PMC4269067_01
T2 image (left) and T2 FS presents small fluid collection in the medial epicondyle area (arrow). The ulnar nerve is moderately enlarged (arrowhead).
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T (Siemens) device using an examination protocol proposed by the ESSR Sports Subcommittee (PD TSE axial/coronal/sagittal and T2 TSE axial/coronal) with additional T1 sequences (axial/coronal). The scan showed tiny fluid collections near to the medial epicondyle (Figure 1).
Enlargement of the ulnar nerve to 0.19 cm2 compared to a normal right nerve (0.05 cm2). The left ulnar nerve is stiffer (green-red color) than the right one (arrow).
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Apart from the fluid, the only abnormality noticed in the classic elbow US protocol (ESSR protocol) was enlargement of the ulnar nerve to 19 mm2 with mild hyperemia inside (Figure 2).
Bifurcated medial triceps head. The additional muscle band has higher softness than the normal one (red color in sonoelastography).
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The additional band of the medial triceps head was less stiff as well (Figure 3).
Dislocation of the ulnar nerve (*) and an additional muscle band (arrow) over the medial epicondyle. (A) extended arm, (B) 45-degree flexion, (C) 90-degree flexion.
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When the study was repeated and counter-resistance was applied to the forearm, it revealed an almost simultaneous slipping of the ulnar nerve and muscle band over the medial epicondyle, with compression of the nerve by the medial epicondyle during that process (Figure 4).