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 accessOne-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 RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Incidence of ulnar neuropathy at the elbow in the province of Siena (Italy).J Neurol Sci. 2005; 234: 5-10
- Cubital tunnel syndrome.J Hand Surg. 2010; 35: 153-163
- 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
- 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
- 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
- Treatment for ulnar neuropathy at the elbow.Cochrane Database Syst Rev. 2016; 11CD006839
- Diagnosis and treatment of work-related ulnar neuropathy at the elbow.Phys Med Rehabil Clin N Am. 2015; 26: 513-522
- Perineural dextrose injections in the treatment of lower urinary tract symptoms and dyspareunia induced by obturator neuralgia.Med Hypotheses. 2020; 144109991
- Ultrasound-guided perineural injection with dextrose for treatment of radial nerve palsy: a case report.Medicine (Baltimore). 2018; 97: e10978
- Six-month efficacy of perineural dextrose for carpal tunnel syndrome: a prospective, randomized, double-blind, controlled trial.Mayo Clin Proc. 2017; 92: 1179-1189
- Randomized double-blinded clinical trial of 5% dextrose versus triamcinolone injection for carpal tunnel syndrome patients.Ann Neurol. 2018; 84: 601-610
- Perineural dextrose and corticosteroid injections for ulnar neuropathy at the elbow: a randomized double-blind trial.Arch Phys Med Rehabil. 2020; 101: 1296-1303
- Are extramedian symptoms associated with peripheral causes in patient with carpal tunnel syndrome? Electrodiagnostic and ultrasonographic study.J Electromyogr Kinesiol. 2018; 38: 203-207
- Development of the QuickDASH: comparison of three item-reduction approaches.J Bone Joint Surg Am. 2005; 87: 1038-1046
- 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
- Movement of the ulnar nerve at the elbow: a sonographic study.J Ultrasound Med. 2013; 32: 1747-1752
- Effects of hypertonic dextrose injections in the rabbit carpal tunnel.J Orthop Res. 2011; 29: 1022-1027
- Topical mannitol reduces capsaicin-induced pain: results of a pilot-level, double-blind, randomized controlled trial.PM R. 2015; 7: 1111-1117
- 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
- Ultrasound-guided nerve hydrodissection for pain management: rationale, methods, current literature, and theoretical mechanisms.J Pain Res. 2020; 13: 1957-1968
- Activation of C fibers by metabolic perturbations associated with tourniquet ischemia.Anesthesiology. 1992; 76: 617-623
- Fibromyalgia and overlapping disorders: the unifying concept of central sensitivity syndromes.Semin Arthritis Rheum. 2007; 36: 339-356
- Dextrose prolotherapy versus lidocaine injection for temporomandibular dysfunction: a pragmatic randomized controlled trial.J Altern Complement Med. 2020; 26: 1064-1073
- Ultrasound-guided dextrose injection treatment for chronic myofascial pain syndrome: a retrospective case series.J Chin Med Assoc. 2020; 83: 876-879
- Long-term outcome after perineural injection with 5% dextrose for carpal tunnel syndrome: a retrospective follow-up study.Rheumatology (Oxford). 2021; 60: 881-887
Article Info
Publication History
Published online: June 08, 2022
Accepted:
April 11,
2022
Received in revised form:
April 6,
2022
Received:
December 23,
2021
Publication stage
In Press Journal Pre-ProofFootnotes
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Clinical Trials Registry Number: NCT03737916.
Disclosures: none.
Written and verbal informed consent was obtained from each patient.
Identification
Copyright
© 2022 by the American Congress of Rehabilitation Medicine.
