Disclosures: Jesse Lou, MD: No financial relationships or conflicts of interest

Case Diagnosis: Bilateral anconeus epitrochlearis associated with ulnar nerve compression.

Case Description or Program Description: A 66-year-old male initially presented with a history of progressive weakness, numbness, and tingling in both hands for six months. His symptoms were predominantly over the fourth and fifth digits and he had worsening burning pain in the ulnar distribution. On exam, his pain worsened with elbow flexion, and he had weakness of the bilateral thumb adductors. There was no identifiable history of trauma to the elbows. Brain magnetic resonance imaging (MRI) was unremarkable. Cervical MRI revealed disc protrusions at C5/C6 and C6/C7. No significant pathology was seen at the level of C7/T1. Electrodiagnostic testing (EMG) of the bilateral upper extremities showed advanced ulnar neuropathy at the bilateral elbows. There was a primarily demyelinating process with conduction block and a drop of 21 m/s across the elbows bilaterally without active denervation. After the EMG study, he decided to undergo surgical exploration.

Setting: Outpatient Office

Assessment/Results: Decompressive surgery was performed at the bilateral elbows and patient was found to have an anomalous anconeus epitrochlearis at both elbows. On a follow-up visit, he was noted to have markedly improved symptoms in his upper extremities. Repeat EMG four months later showed stabilization and slight improvement.

Discussion (relevance): Bilateral anconeus epitrochlearis is rare and is often under-recognized. Anconeus epitrochlearis (AE) was first described in 1868 and is present in 4% to 34% of individuals. Interestingly, some studies find that AE may actually be protective against the development of cubital tunnel syndrome while others suggest hypertrophy of the AE as a direct cause to ulnar nerve compression.

Conclusions: More studies are needed to accurately study the prevalence of anconeus epitrochlearis and the role in cubital tunnel syndrome, including genetic disposition. This may help identify populations most susceptible to developing ulnar nerve compression and develop better definition to Osborne’s ligament.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/i-am-weak-in-both-hands-a-curious-case-of-a-66-year-old-man-with-ulnar-nerve-compression-associated-with-bilateral-anconeus-epitrochlearis/