Disclosures: Kevin T. Ozment, MD: No financial relationships or conflicts of interest

Case Diagnosis: 28-year-old right-handed male professional guitarist with bilateral ulnar neuritis secondary to subluxation at cubital tunnels.

Case Description: Our patient presented with 6 weeks of intermittent right 4th/5th digit paresthesias, fatigue, and right worse than left medial elbow pain. Symptoms were provoked by playing guitar more than 30 minutes. He then completed two months of occupational therapy, trialed over-the-counter anti-inflammatories, and wore a nighttime elbow extension orthotic with temporary relief. Nine months after initial presentation, he had a notable exacerbation. He developed snapping sensations over medial bilateral elbows, right worse than left, with symptoms radiating into medial forearm and hand. Symptoms continued to intensify with playing guitar, affecting his ability to perform and work as a guitar instructor. Physical exam was notable for diminished palmar pinprick of right 4th and 5th digits, positive ulnar neural tension test on the right, and positive Tinel’s sign at the medial elbow bilaterally. He had palpable and painful snapping at bilateral medial elbows moving from extension to flexion.

Setting: Outpatient Sports Medicine ClinicAssessment/

Results: Elbow ultrasound revealed bilateral ulnar nerve subluxation over medial epicondyles as elbow moved from extension to 95 degrees flexion on both sides, without anconeus epitrochlearis or snapping triceps tendon. Bilateral upper extremity electrodiagnostics were normal. Patient began gabapentin, continued an exercise program consisting of nerve glides, postural correction, and wore nighttime elbow orthotics with symptom improvement.

Discussion: While ulnar nerve subluxation has been reported in the general population, bilateral ulnar nerve subluxation with neuritis in a guitarist is rare and under-reported. Prevalence may be higher amongst professional instrumentalists due to repetitive movements, unnatural posture, and lengthy playing hours.

Conclusion: Focused diagnostic ultrasound is a valuable tool to dynamically detect ulnar subluxation, especially amongst musicians who are prone to peripheral nerve syndromes. Performing artists are an evolving patient population that physiatrists are well equipped to care for.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/cant-get-in-the-groove-bilateral-ulnar-nerve-subluxation-in-a-professional-guitarist-a-case-report/