Tardy Ulnar nerve palsy

Mrs. XX, 22 years old female hailing from Cumilla with the complaints of
Progressive worsening of pain. Paresthesia, weakness, numbness with left hand
ulnar side deformity for 4 years, Difficulties of grip and limitation in daily living
activities with her left hand for same duration. According to the statement of the
patient she was reasonably well 4 years back. Thereafter, insidiously, one day she
felt tingling, numbness and intermittent pain with her left hand with 4th and 5th
fingers. Pain was initially intermittent, mild in nature, non-radiating, aggravated by
heavy work and weight lifting with her left upper limb and relieved by taking rest.
But later, her symptoms are worsened within time. She also complaints about the
progressive deformity of 4th and 5th fingers of her left hand and also mansion about
the progressive decrease of her grip strength of the left hand. With these features she
went to many physicians but could not get any satisfactory result. She had no history
of recent trauma to her left upper limb and cervical spine. She is normotensive, non-
diabetic and non-asthmatic. History of trauma to the left elbow lateral aspect about
15 years back, for which she took treatment from the local bone-settler. on
examination found that, Cubitus valgus deformity of left elbow, Hypothener muscle
wasting on left hand, 4th & 5th finger claw of left hand, Mild Hyper extension of
left elbow, No shoulder drooping and spinal kypho-scoliosis deformity, Temperature
is Normal, Tenderness is absent, Isosceles triangle distorted of left, Prominence of
left lateral epicondyle at elbow, Galleazi test is normal, 1st interrossi muscle wasting
on left hand, Q-angle one left side is 27˚ & right is 12˚. Tinel’s sign at left elbow is
positive, Froment sign and card are positive on left side, Bunnel’s OK sign &
Ochsner's clasp sign are negative, Egawa’s sign is positive on left side, Sensory-
sensation is diminished over the autonomous zone of left ulnar nerve, Motor- FDP
& FDS have MRC grade 5/5 bilaterally, left hand fingers abductor and adductors
have 4/5. Radial artery- symmetrically palpable, all other joints have full ROM.

4 years old left sided tardy ulnar nerve palsy, low variety, with post traumatic cubitus
valgus deformity in a 22 years old female