423 - Compressive ulnar neuropathy at the wrist due to a rolling walker. A Case Report

A 77-year-old female presented with tingling and numbness in the medial 2 fingers of both hands for 4 months.  She had onset of symptoms 2-3 weeks after  right hip surgery.  She also has tingling and numbness in the other fingers of the hands but less so than the medial 2 fingers.  Pain was 0/10.    She did not have any neck pain radiating to the upper limbs. Tinel sign was positive at left Guyon's canal and left carpal tunnel and negative on the right. Tinel sign is negative at bilateral cubital tunnel.  She ambulated with a rolling walker.  There was decreased sensation to light touch at medial 1-1/2 fingers of right hand; medial 2 fingers of the left hand and medial palm left hand.  Muscle strength was 5/5 in both upper limbs except for left finger abduction which was 3/5.



Discussions:

NCS/ EMG of both upper limbs revealed bilateral severe ulnar neuropathy distally; severe left and moderate right carpal tunnel syndrome. Patient has abnormal latencies and conduction velocities of all the nerves in both upper limbs and peripheral polyneuropathy may present with similar findings.  Based on her clinical history, it seemed more like carpal tunnel and ulnar neuropathy. Median and ulnar nerves were evaluated with ultrasound.

This is an uncommon case of ulnar neuropathy after using rolling walker. Like a bicyclist, she was putting pressure on the hypothenar area.  She was educated and recommended to take off pressure from hypothenar area by using bicycle gloves. Previous studies have described occurrence of neuropathy with crutches and walker.  Pressure may be applied on the ulnar nerves when using assistive devices with lower limb surgery.

Conclusions:

This case report illustrates that patient with lower limb surgery with assistive devices to be educated regarding techniques to avoid pressure on the nerves.