Abstract

A 74-year-old male presented with right elbow pain and weakness of the right hand of one year duration. He had longstanding polyarticular joint disease since childhood with bony ankylosis of the right elbow in flexion. Neurological examination revealed wasting of all intrinsic muscles of the right hand with hypoesthesia on ulnar nerve distribution. Plain radiographs confirmed advanced elbow osteoarthritis with bony ankylosis and osteophytes. Electrodiagnostic studies localized an ulnar nerve interruption at the level of the elbow. On surgical exploration, a fibro-fatty band was found constricting the nerve, which was found to be completely ruptured. Direct epineural repair with anterior subfascial transposition was performed. At one-year follow-up, the patient reported relief of elbow pain and improvement in hand numbness, though motor recovery did not occur, consistent with the delayed presentation. To our knowledge, this is the first reported case of complete ulnar nerve rupture secondary to primary elbow osteoarthritis.