25 year old female, right hand dominant, who presents with one month history of hand weakness and three months of elbow pain with deep flexion. Unable to extend fingers or thumb for one month. Denies trauma. Denies numbness or tingling throughout hand.
MRI obtained by nonoperative orthopaedist which showed multiloculated lesion at the volar aspect of the radial head with mass effect on the radial nerve. She was referred to hand surgeon for further management.
Inspection/Palpation: No swelling, No deformity. TTP over radiocapitellar joint
Motor: 5/5 AIN/Ulnar, Full flexion and pronation/supination of hand and forearm. Unable to extend digits at the MCP joint and unable to extend thumb. Able to extend IP joints in index, long, ring and small fingers. Able to extend wrist
Sensation: SILT in radial, ulnar and medial distributions.
Vascular: WWP, BCR
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Decompression of the right posterior interosseous nerve at the radial tunnel. Excision of a ganglion cyst from the right elbow proximal radial ulnar joint (3cm x 2cm x 1cm).