A reliable technique for ultrasound-guided perineural injection in ulnar neuropathy at the elbow

Hamscha, Ulrike M.; Tinhofer, Ines; Heber, Stefan; Grisold, Wolfgang; Weninger, Wolfgang J.; Meng, Stefan

doi:10.1002/mus.25490

Cited by 6 publications

(7 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Evidence on imaging guided injections at peripheral nerves outside the carpal tunnel is scarce and mainly derives from observational and cadaveric studies,34–39 hence, this aspect has been included in the research agenda.…”

Section: Resultsmentioning

confidence: 99%

“…A bifid median nerve is the most common anatomical variant occurring in 15%-20% of the population, 11% have a persistent median artery. 32 33 Evidence on imaging guided injections at peripheral nerves outside the carpal tunnel is scarce and mainly derives from observational and cadaveric studies, [34][35][36][37][38][39] hence, this aspect has been included in the research agenda.…”

Section: Point To Considermentioning

confidence: 99%

See 1 more Smart Citation

EULAR points to consider for the use of imaging to guide interventional procedures in patients with rheumatic and musculoskeletal diseases (RMDs)

Dejaco

Machado

Carubbi

et al. 2022

Annals of the Rheumatic Diseases

View full text Add to dashboard Cite

ObjectivesTo develop evidence-based Points to Consider (PtC) for the use of imaging modalities to guide interventional procedures in patients with rheumatic and musculoskeletal diseases (RMDs).MethodsEuropean Alliance of Associations for Rheumatology (EULAR) standardised operating procedures were followed. A systematic literature review was conducted to retrieve data on the role of imaging modalities including ultrasound (US), fluoroscopy, MRI, CT and fusion imaging to guide interventional procedures. Based on evidence and expert opinion, the task force (25 participants consisting of physicians, healthcare professionals and patients from 11 countries) developed PtC, with consensus obtained through voting. The final level of agreement was provided anonymously.ResultsA total of three overarching principles and six specific PtC were formulated. The task force recommends preference of imaging over palpation to guide targeted interventional procedures at peripheral joints, periarticular musculoskeletal structures, nerves and the spine. While US is the favoured imaging technique for peripheral joints and nerves, the choice of the imaging method for the spine and sacroiliac joints has to be individualised according to the target, procedure, expertise, availability and radiation exposure. All imaging guided interventions should be performed by a trained specialist using appropriate operational procedures, settings and assistance by technical personnel.ConclusionThese are the first EULAR PtC to provide guidance on the role of imaging to guide interventional procedures in patients with RMDs.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Point To Considermentioning

confidence: 99%

EULAR points to consider for the use of imaging to guide interventional procedures in patients with rheumatic and musculoskeletal diseases (RMDs)

Dejaco

Machado

Carubbi

et al. 2022

Annals of the Rheumatic Diseases

View full text Add to dashboard Cite

show abstract

“…Proponents of US-guided cubital tunnel injections have argued for its logical physiologic mechanism and feasibility. 23 Some authors have noted the similarities in the pathogenesis between CTS and CuTS based on the theory that both stem from edema of surrounding tissues and of the nerve itself. [24][25][26] In CTS, injections near or in the carpal tunnel are thought to reduce swelling of the local connective tissue to limit nerve compression.…”

Section: Overview Of the Available Evidencementioning

confidence: 99%

Ultrasound-guided Cubital Tunnel Injection: A Review and Exploration of Utility as a Diagnostic Aid in Mild or Nonclassic Cubital Tunnel Patients

Gronbeck

Wolf

Rodner

2020

Techniques in Orthopaedics

View full text Add to dashboard Cite

Cubital tunnel syndrome (CuTS) is a common and potentially debilitating neuropathy that results from chronic forces on the ulnar nerve at the elbow. First-line treatment options such as physiotherapy and nighttime splinting are effective in many patients, with refractory patients often benefiting from in situ ulnar nerve decompression or ulnar nerve decompression and transposition. However, identification of the most ideal surgical candidates can often present a clinical challenge, particularly in patients with a nonclassic presentation, significant comorbidities, or a negative nerve conduction study. Current literature suggests that there may be both a therapeutic and diagnostic benefit of ultrasound (US)-guided corticosteroid injections into the cubital tunnel among this population, although existing study designs have differed in terms of injection technique and outcome measurements. A descriptive case series at our institution examined 63 patients (66 arms) with mild CuTS symptoms over the course of 6 years and suggested a potential diagnostic benefit of US-guided injections in this population. In this series, those patients who experienced transient relief after US-guided injection also exhibited good long-term outcomes from surgical decompression. Randomized, controlled studies that further investigate the therapeutic and diagnostic value of US-guided cubital tunnel injections for certain patients with mild or nonclassic presentations of CuTS are recommended.

show abstract

“…Perineural injection of the ulnar nerve can be performed anywhere along the potential entrapment sites. An in‐plane transverse approach between the medial epicondyle and olecranon has been shown to result in good spread of the injectate to all sites of potential entrapment in a recent cadaver study . Careful patient positioning when using an in‐plane transverse approach is often necessary given that access to the nerve can be blocked by the medial epicondyle or the olecranon.…”

Section: Approach To Ultrasound‐guided Treatment Of Individual Entrapmentioning

confidence: 99%

“…An in-plane transverse approach between the medial epicondyle and olecranon has been shown to result in good spread of the injectate to all sites of potential entrapment in a recent cadaver study. 53 Careful patient positioning when using an in-plane transverse approach is often necessary given that access to the nerve can be blocked by the medial epicondyle or the olecranon. There is currently no evidence to support a role for needle release of the cubital tunnel, arcuate ligament, or arcade of Struthers.…”

Section: Fibular (Peroneal) Nerve At the Fibular Neck Neuropathymentioning

confidence: 99%

Ultrasound‐guided treatment of peripheral entrapment mononeuropathies

Norbury

Nazarian

2019

Muscle and Nerve

View full text Add to dashboard Cite

The advent of high‐resolution neuromuscular ultrasound (US) has provided a useful tool for conservative treatment of peripheral entrapment mononeuropathies. US‐guided interventions require careful coordination of transducer and needle movement along with a detailed understanding of sonoanatomy. Preprocedural planning and positioning can be helpful in performing these interventions. Corticosteroid injections, aspiration of ganglia, hydrodissection, and minimally invasive procedures can be useful nonsurgical treatments for mononeuropathies refractory to conservative care. Technical aspects as well as the current understanding of the indications and efficacy of these procedures for common entrapment mononeuropathies are reviewed in this study. Muscle Nerve, 2019

show abstract

A reliable technique for ultrasound-guided perineural injection in ulnar neuropathy at the elbow

Abstract: US-guided injection between the olecranon and the medial epicondyle is a feasible and safe method to reach the most common sites of ulnar nerve entrapment. Muscle Nerve 56: 237-241, 2017.

Cited by 6 publications

References 39 publications

EULAR points to consider for the use of imaging to guide interventional procedures in patients with rheumatic and musculoskeletal diseases (RMDs)

EULAR points to consider for the use of imaging to guide interventional procedures in patients with rheumatic and musculoskeletal diseases (RMDs)

Ultrasound-guided Cubital Tunnel Injection: A Review and Exploration of Utility as a Diagnostic Aid in Mild or Nonclassic Cubital Tunnel Patients

Ultrasound‐guided treatment of peripheral entrapment mononeuropathies

Contact Info

Product

Resources

About