2021 Workshop Handout Bundle-US Guided Treatment of Peripheral Mononeuropathies

US Guided Treatment of Peripheral Mononeuropathies - Norbury

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The workshop, led by Dr. John Norbury and Dr. Levon Nazarian, delved into the advancements and methodologies of using high-resolution ultrasound (US) to treat peripheral mononeuropathies. Ultrasound has revolutionized the diagnosis and treatment of these conditions by providing real-time, detailed images that guide minimally invasive procedures such as corticosteroid injections, hydrodissection, and needle aspiration of ganglia.<br /><br />Corticosteroid injections, which reduce inflammation and edema, are a primary treatment for various entrapment neuropathies. However, these injections' efficacy can be significantly enhanced when guided by ultrasound, minimizing the risk of nerve damage and ensuring precise delivery of the medication. Hydrodissection, which involves injecting a large volume of fluid to break down adhesions around the nerve, has shown to reduce symptoms effectively, especially in cases like recurrent carpal tunnel syndrome.<br /><br />Another key technique discussed was US-guided aspiration of ganglia. Ganglion cysts, which can cause nerve compression, are treated by draining the cysts with a large-gauge needle, sometimes followed by a corticosteroid injection to reduce the likelihood of recurrence.<br /><br />Technical proficiency in US-guided procedures involves mastering needle visualization and coordination of the transducer and needle. Techniques such as in-plane and out-of-plane needle guidance each have their strengths and limitations; in-plane guidance allows continuous visualization of the needle, while out-of-plane provides direct access to superficial structures.<br /><br />Successful intervention requires careful preprocedural planning and proper ergonomic setup to ensure precision and reduce procedural time. Common peripheral mononeuropathies treated with US guidance include carpal tunnel syndrome, where US-guided injections have proven superior to non-guided methods, and cubital tunnel syndrome, although its efficacy is still under review.<br /><br />Finally, the workshop emphasized the importance of future research to continue improving the efficacy of these minimally invasive treatments and explore their full potential compared to traditional surgical methods. Integrating diagnostic and therapeutic US into clinical practice may greatly enhance patient care by offering precise and minimally invasive treatment options.

Keywords

high-resolution ultrasound

peripheral mononeuropathies

corticosteroid injections

hydrodissection

needle aspiration

ganglion cysts

needle visualization

carpal tunnel syndrome

CTS

cubital tunnel syndrome

minimally invasive treatments

CTS

carpal tunnel syndrome