch

  2. Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic

    Kachlík David

  3. Clinic of Neurosurgery, Masaryk Hospital, Sociální péče 3316/12A, 400 111, Usti nad Labem, Czech Republic

    Humhej Ivan

Authors
  1. Kunc Vojtěch
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  2. Kachlík David
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  3. Humhej Ivan
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Contributions

VK wrote the original manuscript, made the data analysis and contributed to the data analysis. DK revised the manuscript and contributed to the study as well as to data analysis and study concept. IH provided supervision of the project, collected and analysed data and participated in the drafting of the manuscript.

Corresponding author

Correspondence to Humhej Ivan.

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Authors do not have any competing interests to declare.

Ethical approval

The study followed the ethical principles stated in Declaration of Helsinki (1964).

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Vojtěch, K., David, K. & Ivan, H. Ulnar nerve neuropathy caused by pathologic ossification: a case report. Surg Radiol Anat 45, 1107–1110 (2023). https://doi.org/10.1007/s00276-023-03217-5

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  • DOI: https://doi.org/10.1007/s00276-023-03217-5

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