Ulnar nerve lesion at the wrist related to pisotriquetral joint arthropathy

Introduction: Ulnar nerve lesions at the wrist (UNLW) are always difficult to localize clinically and sometimes electrophysiologically. Finding conduction block when studying ulnar motor nerve conduction (CB) across the wrist is sometimes the only way to demonstrate that the ulnar deep motor branch (UDMB) is entrapped. Methods: An elderly woman who had bilateral carpal tunnel syndrome (CTS) and thumb osteoarthritis for many years experienced worsening of left hand impairment recently. Results: Electrodiagnostic and ultrasound examinations revealed an acute and severe UDMB lesion related to pisotriquetral joint effusion. The patient received a local injection of a corticosteroid that provided rapid recovery. Conclusions: The diagnosis of UDMB lesion is especially difficult when CTS coexists, but CTS may allow for early diagnosis, if CB at the wrist is not overlooked. Chondrocalcinosis was responsible for the systemic inflammation, the CTS, the pisotriquetral joint effusion, and the UDBM compression, which has not been reported previously. Muscle Nerve, 2013