Clinical implications of real-time visualized ultrasound-guided injection for the treatment of ulnar neuropathy at the elbow: a pilot study.
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.


CONCLUSIONS
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.
Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea.
Chang Kweon
CK
Choi
Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea.
Hyun Seok
HS
Lee
Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea.
Jae Yeoun
JY
Kwon
Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea.
Won-Jae
WJ
Lee
Cubital tunnel syndrome; Injections; Neural conduction; Ulnar nerve; Ultrasonography