case_images: PMC6467032_01
case_images: Electrophysiology testing shows the summary and waveforms of the motor and antisensory testing at the right and left ulnar nerve at the levels of the wrist, and below and above the elbow. Bilateral ulnar motor responses recording at the first dorsal interossei had normal latencies, severely decreased amplitudes, and normal conduction velocities. The right ulnar antidromic sensory response had mildly prolonged latency and severely decreased amplitude. The left ulnar antidromic sensory response was absent
case_images: IJRI-29-67-g001.jpg
case_images: PMC6467032_01_IJRI-29-67-g001.jpg
case_images: F1
case_images: She underwent a nerve conduction study, which showed evidence of bilateral ulnar neuropathies [Figure 1].
case_images: Coronal (A) and (B) reformatted DW-PSIF maximum intensity projection images through the left and right arm, respectively, show the abnormally enlarged and markedly hyperintense ulnar nerves (long arrows). The slightly prominent and moderately hyperintense median nerves (medium arrows) and radial nerves (short arrows) are also seen. Extensive intramedullary bone infarcts in both humeral shafts are leading to hyperintense marrow signal. Focused imaging of left and right elbow (C, D) demonstrate both abnormal ulnar nerves, left > right with diffuse lesions. Notice mild flattening of the nerves in the tunnels with slight decreased signal of the nerves related to mild superimposed entrapments of the swollen nerves coursing through the confined space of the cubital tunnels
case_images: IJRI-29-67-g002.jpg
case_images: PMC6467032_01_IJRI-29-67-g002.jpg
case_images: F2
case_images: T2 hyperintensity, more pronounced on the left side consistent with bilateral ulnar neuropathy [Figure 2]. There was also minimal flattening of both ulnar nerves at the cubital tunnels with some loss of signal intensity, suggesting a mild degree of superimposed compression [Figures 2 and 3].
case_images: Sequential T2-weighted SPAIR images proximal to (A) and within the cubital tunnel (B) show the hyperintense and flattened ulnar nerve on the left side (arrow). Similar findings are seen on the right side (C and D, arrow)
case_images: IJRI-29-67-g003.jpg
case_images: PMC6467032_01_IJRI-29-67-g003.jpg
case_images: F3
case_images: T2 hyperintensity, more pronounced on the left side consistent with bilateral ulnar neuropathy [Figure 2]. There was also minimal flattening of both ulnar nerves at the cubital tunnels with some loss of signal intensity, suggesting a mild degree of superimposed compression [Figures 2 and 3].
case_images: Axial T1-weighted images of the left (A) and right (B) elbows show fatty atrophy of the pronator teres (P), brachialis (Br), brachioradialis (BR), and biceps (Bi) muscles, in keeping with chronic denervation change
case_images: IJRI-29-67-g004.jpg
case_images: PMC6467032_01_IJRI-29-67-g004.jpg
case_images: F4
case_images: Axial T1W imaging of the included field-of-view at the level of the elbow revealed fatty atrophy of bilateral pronator teres, biceps, brachialis, and brachioradialis muscles consistent with chronic denervation change [Figure 4].
case_images: DTI shows reduced fiber tracks in bilateral ulnar nerves (long arrows) consistent with chronic neuropathy, more pronounced on the left side (A) than on the right (B). The fiber tracks of both median (short arrows) and radial nerves (arrowheads) are relatively preserved
case_images: IJRI-29-67-g005.jpg
case_images: PMC6467032_01_IJRI-29-67-g005.jpg
case_images: F5
case_images: The fiber tracts for both median and radial nerves were relatively preserved [Figure 5].
case_images: PMC6467032_02