Monograph: Ultrasound-Guided Treatment of Peripheral Entrapment Mononeuropathies-Article

Article

Pdf Summary

This review describes high-resolution ultrasound (US) as a tool for diagnosing, locating, and treating peripheral entrapment mononeuropathies. US can reveal nerve abnormalities, nearby masses, and anatomical variations, while guiding injections and procedures to improve placement and reduce risk to nerves, vessels, and other structures.<br /><br />Options for patients whose symptoms persist despite conservative care include corticosteroid injections, perineural hydrodissection, aspiration of ganglion cysts, platelet-rich plasma (PRP), prolotherapy, chemical neurolysis for selected sensory nerves, and minimally invasive mechanical release. Effective procedures depend on understanding sonoanatomy, careful patient and operator positioning, and continuous coordination of the probe and needle. The authors outline practical needle-guidance methods and a stepwise planning approach; potential complications include infection, bleeding, pain, and nerve or adjacent-structure injury.<br /><br />The strongest evidence concerns carpal tunnel syndrome (CTS). US-guided injections may outperform landmark-guided injections, and studies report short-term benefits from corticosteroids, hydrodissection, PRP, and prolotherapy. However, studies vary in technique, injectate, volume, and accompanying care. Evidence for other entrapments—including ulnar neuropathy at the elbow, radial tunnel syndrome, suprascapular neuropathy, meralgia paresthetica, piriformis-related sciatic symptoms, and fibular neuropathy—is more limited and often based on small studies or case reports. For example, a controlled trial did not find corticosteroid injection beneficial for ulnar neuropathy.<br /><br />The authors emphasize that promising short-term results do not establish durable benefit. PRP is not standard CTS treatment, and guidelines call for longer-term, placebo-controlled research. Severe nerve compression, progressive weakness, or substantial motor axon loss may favor surgical decompression. Further studies should standardize treatments and compare US-guided interventions directly with one another and with surgery.

Keywords

high-resolution ultrasound

peripheral entrapment mononeuropathies

ultrasound-guided injections

carpal tunnel syndrome

CTS

corticosteroid injection

perineural hydrodissection

platelet-rich plasma

nerve entrapment

sonoanatomy

surgical decompression