Ultrasound‐guided injection of the elbow: Cadaveric description for the proximal to distal approach
Vincenzo Ricci, Kamál Mezian, Ke‐Vin Chang, Nimish Mittal, Murat Kara, Ondřej Naňka, Levent Özçakar
Abstract
BACKGROUND: Ultrasound (US) guided intra-articular elbow injections are commonly performed in clinical practice. OBJECTIVE: To describe a proximal to distal approach for US-guided intra-articular elbow injection. DESIGN: Cadaveric study. SETTINGS: Academic institution. METHODS: Both elbows of a single cadaver were injected with green-colored water-diluted latex dye using the US-guided proximal to distal approach. In the left elbow, the needle was kept in situ; in the right elbow, the needle was removed. Subsequently, a layer-by-layer anatomical dissection was performed in both elbows. MAIN OUTCOME MEASURES: Presence and distribution of the latex dye and location of the needle tip within the elbow joint capsule. RESULTS: Anatomical dissection of both elbows confirmed the correct intra-articular position of the needle tip in the left elbow as well as correct placement of the latex dye bilaterally. During layer-by-layer dissection of the left elbow, the position of the radial nerve was observed anterior to the needle. CONCLUSIONS: This cadaveric observation demonstrated that the US-guided proximal to distal approach is a convenient technique to access the elbow joint. Compared to the previously described techniques, the in-plane, proximal to distal approach may provide excellent needle visibility during the entire procedure, precisely targeting the articular space. The preliminary data need to be validated in additional clinical studies.