Precise localization of ulnar neuropathy at the elbow

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

“…One randomized, controlled trial could not demonstrate a positive effect of corticosteroid injection in UNE compared with placebo, possibly in part due to the fact that the injection target was selected at the thickest segment of the ulnar nerve regardless of specific segment of the elbow region . Recent studies have highlighted differentiation of a proximal and distal UNE . Thus, we hypothesize that an injected steroid should reach the affected segment, either the retroepicondylar groove or the cubital tunnel, of the elbow region.…”

“…Thus, we hypothesize that an injected steroid should reach the affected segment, either the retroepicondylar groove or the cubital tunnel, of the elbow region. For cases in which the actual site of nerve injury can be determined by the use of short‐segment nerve conduction studies and high‐resolution US, a targeted US‐guided injection can be applied . For those cases in which the exact site of entrapment cannot be found and even meticulous electrophysiologic examinations cannot differentiate, the question is whether a standardized untargeted injection could reach all segments relevant in UNE.…”

“…At the elbow, a plethora of sites for potential ulnar nerve entrapment have been described with a non‐uniform terminology, thus complicating the comparability of existing studies . According to studies by Omejec and Podnar, 93% of UNE can be assigned to 2 distinct sites following an anatomic categorization by Campbell et al ., the retroepicondylar groove and the cubital tunnel . The retroepicondylar groove is formed by the medial epicondyle of the humerus medially and the olecranon process of the ulna laterally.…”

Reply

“…We designed our study before the first subject was enrolled. However, due to the large amount of data, we presented our findings in a series of reports …”

“…To resolve the role of ulnar nerve dislocation in (subclinical) UNE, better powered studies with larger numbers of controls, particularly those with dislocation, are needed. These studies should evaluate separately UNE in the RTC that might be related to dislocation and UNE due to entrapment under the humeroulnar aponeurotic arcade that cannot be caused by dislocation. Furthermore, partial and complete dislocation should also be analyzed separately in future studies.…”