1. Teaching NeuroImages Neurology Resident and Fellow Section A 51 year old female with intermittent left hand numbness and weakness. © 2013 American Academy of Neurology

2. VIGNETTE A 51 year-old woman experienced intermittent left hand numbness and weakness over 2 years. There was a “claw hand” deformity, weakness of finger abduction, adduction and distal inter-phalangeal joint flexion of the medial 2 fingers. Wrist flexion saw radial deviation of the hand. Palmar and dorsal aspects of digits IV (medially) and V, including the medial forearm, had decreased pinprick sensation. NCS showed conduction block 14cm above the medial epicondyle (Figure 1) where Tinel’s sign was positive. Sonographic interrogation (figure 2) revealed a hyperechogenic structure distorting the ulnar nerve. Jonathan JY Ong et al © 2013 American Academy of Neurology

3. IMAGING Jonathan JY Ong et al © 2013 American Academy of Neurology

4. IMAGING Jonathan JY Ong et al © 2013 American Academy of Neurology

5. ULNAR NEUROPATHY RELATED TO A CONTRACEPTIVE SUBDERMAL IMPLANT This patient had a surgically implanted subdermal contraceptive device over the left arm 10 years prior, which was only recalled when further investigations were performed. Physical examination features are suggestive of a left proximal ulnar neuropathy. This case highlights the usefulness of nerve conduction studies coupled with sonographic correlation, allowing the etiology to be clarified and for the diagnosis to be clinched. The patient subsequently had the implant surgically removed with ensuing good recovery. Jonathan JY Ong et al © 2013 American Academy of Neurology