PMC5362866_01
Preoperative craniocaudal radiographs of the (a) right and (b) left elbows performed prior to referral and three-dimensional reconstructions (c) craniocaudal, (d) caudocranial and (e) oblique orientations demonstrating the large mineral-attenuating synovial and periarticular foci surrounding both elbows. Particularly evident are the large mineral fragments in the medial flexor tendons (yellow arrows)
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Large mineral fragments were noted in the medial flexor tendons, adjacent to the olecranon of the ulna bilaterally (Figure 1a-c).
Sagittal slice from a (a) CT scan and (b) three-dimensional reconstruction from CT scan showing displacement of the right radius craniolaterally in relation to the humerus
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The right radius was mildly displaced craniolaterally in relation to the humerus, and there was humeroradial subluxation noted (Figure 2 a,b).
Intraoperative photograph demonstrating ulnar nerve being retracted following external neurolysis. The extensive area of mineralization within the flexor carpi ulnaris muscle can also be seen within the tips of the forceps. This was then removed by blunt dissection
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External neurolysis was performed, detaching the nerve from all points of compression (Figure 3), and the nerve was re-situated in a bed free of scar tissue, as has been previously described. The extensive area of mineralization within the flexor carpi ulnaris muscle was then removed by blunt dissection (Figures 3 and 4).
Intraoperative photograph demonstrating areas of mineralization removed from both the humeral head of flexor carpi ulnaris muscle and within the elbow, adjacent to a measuring device
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The extensive area of mineralization within the flexor carpi ulnaris muscle was then removed by blunt dissection (Figures 3 and 4).