Advertisement

Effect of Perineural Dextrose Injection on Ulnar Neuropathy at the Elbow: A Randomized, Controlled, Double-Blind Study

      Abstract

      Objective

      To compare perineural dextrose injection efficacy in the treatment of ulnar neuropathy at the elbow with a control group.

      Design

      Prospective double-blind randomized control study.

      Setting

      Training and research hospital.

      Participants

      The study was completed with 40 patients with ulnar neuropathy at the elbow.

      Intervention

      Normal saline (0.9% sodium chloride) was injected in patients in the control group (n=20; mean age=38.1±10.7 years; median duration of symptoms=4.5 months), and 5% dextrose was injected in patients in the dextrose group (n=20; mean age=43.6±13.5 years; median duration of symptoms=5 months), perineurally under ultrasound guidance twice at 2-week intervals. Ultrasound-guided perineural injection of 1 cc each was administered into the ulnar nerve, 2 cm and 4 cm distal to the medial epicondyle, at the level of the medial epicondyle, and 2 cm and 4 cm proximal to the medial epicondyle. The amount of total fluid injected was 5 cc.

      Main Outcome Measure(s)

      At baseline and weeks 2, 4, and 12, the patients were evaluated with the Visual Analog Scale for pain and the Disabilities of the Arm Shoulder and Hand questionnaire for disability. Electrophysiological evaluation was performed with ulnar nerve conduction studies, and the ulnar nerve cross-sectional area was measured on ultrasonography.

      Results

      The improvements in pain, disability, ulnar motor nerve velocity, and ulnar nerve cross-sectional area in the dextrose group were superior to those in the control group, especially at weeks 4 and 12 (P<.001, using independent samples t tests).

      Conclusion

      Perineural 5% dextrose may be an effective alternative therapy for those with ulnar neuropathy at the elbow for up to the 12th week.

      Keywords

      List of abbreviations:

