Ulnar Nerve Hydrodissection at the Elbow With Ultrasound Guidance

Abstract

Background: Ulnar neuropathy at the elbow (UNE) is common, and treatment ranges from bracing and nonsteroidal anti-inflammatory drugs (NSAIDs) to surgical decompression. Prior to surgical intervention, some patients may opt to receive perineural injections to the ulnar nerve. The goal of this injection is to reduce pain, improve symptoms, and decrease nerve cross-sectional area through mechanical decompression. While the use of hydrodissection as a treatment for carpal tunnel syndrome has been well studied, there are few studies evaluating its utility in UNE. Indications: Ultrasound-guided perineural injections can be used to alleviate symptoms of UNE caused by compression. The use of a gel stand-off technique is helpful in maintaining adequate visualization of the needle with a steeper needle angle. Technique Description: The procedure was carried out with patient supine, shoulder abducted to 90°, and the forearm supinated. A 15-6 MHz linear array ultrasound transducer was used to localize the right ulnar nerve proximal to the retrocondylar groove at an area of focal hypoechogenicity and increased nerve cross-sectional area. A 3 mL mixture of 2 mL of 1% lidocaine and 1 mL of 10 mg/mL dexamethasone was injected using a sonographically guided in-plane anterior-to-posterior technique. Results: Our patient was seen 3 weeks after her right-sided ulnar nerve hydrodissection and had experienced temporary reduction in symptoms. Discussion/Conclusion: UNE is a common cause of focal neuropathy. Most patients will experience adequate relief of symptoms with conservative treatment modalities. If patients do not experience adequate symptom relief, ultrasound-guided ulnar nerve injection is a minimally invasive option that can provide symptom relief. However, if patients continue to experience significant symptom burden, it is reasonable to discuss surgical options for ulnar nerve decompression. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.