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Anconeus epitrochlearis

Case contributed by Maulik S Patel
Diagnosis almost certain

Presentation

Localized pain involving the medial aspect of the right elbow for about 1 year. Complaining of numbness along the ulnar aspect of the right forearm while sleeping with a flexed elbow. Complaining of numbness in the left forearm also.

Patient Data

Age: 60 yrs
Gender: Male
x-ray

There is tiny bone spur at medial epicondyle and olecranon process of the ulna. There is no fracture/ dislocation/ bone lesion.

ultrasound

Right elbow

  •  Common flexure tendon shows thickened, hypoechoic posterior fibers with a tiny bone spur from epicondyle. There is no tear. There is no hypervascularity. Anterior fibers show normal echopattern
  • The ulnar nerve is edematous, hypoechoic in cubital tunnel region.
  • There is a presence of anconeus epitrochlearis muscle between medial epicondyle of humerus and olecranon process of the ulna. Muscle is superficial to the ulnar nerve.

Left elbow

  • The ulnar nerve is edematous, hypoechoic in cubital tunnel region.
  • There is a presence of anconeus epitrochlearis muscle between medial epicondyle of humerus and olecranon process of the ulna. Muscle is superficial to the ulnar nerve.

Case Discussion

A male presented with right elbow pain localized to the medial epicondyle. It was clinically diagnosed as medial epicondylitis and ultrasound shows changes of medial epicondylitis. In addition, the patient had numbness in both forearms when he sleeps in the flexed position of the elbow. This is explained by changes of bilateral ulnar neuropathy ( edematous ulnar nerve in the cubital tunnel ). The cause of ulnar neuropathy is the presence of an accessory muscle known as anconeus epitrochlearis.

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