Ultrasound‐Guided Perineural Injection for Pronator Syndrome Caused by Median Nerve Entrapment

Abstract

Patients and physicians have increasingly sought minimally invasive procedures such as ultrasound-guided injection for the treatment of peripheral nerve entrapment syndromes. In this series, we assessed subjective outcome data in 14 patients who underwent ultrasound-guided perineural hydrodissection and steroid injection for pronator syndrome secondary to median nerve entrapment in the pronator tunnel. Excellent symptomatic relief (≥75% improvement) was achieved in 70% of nerves with 3-month follow-up data, with no significant change in symptoms between 3 and 6 months. These outcomes suggest that this technique could play a role in the management of pronator syndrome due to median nerve entrapment.

A review of upper extremity peripheral nerve injuries in throwing athletes

“…Clinical tests include provocation on examination with resisted pronation of the extended forearm (pronator teres entrapment), with resisted elbow flexion and forearm supination (lacertus fibrosus), and with resisted flexion of the third proximal interphalangeal joint (flexor digitorum superficialis arch) 64 . Diagnostic ultrasound can also be helpful in localizing the site of compression with or without a diagnostic injection 175,176 . Treatment most frequently involves rest and physical therapy focusing on appropriate throwing mechanics and kinetic chain optimization.…”

“…Treatment most frequently involves rest and physical therapy focusing on appropriate throwing mechanics and kinetic chain optimization. Ultrasound‐guided injections can also help with pain relief 176 . Surgical decompression is warranted in refractory cases 64,92 .…”

“…64 Diagnostic ultrasound can also be helpful in localizing the site of compression with or without a diagnostic injection. 175,176 Treatment most frequently involves rest and physical therapy focusing on appropriate throwing mechanics and kinetic chain optimization. Ultrasound-guided injections can also help with pain relief.…”

“…Ultrasound-guided injections can also help with pain relief. 176 Surgical decompression is warranted in refractory cases. 64,92 However, there are no randomized controlled trials indicating treatment outcomes in pronator syndrome or to guide the duration of conservative management before pursuing surgical intervention.…”

High Volume Injection (Hydrodissection) for Tarsal Tunnel Syndrome Using Peripheral Nerve Stimulation: Treatment Protocol

“…Figure 1: TTS injection (Reilly, 2010) The basic technique of hydrodissection (high volume injection [HVI]) includes identifying the region of nerve entrapment or compression and the use of a fluid medium, usually local anaesthetic and/or saline, to dissect between structures or fascial planes (Beard & Gousse, 2018;Cass, 2016;Delzell & Patel, 2020;Lam et al, 2020). Pathological nerves can be identified by examination or ultrasound visualisation (Fernández-Gibello, 2019).…”