Ultrasound‐Guided Perineural Injection for Pronator Syndrome Caused by Median Nerve Entrapment

2019 ◽  
Vol 39 (5) ◽  
pp. 1023-1029
Author(s):  
Patricia B. Delzell ◽  
Mital Patel
Keyword(s):  
Median Nerve ◽  
Nerve Entrapment ◽  
Ultrasound Guided ◽  
Perineural Injection ◽  
Pronator Syndrome

The sublime bridge: anatomy and implications in median nerve entrapment

2010 ◽  
Vol 113 (1) ◽  
pp. 110-112 ◽  
Author(s):  
R. Shane Tubbs ◽  
Tyler Marshall ◽  
Marios Loukas ◽  
Mohammadali M. Shoja ◽  
Aaron A. Cohen-Gadol
Keyword(s):  
Range Of Motion ◽  
Median Nerve ◽  
Nerve Entrapment ◽  
Pronator Teres ◽  
The Sublime ◽  
Potential Site ◽  
Mean Width ◽  
Pronator Syndrome ◽  
Relationship Of ◽  
The Relationship

Object The sublime bridge is a potential site of entrapment of the median nerve in the forearm. To the authors' knowledge, this structure and its relationship to the median nerve have not been studied. The aim of the present study was to quantitate this structure and elucidate its relationship to the median nerve. Methods Sixty adult cadaveric forearms underwent dissection of the sublime bridge. Relationships of this structure were observed, and measurements of its anatomy were made. The relationship of the median nerve to the sublime bridge was observed with range of motion about the forearm. Results The sublime bridge was found to be tendinous in the majority (45 [75%]) of specimens and muscular in the remaining forearms (15 [25%]). The maximal mean width of the sublime bridge was 7 cm proximally, and the minimal mean width was 3 cm distally. The mean distance from the medial epicondyle to the apex of the sublime bridge was found to be 8.1 cm. The relation of the median nerve to the bridge was always intimate. On 2 sides (1 left and 1 right) from different male specimens, the median nerve was attached to the deep aspect of the sublime bridge by a strong connective tissue band, thus forming a tunnel on the deep aspect of this structure. With range of motion of the forearm, increased compression of the median nerve by the overlying sublime bridge was seen with extension but no other movement. Conclusions Based on the authors' study, pronator syndrome is an incorrect term applied to compression of the median nerve at the sublime bridge. This potential site of median nerve compression is distinct and has characteristics that can clinically differentiate it from compression of the median nerve between the heads of the pronator teres. The authors hope that these data will be of use to the surgeon in the evaluation and treatment of patients with proximal median nerve entrapment.

Ultrasound‐Guided Hydrodissection of the Median Nerve in Pronator Syndrome: Where Is the “Pronator Tunnel”?

2020 ◽  
Vol 39 (7) ◽  
pp. 1463-1464
Author(s):  
Vincenzo Ricci ◽  
Marco Becciolini ◽  
Levent Özçakar
Keyword(s):  
Median Nerve ◽  
Ultrasound Guided ◽  
Pronator Syndrome

Effect of Ultrasound-Guided Perineural Injection with Dextrose for Direct Traumatic Injury of Median Nerve

Clinical Pain ◽  
2021 ◽  
Vol 20 (2) ◽  
pp. 127-130
Author(s):  
Yu Sang Jung ◽  
Hyerin Park ◽  
Jung Hyun Park ◽  
Hee Jae Park ◽  
Han Eol Cho
Keyword(s):  
Median Nerve ◽  
Traumatic Injury ◽  
Ultrasound Guided ◽  
Perineural Injection

scholarly journals The Effectiveness and Safety of Commonly Used Injectates for Ultrasound-Guided Hydrodissection Treatment of Peripheral Nerve Entrapment Syndromes: A Systematic Review

2021 ◽  
Vol 11 ◽  
Author(s):  
Montana Buntragulpoontawee ◽  
Ke-Vin Chang ◽  
Timporn Vitoonpong ◽  
Sineenard Pornjaksawan ◽  
Kittipong Kitisak ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Normal Saline ◽  
Local Anesthetics ◽  
Nerve Entrapment ◽  
Entrapment Neuropathy ◽  
Control Group ◽  
Clinical Effects ◽  
Ultrasound Guided ◽  
Perineural Injection ◽  
Entrapment Syndromes

