Ann Rehabil Med.  2012 Aug;36(4):496-500. 10.5535/arm.2012.36.4.496.

Real-Time Visualization of Ultrasonography Guided Cubital Tunnel Injection: A Cadaveric Study

• Kim JM
• Oh HM
• Kim MW

• KMID: 2266720
• DOI: http://doi.org/10.5535/arm.2012.36.4.496

Abstract

OBJECTIVE
To describe an ultrasonography-guided technique for cubital tunnel injection. METHOD: The ulnar nerves from 12 elbows of 6 adult cadavers were scanned, and the cross-sectional areas of the ulnar nerves, cubital tunnel inlets and outlets were measured by using ultrasonography. All elbows were dissected after an ultrasonography-guided dye injection at the inlet of the cubital tunnel. The dissectors evaluated the spread of dye and the coloration of the nerve and remeasured the cross-sectional areas of the cubital tunnel inlets and outlets.
RESULTS
After a real-time visualization of an ultrasonography-guided injection, the ulnar nerves were seperated from the medial groove for the ulnar nerve. All the ulnar nerves of the cadavers were successfully colored with the dye, from the inlet to oulet of the cubital tunnel. The post-injection cross-sectional areas were significantly larger than the pre-injection cross-sectional areas. No significant differences were detected in the post-injection cross-sectional areas of the cubital tunnel outlet and the ulnar nerve as compared with the pre-injection areas.
CONCLUSION
Clinicians should consider real-time visualization of ultrasonography for guided injection around the ulnar nerve at the inlet of the cubital tunnel.

Keyword

Cadavers; Ulnar neuropathy; Ultrasonography; Injection

MeSH Terms

Adult
Bays
Cadaver
Elbow
Humans
Ulnar Nerve
Ulnar Neuropathies

Figure

• 

  Fig. 1 Transverse scan of the cubital groove. The needle passed the medial epicondyle, penetrating the Osborne bone between the medial epicondyle and ulnar nerve at the inlet of the cubital tunnel, where most ulnar nerve friction occurs.

• 

  Fig. 2 The Spread of dye and nerve coloration after the injection. It was evaluated by dissection. (A) At first, the red dye was found between the cubital tunnel inlet and outlet, and as we dissected deeper, (B) it spread all over the cubital tunnel from the inlet to the outlet, and the ulnar nerves were successfully colored with dye.

Reference

1. Bayrak AO, Bayrak IK, Turker H, Elmali M, Nural MS. Ultrasonography in patients with ulnar neuropathy at the elbow: comparison of cross-sectional area and swelling ratio with electrophysiological severity. Muscle Nerve. 2010; 41:661–666. PMID: 19941341.

2. Yoon JS, Hong SJ, Kim BJ, Kim SJ, Kim JM, Walker FO, Cartwright MS. Ulnar nerve and cubital tunnel ultrasound in ulnar neuropathy at the elbow. Arch Phys Med Rehabil. 2008; 89:887–889. PMID: 18452736.

3. Alblas CL, van Kasteel V, Jellema K. Injection with corticosteroids (ultrasound guided) in patients with an ulnar neuropathy at the elbow, feasibility study. Eur J Neurol. 2012; 16:1–4.

4. Rampen AJ, Wirtz PW, Tavy DL. Ultrasound-guided steroid injection to treat mild ulnar neuropathy at the elbow. Muscle Nerve. 2011; 44:128–130. PMID: 21660983.

5. Smith J, Wisniewski SJ, Finnoff JT, Payne JM. Sonographically guided carpal tunnel injections: the ulnar approach. J Ultrasound Med. 2008; 27:1485–1490. PMID: 18809959.

6. Hong CZ, Long HA, Kanakamedala RV, Chang YM, Yates L. Splinting and local steroid injection for the treatment of ulnar neuropathy at the elbow: clinical and electrophysiological evaluation. Arch Phys Med Rehabil. 1996; 77:573–577. PMID: 8831474.

7. Pechan J, Kredba J. Treatment of cubital tunnel syndrome by means of local administration of cortisonoids. II. Long-term follow-up. Acta Univ Carol Med (Praha). 1980; 26:135–140. PMID: 7315671.

8. Pechan J, Kredba J. Treatment of cubital tunnel syndrome by means of local administration of corticosteroids. I. Short-term follow-up. Acta Univ Carol Med (Praha). 1980; 26:125–133. PMID: 7315670.