Ultrasound-guided Cubital Tunnel Injection: A Review and Exploration of Utility as a Diagnostic Aid in Mild or Nonclassic Cubital Tunnel Patients

Abstract

Cubital tunnel syndrome (CuTS) is a common and potentially debilitating neuropathy that results from chronic forces on the ulnar nerve at the elbow. First-line treatment options such as physiotherapy and nighttime splinting are effective in many patients, with refractory patients often benefiting from in situ ulnar nerve decompression or ulnar nerve decompression and transposition. However, identification of the most ideal surgical candidates can often present a clinical challenge, particularly in patients with a nonclassic presentation, significant comorbidities, or a negative nerve conduction study. Current literature suggests that there may be both a therapeutic and diagnostic benefit of ultrasound (US)-guided corticosteroid injections into the cubital tunnel among this population, although existing study designs have differed in terms of injection technique and outcome measurements. A descriptive case series at our institution examined 63 patients (66 arms) with mild CuTS symptoms over the course of 6 years and suggested a potential diagnostic benefit of US-guided injections in this population. In this series, those patients who experienced transient relief after US-guided injection also exhibited good long-term outcomes from surgical decompression. Randomized, controlled studies that further investigate the therapeutic and diagnostic value of US-guided cubital tunnel injections for certain patients with mild or nonclassic presentations of CuTS are recommended.