Background: Peripheral nerve entrapment syndromes commonly result in pain, discomfort, and ensuing sensory and motor impairment. Many conservative measures have been proposed as treatment, local injection being one of those measures. Now with high-resolution ultrasound, anatomical details can be visualized allowing diagnosis and more accurate injection treatment. Ultrasound-guided injection technique using a range of injectates to mechanically release and decompress the entrapped nerves has therefore developed called hydrodissection or perineural injection therapy. Several different injectates from normal saline, local anesthetics, corticosteroids, 5% dextrose in water (D5W), and platelet-rich plasma (PRP) are available and present clinical challenges when selecting agents regarding effectiveness and safety.Aims: To systematically search and summarize the clinical evidence and mechanism of different commonly used injectates for ultrasound-guided hydrodissection entrapment neuropathy treatment.Methods: Four databases, including PubMed, EMBASE, Scopus, and Cochrane were systematically searched from the inception of the database up to August 22, 2020. Studies evaluating the effectiveness and safety of different commonly used injectates for ultrasound-guided hydrodissection entrapment neuropathy treatment were included. Injectate efficacy presents clinical effects on pain intensity, clinical symptoms/function, and physical performance, electrodiagnostic findings, and nerve cross-sectional areas. Safety outcomes and mechanism of action of each injectate were also described.Results: From ten ultrasound-guided hydrodissection studies, nine studies were conducted in carpal tunnel syndrome and one study was performed in ulnar neuropathy at the elbow. All studies compared different interventions with different comparisons. Injectates included normal saline, D5W, corticosteroids, local anesthetics, hyaluronidase, and PRP. Five studies investigated PRP or PRP plus splinting comparisons. Both D5W and PRP showed a consistently favorable outcome than those in the control group or corticosteroids. The improved outcomes were also observed in comparison groups using injections with normal saline, local anesthetics, or corticosteroids, or splinting. No serious adverse events were reported. Local steroid injection side effects were reported in only one study.Conclusion: Ultrasound-guided hydrodissection is a safe and effective treatment for peripheral nerve entrapment. Injectate selection should be considered based on the injectate mechanism, effectiveness, and safety profile.

scholarly journals Ultrasound-Guided Triamcinolone Acetonide Hydrodissection for Carpal Tunnel Syndrome: A Randomized Controlled Trial

2021 ◽  
Vol 8 ◽  
Author(s):  
Jia-Chi Wang ◽  
Po-Cheng Hsu ◽  
Kevin A. Wang ◽  
Ke-Vin Chang
Keyword(s):  
Median Nerve ◽  
Triamcinolone Acetonide ◽  
Carpal Tunnel ◽  
Nerve Conduction Velocity ◽  
Controlled Trial ◽  
Sensory Nerve ◽  
Ultrasound Guided ◽  
Randomized Controlled ◽  
Perineural Injection ◽  
Tunnel Syndrome

Background: Despite the wide use of corticosteroid hydrodissection for carpal tunnel syndrome (CTS), there is insufficient evidence to confirm its efficacy. This study aimed to compare the effectiveness of corticosteroid hydrodissection vs. corticosteroid perineural injection alone on clinical and electrophysiological parameters in patients with CTS.Method: This prospective randomized controlled trial (RCT) was conducted in a tertiary care center with a follow-up period of 12 weeks. Subjects were randomly assigned to either ultrasound-guided hydrodissection with a mixture of 1 mL of triamcinolone acetonide (10 mg/mL), 1 mL of 2% lidocaine, and 8 mL normal saline or ultrasound-guided perineural injection with 1 mL of triamcinolone acetonide (40 mg/mL) and 1 mL of 2% lidocaine. The primary outcome measure was the symptom severity subscale (SSS) of Boston Carpal Tunnel Questionnaire (BCTQ) scores at baseline and at 6 and 12 weeks' post-treatment. The secondary outcomes included the functional status subscale (FSS) of BCTQ and the distal motor latency and sensory nerve conduction velocity of the median nerve. The effect of interventions on the designated outcome was analyzed using a 3 × 2 repeated measures analysis of variance. The within-subject and among-subject factors were differences in time (before the intervention, and 6 and 12 weeks after injection) and intervention types (with or without hydrodissection), respectively.Results: Sixty-four patients diagnosed with CTS were enrolled. Both groups experienced improvement in the SSS and FSS of BCTQ and median nerve distal motor latency and sensory nerve conduction velocity. However, group-by-time interactions were not significant in any outcome measurements. No serious adverse events were reported in either group, except for two patients in the hydrodissection group who reported minor post-injection pain on the first day after the intervention, which resolved spontaneously without the need for additional treatments.Conclusion: Hydrodissection did not provide an additional benefit compared to corticosteroid perineural injection alone. More prospective studies are needed to investigate the long-term effectiveness of corticosteroid hydrodissection, as well as its influence on median nerve mobility.

