Cubital tunnel compression with ulnar claw hand - A rare presentation of Primary elbow osteoarthritis

Primary elbow osteoarthritis usually presents with pain and global restriction of range of motion and rarely presents with features of cubital tunnel syndrome. Ulnar claw hand is debilitating to the patient and interferes in the activities of daily living. Cubital tunnel syndrome is a rare presentation of primary elbow OA and can easily be missed. Medial osteophytes and loose bodies from the joints of the elbow (ulno-trochlear and radio-ulnar) can cause compression of the ulnar nerve at the cubital tunnel and present with features of ulnar nerve palsy without substantial symptoms in the elbow. We present a case of ulnar claw hand due to compression neuropathy in an undiagnosed case of primary OA of the elbow. The patient was thoroughly investigated for about an year for all possible etiologies of the Ulnar nerve palsy the cause of compression was not clearly identified. Radiologically the site of compression was identified to be at the cubital tunnel caused by a medial osteophyte and a loose body arising from the degenerated ulno humeral joint. After a thorough work up ulnar nerve decompression at the cubital tunnel was offered, which involved loose body and osteophyte excision with anterior transposition and debulking the ulno humeral joint. Patient had a good postoperative outcome with recovery of neurological symptoms and grip strength at 6 months, though the wasting persisted. Primary OA of the elbow rarely presents as an ulnar claw hand and has to be kept in mind by the practicing clinician. Ulnar nerve decompression with anterior transposition with loose body excision gives good results.