      CSA (cross-sectional area), CTS (carpal tunnel syndrome), D5W (5% dextrose), MNCV (motor nerve conduction velocity), Quick-DASH (short form of Disabilities of the Arm, Shoulder, and Hand questionnaire), SNCV (sensory nerve conduction velocity), UNE (ulnar neuropathy at the elbow), US (ultrasonography), VAS (Visual Analog Scale)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Mondelli M
        • Giannini F
        • Ballerini M
        • Gianneschi F
        • Martorelli E.
        Incidence of ulnar neuropathy at the elbow in the province of Siena (Italy).
        J Neurol Sci. 2005; 234: 5-10
        • Palmer AB
        • Hughes TB.
        Cubital tunnel syndrome.
        J Hand Surg. 2010; 35: 153-163
        • Gelberman RH
        • Yamaguchi K
        • Hollstien SB
        • et al.
        Changes in interstitial pressure and cross-sectional area of the cubital tunnel and of the ulnar nerve with flexion of the elbow. An experimental study in human cadavera.
        J Bone Joint Surg Am. 1998; 80: 492-501
      1. Practice parameter for electrodiagnostic studies in ulnar neuropathy at the elbow: summary statement. American Association of Electrodiagnostic Medicine, American Academy of Neurology, American Academy of Physical Medicine and Rehabilitation.
        Muscle Nerve. 1999; 22: 408-411
        • Chang KV
        • Wu WT
        • Han DS
        • Özçakar L.
        Ulnar nerve cross-sectional area for the diagnosis of cubital tunnel syndrome: a meta-analysis of ultrasonographic measurements.
        Arch Phys Med Rehabil. 2018; 99: 743-757
        • Caliandro P
        • La Torre G
        • Padua R
        • Giannini F
        • Padua L
        Treatment for ulnar neuropathy at the elbow.
        Cochrane Database Syst Rev. 2016; 11CD006839
        • Carter GT
        • Weiss MD
        • Friedman AS
        • Allan CH
        • Robinson L.
        Diagnosis and treatment of work-related ulnar neuropathy at the elbow.
        Phys Med Rehabil Clin N Am. 2015; 26: 513-522
        • Beco J
        • Mouchel J.
        Perineural dextrose injections in the treatment of lower urinary tract symptoms and dyspareunia induced by obturator neuralgia.
        Med Hypotheses. 2020; 144109991
        • Chen SR
        • Shen YP
        • Ho TY
        • Chen LC
        • Wu YT.
        Ultrasound-guided perineural injection with dextrose for treatment of radial nerve palsy: a case report.
        Medicine (Baltimore). 2018; 97: e10978
        • Wu YT
        • Ho TY
        • Chou YC
        • et al.
        Six-month efficacy of perineural dextrose for carpal tunnel syndrome: a prospective, randomized, double-blind, controlled trial.
        Mayo Clin Proc. 2017; 92: 1179-1189
        • Wu YT
        • Ke MJ
        • Ho TY
        • Li TY
        • Shen YP
        • Chen LC.
        Randomized double-blinded clinical trial of 5% dextrose versus triamcinolone injection for carpal tunnel syndrome patients.
        Ann Neurol. 2018; 84: 601-610
        • Chen LC
        • Ho TY
        • Shen YP
        • et al.
        Perineural dextrose and corticosteroid injections for ulnar neuropathy at the elbow: a randomized double-blind trial.
        Arch Phys Med Rehabil. 2020; 101: 1296-1303
        • Mansiz-Kaplan B
        • Akdeniz-Leblecicier M
        • Yagci I.
        Are extramedian symptoms associated with peripheral causes in patient with carpal tunnel syndrome? Electrodiagnostic and ultrasonographic study.
        J Electromyogr Kinesiol. 2018; 38: 203-207
        • Beaton DE
        • Wright JG
        • Katz JN
        • Upper Extremity Collaborative Group
        Development of the QuickDASH: comparison of three item-reduction approaches.
        J Bone Joint Surg Am. 2005; 87: 1038-1046
        • Koldas Dogan S
        • Ay S
        • Evcik D
        • Baser O.
        Adaptation of Turkish version of the questionnaire Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) in patients with carpal tunnel syndrome.
        Clin Rheumatol. 2011; 30: 185-191
        • Yang SN
        • Yoon JS
        • Kim SJ
        • Kang HJ
        • Kim SH.
        Movement of the ulnar nerve at the elbow: a sonographic study.
        J Ultrasound Med. 2013; 32: 1747-1752
        • Yoshii Y
        • Zhao C
        • Schmelzer JD
        • Low PA
        • An KN
        • Amadio PC.
        Effects of hypertonic dextrose injections in the rabbit carpal tunnel.
        J Orthop Res. 2011; 29: 1022-1027
        • Bertrand H
        • Kyriazis M
        • Reeves KD
        • Lyftogt J
        • Rabago D.
        Topical mannitol reduces capsaicin-induced pain: results of a pilot-level, double-blind, randomized controlled trial.
        PM R. 2015; 7: 1111-1117
        • Zamami Y
        • Takatori S
        • Yamawaki K
        • et al.
        Acute hyperglycemia and hyperinsulinemia enhance adrenergic vasoconstriction and decrease calcitonin gene-related peptide-containing nerve-mediated vasodilation in pithed rats.
        Hypertens Res. 2008; 31: 1033-1044
        • Lam KHS
        • Hung CY
        • Chiang YP
        • et al.
        Ultrasound-guided nerve hydrodissection for pain management: rationale, methods, current literature, and theoretical mechanisms.
        J Pain Res. 2020; 13: 1957-1968
        • MacIver MB
        • Tanelian DL.
        Activation of C fibers by metabolic perturbations associated with tourniquet ischemia.
        Anesthesiology. 1992; 76: 617-623
        • Yunus MB.
        Fibromyalgia and overlapping disorders: the unifying concept of central sensitivity syndromes.
        Semin Arthritis Rheum. 2007; 36: 339-356
        • Zarate MA
        • Frusso RD
        • Reeves KD
        • Cheng AL
        • Rabago D.
        Dextrose prolotherapy versus lidocaine injection for temporomandibular dysfunction: a pragmatic randomized controlled trial.
        J Altern Complement Med. 2020; 26: 1064-1073
        • Chou Y
        • Chiou HJ
        • Wang HK
        • Lai YC.
        Ultrasound-guided dextrose injection treatment for chronic myofascial pain syndrome: a retrospective case series.
        J Chin Med Assoc. 2020; 83: 876-879
        • Li TY
        • Chen SR
        • Shen YP
        • et al.
        Long-term outcome after perineural injection with 5% dextrose for carpal tunnel syndrome: a retrospective follow-up study.
        Rheumatology (Oxford). 2021; 60: 881-887