scholarly journals A randomized trial to determine the minimum effective lidocaine volume for median nerve block using hydrodissection

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Eric Dufour ◽  
Souhail Jaziri ◽  
Marie Alice Novillo ◽  
Lila Aubert ◽  
Anne Chambon ◽  
...  
Keyword(s):  
Median Nerve ◽  
Nerve Block ◽  
Index Finger ◽  
Randomized Study ◽  
Onset Time ◽  
Hand Surgery ◽  
Ultrasound Guided ◽  
Anatomical Structures ◽  
Perineural Injection ◽  
Sequential Allocation

AbstractUltrasound-guided hydrodissection with 5% dextrose in water (DW5) creates a peri-nervous compartment, separating the nerve from the neighboring anatomical structures. The aim of this randomized study was to determine the minimum volume of lidocaine 2% with epinephrine 1:200,000 required when using this technique to achieve an effective median nerve block at the elbow in 95% of patients (MEAV95). Fifty-two patients scheduled for elective hand surgery received an ultrasound-guided circumferential perineural injection of 4 ml DW5 and an injection of local anesthetic (LA) following a biased coin up-and-down sequential allocation method. A successful block was defined as a light touch completely suppressed on the two distal phalanges of the index finger within a 30-min evaluation period. The MEAV95 of lidocaine 2% with epinephrine was 4 ml [IQR 3.5–4.0]. Successful median nerve block was obtained in 38 cases (82.6%) with median onset time of 20.0 [10.0–21.2] minutes (95% CI 15–20). The analgesia duration was 248 [208–286] minutes (95% CI 222–276). Using an ultrasound-guided hydrodissection technique with DW5, the MEAV95 to block the median nerve at the elbow with 2% lidocaine with epinephrine was 4 ml [IQR 3.5–4.0]. This volume is close to that usually recommended in clinical practice.Trial registration clinicaltrials.gov. NCT02438657, Date of registration: May 8, 2015.

Carpal Tunnel Syndrome in Madelung’s Deformity

1988 ◽  
Vol 13 (1) ◽  
pp. 19-22
Author(s):  
R. LUCHETTI ◽  
A. MINGIONE ◽  
M. MONTELEONE ◽  
G. CRISTIANI
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Surgical Approach ◽  
Nerve Entrapment ◽  
Clinical Implications ◽  
Tunnel Syndrome ◽  
Madelung’S Deformity

The authors describe a case of carpal tunnel syndrome due to Madelung’s deformity. They discuss the pathophysiological causes of median nerve entrapment to explain the compression which occurs in this disease and its clinical implications. They take also into consideration the surgical approach to the carpal tunnel in this particular condition.

scholarly journals Ultrasound-guided perineural injection with dextrose for treatment of radial nerve palsy

Medicine ◽  
2018 ◽  
Vol 97 (23) ◽  
pp. e10978 ◽  
Author(s):  
Si-Ru Chen ◽  
Yu-Ping Shen ◽  
Tsung-Yen Ho ◽  
Liang-Cheng Chen ◽  
Yung-Tsan Wu
Keyword(s):  
Radial Nerve ◽  
Nerve Palsy ◽  
Radial Nerve Palsy ◽  
Ultrasound Guided ◽  
Perineural Injection

Transient Proximal Median Nerve Entrapment in a Tetraplegic Hand Cyclist Following a 24-Hour Endurance Race

2021 ◽  
Author(s):  
Søren Bruno Elmgreen
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Unusual Case ◽  
Endurance Athlete ◽  
Nerve Entrapment ◽  
Pronator Teres ◽  
Anterior Interosseous Nerve ◽  
Tunnel Syndrome ◽  
Anterior Interosseous Nerve Syndrome

ABSTRACT Median nerve entrapment is a frequent disorder encountered by all clinicians at some point of their career. Affecting the distal median nerve, entrapment occurs most frequently at the level of the wrist resulting in a carpal tunnel syndrome. Median nerve entrapment may also occur proximally giving rise to the much less frequent pronator teres syndrome and even less frequent anterior interosseous nerve syndrome, which owing to the paucity of cases may prove challenging to diagnose. An unusual case of anterior interosseous syndrome precipitated by extraordinary exertion in a tetraplegic endurance athlete is presented with ancillary dynamometric, electrodiagnostic, ultrasonographic, and biochemical findings.

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