Disclosures: Ovie Enaohwo: No financial relationships or conflicts of interest
Emmanuel C. Achilike, MD, MPH: No financial relationships or conflicts of interest

Case Diagnosis: This case consisted of the work up and diagnosis of an impinged median nerve underneath the Ligament of Struthers originating from a supracondylar spur which was then treated using ultrasound guided hydrodissection.

Case Description or Program Description: Patient was an age 63 male with a past medical history of multiple comorbidities including cervical neck fusion. He presented to the clinic after developing left hand numbness and stiffness which worsened with minimal abduction of the shoulder. During the initial workup plain film radiographs and magnetic resonance imaging were conducted on the neck and the humerus. An electromyography and nerve conduction study was done as well as a diagnostic ultrasound of the upper arm.

It was revealed that the patient had electrodiagnostic evidence of left carpal tunnel syndrome, left cubital tunnel syndrome, and a likely Martin-Gruber Anastomosis. There was no evidence of cervical radiculopathy. Ultrasound found increased vascular lumen size and increased vascularity in the muscles of the left arm. Other imaging revealed stable cervical hardware. There was a finding of a supracondylar spur on the humerus with an associated ligament of struthers.

Setting: Secondary Care Outpatient Physical Medicine and Rehabilitation Clinic

Assessment/Results: Under ultrasound guidance the area under the ligament of Struthers was injected with a solution which was a mix of lidocaine and triamcinolone and then the patient was sent home. When the patient was seen at one month follow up, his pain was 75% improved and he had the ability to abduct his shoulder to 90 degrees with minimal pain.

Discussion (relevance): There are not many cases of ligament of Struther induced neuropathies being treated non-operatively. This could serve as a way to treat pain caused by this anatomical variant without the use of invasive surgery.

Conclusions: More work needs to be done to look into the long term sustainability of this treatment, but it is highly likely it could serve as a treatment or a bridge.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/median-nerve-hydrodissection-at-the-ligament-of-struthers-secondary-to-supracondylar-spur-a-case-report/