Ann Rehabil Med.  2015 Apr;39(2):176-182. 10.5535/arm.2015.39.2.176.

Clinical Implications of Real-Time Visualized Ultrasound-Guided Injection for the Treatment of Ulnar Neuropathy at the Elbow: A Pilot Study

• Choi CK
• Lee HS
• Kwon JY
• Lee WJ

• KMID: 2273038
• DOI: http://doi.org/10.5535/arm.2015.39.2.176

Abstract

OBJECTIVE
To investigate the feasibility of ultrasound (US)-guided steroid injection by in-plane approach for cubital tunnel syndrome (CuTS), based on symptomatic, morphologic and electrophysiological outcomes.
METHODS
A total of 10 patients, who were clinically diagnosed as CuTS and confirmed by an electrodiagnostic study, participated in this study. US-guided injection into the cubital tunnel was performed with 40 mg triamcinolone and 2 mL of 1% lidocaine. Outcomes of the injections were evaluated at pre-injection, 1st week and 4th week after injection. Visual analog scale, self-administered questionnaire of the ulnar neuropathy at the elbow (SQUNE), and McGowan classification were used for clinical evaluation. Cross-sectional area of the ulnar nerve by US and the electrophysiological severity scale through a nerve conduction study were utilized in the evaluation of morphologic and electrophysiological changes. The cross-sectional area of the ulnar nerve was measured at 3 points of condylar, proximal, and distal level of the cubital tunnel.
RESULTS
No side effects were reported during the study period. The visual analog scale and cross-sectional area showed a significant decrease at 1st week and 4th week, as compared to baseline (p<0.05). The electrophysiological severity scale was significantly decreased at the 4th week, as compared with baseline and 1st week (p<0.05). Among the quantitative components of the scale, there were statistically significant improvements with respect to the conduction velocity and block.
CONCLUSION
The new approach of US-guided injection may be a safe tool for the treatment of CuTS. Symptomatic and morphologic recoveries preceded the electrophysiological improvement.

Keyword

Cubital tunnel syndrome; Ulnar nerve; Neural conduction; Ultrasonography; Injections

MeSH Terms

Classification
Cubital Tunnel Syndrome
Elbow*
Humans
Lidocaine
Neural Conduction
Pilot Projects*
Triamcinolone
Ulnar Nerve
Ulnar Neuropathies*
Ultrasonography
Visual Analog Scale
Surveys and Questionnaires
Lidocaine
Triamcinolone

Figure

• 

  Fig. 1 Ultrasound-guided injection into the cubital tunnel was conducted via an in-plane technique. (A) The patient was placed in a supine position with the shoulder abducted and the elbow flexed at 90°. (B) The ulnar nerve within the cubital tunnel was identified in transverse plane, and the injection was conducted after aseptic preparation. (C) The needle (arrowhead) passed between the medial epicondyle (ME) and ulnar nerve (dotted circle) at the level of the epicondyle. (D) After the injection, we confirmed that the ulnar nerve was separated from the epicondyle by the effect of hydrodissection. O, olecranon.

• 

  Fig. 2 Symptom scores and morphologic changes were compared at baseline, 1st week, and 4th week after injection. Among symptom scores, visual analog scale (VAS) was significantly decreased at 1st week and 4th week, as compared to baseline. Cross-sectional area (CSA) of ulnar nerve was measured by ultrasonography at 3 points of P, E, and D (P, 2 cm proximal to the epicondyle; E, the level of the epicondyle; D, 2 cm distal to the epicondyle). Comparing with baseline, the CSA-P showed significant decrease at 1st and 4th week. The CSA-E was significantly decreased at 4th week, as compared to baseline. MGS, McGowan classification; SQUNE, self-administered questionnaire of the ulnar neuropathy at the elbow. *p<0.05.

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