Ultrasound-guided Cubital Tunnel Injection: Description of Technique and Accuracy in a Cadaver Model

Abstract

ABSTRACT Introduction: Ulnar nerve (UN) and cubital tunnel morphology is influenced by elbow positioning, potentially compromising injection accuracy and placing the nerve at risk during cubital tunnel injection. Materials and methods: Based on previous anatomical studies of the cubital tunnel, a proof of concept injection model was developed. Eighteen above-elbow cadaver specimens were positioned in 45° elbow flexion and in neutral forearm rotation. The ultrasound transducer was oriented in the transverse plane, in-line with the medial epicondyle and olecranon tip, facilitating visualization of the UN and cubital tunnel. A 25-gauge needle oriented parallel to the ulna was inserted percutaneously at the midpoint between olecranon and epicondyle. The needle was advanced under ultrasound guidance to replicate injection and was secured. Open dissection confirmed its location. Results: 18/18 needle tips were within the cubital tunnel and no needles penetrated the UN. Discussion: Ultrasound-guided cubital tunnel injection, with the elbow in 45° flexion and with neutral forearm rotation was a safe and reliable technique in this cadaveric model. Future clinical studies may evaluate the efficacy of both diagnostic and therapeutic cubital tunnel injection. Nickel BT, Richard MJ, Cotterell I, Crosmer M, Ruch DS, Leversedge FJ. Ultrasound-guided Cubital Tunnel Injection: Description of Technique and Accuracy in a Cadaver Model. The Duke Orthop J 2017;7(1):43-45.