Hydrodissection technique _2, hydro-decompression of ulnar nerve in cubital tunnel syndrome скачать в хорошем качестве

Hydrodissection technique _2, hydro-decompression of ulnar nerve in cubital tunnel syndrome

I will continue to discuss the hydrodissection technique in compressive ulnar nerve neuropathy at the cubital tunnel. Join our Master Class Membership today and unlock a treasure trove of knowledge. Benefit from twice-weekly lectures, clinical case discussions, and image interpretation insights. Elevate your skills and connect with like-minded doctors. Subscribe now for a brighter professional future! The third case is the ulnar nerve hydrodissection in the cubital tunnel. The cubital tunnel is a passageway in the medial aspect of the elbow through which the ulnar nerve passes. The boundaries of the cubital tunnel are as follows: Medially: The medial epicondyle of the humerus. Laterally: The olecranon process of the ulna. Roof: The Osborne's ligament and fascia. Floor: The elbow joint capsule and the medial collateral ligament. The length of the cubital tunnel varies among individuals, but it generally extends approximately 4 cm along the medial side of the elbow, from the medial epicondyle of the humerus to its distal opening. Osborne's ligament, also known as the cubital tunnel retinaculum or the aponeurotic band, is a fibrous band that forms the roof of the cubital tunnel. It extends from the medial epicondyle of the humerus to the olecranon process of the ulna. This ligament runs obliquely, creating a roof-like structure over the ulnar nerve. The ulnar nerve passes through the cubital tunnel beneath Osborne's ligament, making it susceptible to compression and entrapment at this site. ---- Let me discuss the technical aspect of hydrodistention of the ulnar nerve in the cubital tunnel. Ulnar nerve hydrodissection is the second awkward procedure in terms of posing the target exposure. The first notorious structure is the trigger thumb release, especially in the left hand. I will talk about it later, but it is the most challenging structure to perform ultrasound-guided A1 pulley release using the needle blade. Here are the tips for my procedure: First, take a comfortable the patient's position. For example, let the patient's body supine with external rotation and 90 degrees shoulder abduction, with the affected arm supported and the elbow nearly 90 degrees flexed. Second, use the motorized table and elevate the table until the elbow poses equal to the operator's face level. It makes to approach the needle posteriorly to the ulnar nerve. Third, use the 1-inch needle. Under ultrasound guidance, insert the needle in-plane, approaching from the medial to the lateral side using a 26 gauge 1-inch needle. The longer needle is more challenging because of the short travel distance from the medial skin. Fourth, hydrodissect the nerve for the whole length of the cubital tunnel. Find the honeycomb-shaped ulnar nerve in the medial epicondylar area and trace the nerve proximally and distally. Fifth, find the underlying pathology. For example, ulnar nerve neuropathy accompanies elbow joint osteoarthritis or ulnar nerve dislocation. In cases where a ganglion cyst or saccular distension is compressing the nerve, aspiration of the cyst fluid can be performed along with the hydrodissection. It may help alleviate the compression of the ulnar nerve. Ulnar nerve neuropathy is common in musicians and other occupations, such as assembly line workers, typists, hairdressers, mechanics, construction workers, and athletes, due to repetitive motions and prolonged periods of elbow flexion, causing strain on the ulnar nerve. So, always educate the patient to forbid long-term elbow flexion positions and modify daily activities. If conservative management and hydrodissection do not provide sufficient relief or if the patient has significant osteoarthritis of the elbow joint, referral to an orthopedic surgeon may be necessary. The surgeon may recommend further treatment options, such as surgical decompression or joint replacement, depending on the severity of the patient's condition. #PracticalPainManagement #spinalintervention #imageguided #learning #imagetrain #GE #Ziehm #MSK #chronicpain #case #lecture #cervical #lumbar #knee #elbow #noninvasive #painfree #ISURA #paindiploma #montpellier #madi #precise #decisionmaking #limethasone #dexamethasone #palmitate #이미지트레이닝 #만성통증 #통증 #초음파시술 #초음파 #시술 #안전한시술