Disclosures: Christopher Radlicz, MS, MPH: No financial relationships or conflicts of interest

Case Diagnosis: 57-year-old male with radial tunnel syndrome

Case Description: The patient presented with concern for a distal biceps brachii injury with gradually worsening pain for the past eight months following arthroscopic rotator cuff repair and non-repaired biceps brachii long head rupture. However, the primary complaint was pain near the elbow that worsened with activity. An ultrasound of the entire biceps brachii complex was requested. Upon examination, pain was elicited over the area of the radial tunnel with palpation, and during resisted supination and wrist extension. The distal biceps brachii examination near the elbow was unremarkable with normal sensory and motor testing.

Setting: Outpatient ClinicAssessment/

Results: An ultrasound study of the requested area demonstrated the long head rupture and retraction but no distal biceps brachii pathology. Additional imaging of the radial nerve was performed in light of the physical examination findings and a dramatic focal enlargement of greater than 12 mm2 was seen at the entrance to the radial tunnel, correlating with the source of his complaint.

Discussion: In this case, the “point-of-care” utilization of ultrasound allowed expansion of imaging beyond the initial area of request to determine the correct diagnosis. The referring physician and patient presumed that the pain was directly related to either the initial injury or shoulder surgery, but was likely aggravated by repetitive activity during the rehabilitation process. Nerve compression syndromes without localizing neurologic deficit, such radial tunnel syndrome, can be challenging to diagnose but are more easily illuminated with the use of ultrasound.

Conclusion: High frequency ultrasound is an effective modality for evaluating soft tissue pain around the elbow, including focal nerve entrapments. The point-of-care nature of ultrasound has distinct advantages over other imaging modalities by allowing simultaneous correlation of the findings to the clinical examination.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/ultrasound-identification-of-radial-tunnel-syndrome-following-rotator-cuff-repair-a-case-report/