Ultrasound-guided therapeutic injection of the surgically transposed ulnar nerve at the elbow: sonographic appearances, technique and clinical follow-up

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Abstract
Aim: To evaluate the therapeutic efficacy of ultrasound-guided injection of the transposed ulnar nerve at the elbow. Methods: Fifteen patients who underwent injection of a transposed ulnar nerve between 2014–2024 were identified. Sonographic appearances of the injected segment were scored using a Likert grading system for abnormality, and the cross-sectional area (mm2) was measured. Follow-up with respect to clinical response, need for subsequent therapeutic injection or decompressive surgery was recorded. Results: The grade of abnormality was mild (n = 4), moderate (n = 5), and severe (n = 3), with the remainder morphologically normal (n = 3). Inter-rater agreement was 0.91 (95% CI 0.80–1.00) with p 0.05), nor differences in deformity or cross-sectional area between those who underwent subsequent injection (p >0.05) or surgery (p >0.05). Conclusion: Ultrasound-guided injection is a viable option for refractory neuropathic symptoms, although relief was often temporary, and 20% eventually required revision surgery.

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