Ulnar Nerve Entrapment at the Cubital Tunnel Successfully Treated with Ultrasound-Guided Peripheral Nerve Hydrodissection: A Case Report and Further Evidence for a Developing Treatment Option

Stoddard, Jonathan M.; Taylor, Cole R; O’Connor, Francis G.

doi:10.1249/jsr.0000000000000649

Cited by 7 publications

(7 citation statements)

References 23 publications

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“…There were no complications (bleeding, infection, pain aggravation or intraneural injection). The procedure was safe and the results satisfactory ( 19 ).…”

Section: Resultsmentioning

confidence: 92%

Conservative therapy in ulnar neuropathy at the elbow (Review)

et al. 2022

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Ulnar neuropathy at the elbow (UNE) is the second most frequent entrapment syndrome in the upper limb after carpal tunnel syndrome. Clinical features are validated through electromyographic and sonographic examination. Although the two aforementioned entrapment syndromes share common pathophysiological traits, the conservative treatment approach for mild and moderate cases of UNE differs from that for median nerve entrapment. The present study identified 23 different types of scientific articles aimed to address this issue. The research stressed the importance of patient education and activity modification. Night splinting offers clinical and functional improvement. Although corticosteroid injections play a role in selected cases, their utility remains to be validated. Physiotherapy trials evaluated ultrasound, low-level laser therapy, diathermy, extracorporeal shock wave therapy and dry cupping. Neurodynamic mobilization may add value to therapeutic approaches and should be a part of it.

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“…There were no complications (bleeding, infection, pain aggravation or intraneural injection). The procedure was safe and the results satisfactory ( 19 ).…”

Section: Resultsmentioning

confidence: 92%

Conservative therapy in ulnar neuropathy at the elbow (Review)

et al. 2022

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“…The use of US-guided peripheral nerve hydrodissection for the management of cubital tunnel syndrome has previously been described in the literature, though only in cadaveric studies or single case reports and never in the case of AE-induced cubital tunnel syndrome (13,14). While the definitive management of AE-induced cubital tunnel syndrome is myotomy, there remain a number of patients who may prefer to avoid surgery when effective, less invasive treatment options are available.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Anconeus Epitrochlearis- Induced Cubital Tunnel Syndrome With Ultrasound-Guided Hydrodissection

Chien¹,

Marcolina²,

Castro³

2021

PMCR

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BACKGROUND: Cubital tunnel syndrome is the second most common cause of peripheral nerve entrapment in the upper extremity, trailing only carpal tunnel neuropathy. While the roof of the cubital tunnel is most often formed by Osborne’s ligament, the anomalous, evolutionary remnant muscle, the anconeus epitrochlearis, has been previously identified as a potential cause of cubital tunnel syndrome. CASE REPORT: A 45-year-old female physical education coach noted bilateral upper extremity pain, numbness, paresthesias, and early onset exercise fatigue originating at the medial elbow and radiating down the ulnar nerve distribution. Sonographic evaluation showed evidence of a hypertrophic anconeus epitrochlearis in the right upper extremity causing compression of an enlarged, bifid ulnar nerve. The patient was treated with 3 separate ultrasound-guided hydrodissection injections, which resulted in complete resolution of her symptoms and a decrease in the ulnar nerve cross-sectional area on sonographic evaluation at 24-week follow-up. CONCLUSION: A hypertrophic anconeus epitrochlearis can cause cubital tunnel syndrome and ultrasound-guided hydrodissection is a potentially efficacious surgery-sparing treatment option. KEY WORDS: Cubital tunnel syndrome, hydrodissection, ulnar neuralgia, ultrasound

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“…vanVeen et al (90) in their study used visualization in the long axis, which, according to other authors, is less convenient because the nerve can be confused with other structures (91). In a case report, Stoddard suggested that hydrodissection with a higher injected volume might also be beneficial (92).…”

Section: Ultrasound-guided Injection Techniques and Exemplary Evidencementioning

confidence: 99%

Ulnar Neuropathy at the Elbow: From Ultrasound Scanning to Treatment

et al. 2021

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Ulnar neuropathy at the elbow (UNE) is commonly encountered in clinical practice. It results from either static or dynamic compression of the ulnar nerve. While the retroepicondylar groove and its surrounding structures are quite superficial, the use of ultrasound (US) imaging is associated with the following advantages: (1) an excellent spatial resolution allows a detailed morphological assessment of the ulnar nerve and adjacent structures, (2) dynamic imaging represents the gold standard for assessing the ulnar nerve stability in the retroepicondylar groove during flexion/extension, and (3) US guidance bears the capability of increasing the accuracy and safety of injections. This review aims to illustrate the ulnar nerve's detailed anatomy at the elbow using cadaveric images to understand better both static and dynamic imaging of the ulnar nerve around the elbow. Pathologies covering ulnar nerve instability, idiopathic cubital tunnel syndrome, space-occupying lesions (e.g., ganglion, heterotopic ossification, aberrant veins, and anconeus epitrochlearis muscle) are presented. Additionally, the authors also exemplify the scientific evidence from the literature supporting the proposition that US guidance is beneficial in injection therapy of UNE. The non-surgical management description covers activity modifications, splinting, neuromobilization/gliding exercise, and physical agents. In the operative treatment description, an emphasis is put on two commonly used approaches—in situ decompression and anterior transpositions.

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Ulnar Nerve Entrapment at the Cubital Tunnel Successfully Treated with Ultrasound-Guided Peripheral Nerve Hydrodissection: A Case Report and Further Evidence for a Developing Treatment Option

Cited by 7 publications

References 23 publications

Conservative therapy in ulnar neuropathy at the elbow (Review)

Conservative therapy in ulnar neuropathy at the elbow (Review)

Treatment of Anconeus Epitrochlearis- Induced Cubital Tunnel Syndrome With Ultrasound-Guided Hydrodissection

Ulnar Neuropathy at the Elbow: From Ultrasound Scanning to Treatment

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