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Role of ultrasound-guided perineural injection of the posterior antebrachial cutaneous nerve for diagnosis and potential treatment of chronic lateral elbow pain

Abstract

Objective

To examine diagnostic and therapeutic utility of novel ultrasound-guided perineural injection of posterior antebrachial cutaneous nerve in chronic lateral elbow pain.

Materials and methods

We performed a retrospective analysis of ultrasound-guided perineural injection of the posterior antebrachial cutaneous nerve with local anesthetic with or without corticosteroid in patients with chronic lateral elbow pain. Data variables collected included patient demographics, illness course, diagnostic ultrasound findings, immediate pre- and post-injection pain using numeric rating pain scale between 0 and 10, injection complications, and post-injection outcomes.

Results

Fifteen patients (9 females and 6 males) with average age 46.9 (range 16–69 years) underwent 20 perineural injections between 2009 and 2019. Patients had on average 84% reduction in pain immediately after the injection (median pre- and post-procedure numeric rating pain scale of 6 and 0, respectively, p < 0.001). Patients had pain relief for an average of 15 h (range 2–48 h) when only local anesthetic was injected, compared with average pain relief of 26.5 days (range 2 h—43 days) when local anesthetic was combined with corticosteroid, p = 0.01.

Conclusion

Novel ultrasound-guided perineural anesthetic injections around the posterior antebrachial cutaneous nerve can be performed safely and have diagnostic and potentially therapeutic utility in select patients with chronic refractory lateral elbow pain.

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References

  1. 1.

    Kotnis NA, Chiavaras MM, Harish S. Lateral epicondylitis and beyond: imaging of lateral elbow pain with clinical-radiologic correlation. Skelet Radiol. 2012;41:369–86.

    Article  Google Scholar 

  2. 2.

    Doyle JJ, David WS. Posterior antebrachial cutaneous neuropathy associated with lateral elbow pain. Muscle Nerve. 1993;16:1417–8.

    CAS  PubMed  Google Scholar 

  3. 3.

    Shiri R, Viikari-Juntura E, Varonen H, Heliövaara M. Prevalence and determinants of lateral and medial epicondylitis: a population study. Am J Epidemiol. 2006;164:1065–74.

    Article  Google Scholar 

  4. 4.

    Lai WC, Erickson BJ, Mlynarek RA, Wang D. Chronic lateral epicondylitis: challenges and solutions. Open Access J Sports Med. 2018;9:243–51.

    Article  Google Scholar 

  5. 5.

    Berry N, Neumeister MW, Russell RC, Dellon AL. Epicondylectomy versus denervation for lateral humeral epicondylitis. Hand. 2011;6:174–8.

    Article  Google Scholar 

  6. 6.

    Sanders TL, Kremers HM, Bryan AJ, Ransom JE, Smith J, Morrey BF. The epidemiology and health care burden of tennis elbow [Internet]. Am J Sports Med. 2015:1066–71. https://doi.org/10.1177/0363546514568087.

  7. 7.

    Morrey ME, Dean BJF, Carr AJ, Morrey BF. Tendinopathy: same disease different results—why? [Internet]. Oper Tech Orthop. 2013:39–49. https://doi.org/10.1053/j.oto.2013.06.004.

  8. 8.

    Maida E, Chiavaras MM, Jelsing EJ, O’Driscoll SW, Pawlina W, Smith J. Sonographic visualization of the posterior cutaneous nerve of the forearm: technique and validation using perineural injections in a cadaveric model [Internet]. J Ultrasound Med. 2017:1627–37. https://doi.org/10.7863/ultra.16.08027.

  9. 9.

    Moritz T, Prosch H, Pivec CH, Sachs A, Pretterklieber ML, Kriechbaumer L, et al. High-resolution ultrasound visualization of the subcutaneous nerves of the forearm: a feasibility study in anatomic specimens. Muscle Nerve. 2014;49:676–9.

    Article  Google Scholar 

  10. 10.

    Li H, Zhu W, Wu S, Wei Z, Yang S. Anatomical analysis of antebrachial cutaneous nerve distribution pattern and its clinical implications for sensory reconstruction. PLoS One. 2019;14:e0222335.

    CAS  Article  Google Scholar 

  11. 11.

    Rose NE, Forman SK, Dellon AL. Denervation of the lateral humeral epicondyle for treatment of chronic lateral epicondylitis. J Hand Surg Am. 2013;38:344–9.

    Article  Google Scholar 

  12. 12.

    Sacks D, McClenny TE, Cardella JF, Lewis CA. Society of interventional radiology clinical practice guidelines [Internet]. J Vasc Interv Radiol. 2003:S199–202. https://doi.org/10.1097/01.rvi.0000094584.83406.3e.

  13. 13.

    Finneran JJ, Sandhu N. Ultrasound-guided posterior antebrachial cutaneous nerve block: technical description and block distribution in healthy volunteers [Internet]. J Ultrasound Med. 2019:239–42. https://doi.org/10.1002/jum.14678.

  14. 14.

    Sims SEG, Miller K, Elfar JC, Hammert WC. Non-surgical treatment of lateral epicondylitis: a systematic review of randomized controlled trials. Hand. 2014;9:419–46.

    Article  Google Scholar 

  15. 15.

    Kaplan EB. Treatment of tennis elbow (epicondylitis) by denervation. J Bone Joint Surg Am. 1959;41-A:147–51.

    CAS  Article  Google Scholar 

  16. 16.

    Khodair S, Elshafey R. Ultrasound guided lateral femoral cutaneous nerve block in meralgia paresthesia; review of 25 cases [Internet]. Egypt J Radiol Nucl Med. 2014:1127–31. https://doi.org/10.1016/j.ejrnm.2014.06.002.

  17. 17.

    Tagliafico A, Serafini G, Lacelli F, Perrone N, Valsania V, Martinoli C. Ultrasound-guided treatment of meralgia paresthetica (lateral femoral cutaneous neuropathy): technical description and results of treatment in 20 consecutive patients. J Ultrasound Med. 2011;30:1341–6.

    Article  Google Scholar 

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Correspondence to Sagar Wagle.

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Wagle, S., Glazebrook, K., Moynagh, M. et al. Role of ultrasound-guided perineural injection of the posterior antebrachial cutaneous nerve for diagnosis and potential treatment of chronic lateral elbow pain. Skeletal Radiol 50, 425–430 (2021). https://doi.org/10.1007/s00256-020-03594-7

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Keywords

  • Posterior antebrachial cutaneous nerve
  • Posterior cutaneous nerve of forearm
  • Chronic lateral elbow pain
  • Cutaneous nerve block
  • Ultrasound guided nerve block