Attrition rupture of ulnar nerve in a rheumatoid elbow arthr
Cubital tunnel syndrome has been recognized as a common pathology in rheumatoid arthritis (RA) of the elbow. Published in the journal Medicine, the authors encountered a patient with RA of the elbow showing attrition rupture of the ulnar nerve.

A 53-year-old woman, received drug treatment for RA since 30 years earlier, had numbness in the left ulnar nerve territory, dorsal interossei muscle atrophy, and resulting claw hand. Plain x-ray examination revealed bone destruction of the left elbow joint and marked osteophyte formation in the medial joint space. In nerve conduction velocity (NCV) tests, the Motor NCV was immeasurable in the ulnar nerve territory. Based on these findings, a diagnosis of left cubital tunnel syndrome was made, and anterior transposition of the ulnar nerve was planned.

When the ulnar nerve dissection was advanced, about 80% portion of the ulnar nerve was ruptured. After the ends of the divided nerve were freshened, end-to-end anastomosis was possible by anterior transposition of the ulnar nerve. Two years after the operation, numbness and muscle atrophy also remained. There were no changes in the level of daily activities after the operation. However, motor NCV, had improvement (22.8 m/s) after the operation.

Lessons:
- In patients with RA showing ulnar neuropathy symptoms, marked osteophyte formation in the medial joint space or valgus deformity may indicate attrition nerve rupture.

- In the future, when such patients with RA are examined, active nerve exposure and dissection should be considered in terms of ulnar nerve protection.

Read about the case in detail here: https://pxmd.co/jWeTI
Like
Comment
Share