Thomas Apard1, Olivier Mares2, Fabrice Duparc3,4,5, Paul Michelin6,7,8. 1. Hand Ultrasound Surgery Center - Clinique Les Franciscaines of Versailles, 2 rue de Tocqueville, 78000, Versailles, France. 2. Department of Orthopaedic Surgery and Traumatology, Hôpital Carémeau, University Hospital of Nîmes, Place Robert Debré, 30029, Nîmes, France. 3. Department of Orthopaedic Surgery and Traumatology, Hôpital Charles Nicolle, University Hospital of Rouen, 37 Boulevard Gambetta, 76000, Rouen, France. 4. Laboratory of Anatomy, Faculty of Medicine and Pharmacy of Rouen, University of Normandy, 22 Boulevard Gambetta, 76000, Rouen, France. 5. CETAPS Laboratory EA3832, Faculty of Sports Sciences of Rouen - Boulevard Siegfried, University of Normandy, 76821, Mont Saint Aignan, France. 6. Laboratory of Anatomy, Faculty of Medicine and Pharmacy of Rouen, University of Normandy, 22 Boulevard Gambetta, 76000, Rouen, France. paul.michelin@chu-rouen.fr. 7. CETAPS Laboratory EA3832, Faculty of Sports Sciences of Rouen - Boulevard Siegfried, University of Normandy, 76821, Mont Saint Aignan, France. paul.michelin@chu-rouen.fr. 8. Department of Radiology, University Hospital of Rouen, Rouen, France. paul.michelin@chu-rouen.fr.
Abstract
PURPOSE: The aim of this technical note is to present a microinvasive percutaneous ultrasound-guided release of the lacertus fibrosus of the biceps brachii for pronator syndrome, i.e., entrapment of the median nerve at the elbow. METHODS: Fifteen consecutive patients were included. Patients showed isolated pronator syndrome including pain plus reduced strength of specific median nerve innervated muscles. The release was performed in a non-operating interventional room under wide-awake local anesthesia no tourniquet (WALANT). It was conducted superficial to the pronator teres with in-plane ultrasound guidance. The recovery of strength was first assessed peroperatively, and then systematic visits at postoperative weeks 1 and 4 included assessments of both strength and pain. RESULTS: Procedures were comfortably completed with no immediate surgical or anesthetic complication. Muscle strength returned immediately and persisted at postoperative visits. Visual analog scores for pain reduced from 6.2 to 2.5 and 0.6 at weeks 1 and 4, respectively. All working patients were able to perform in their professional activities at week 1. The millimetric skin incision healed with no hypertrophic scar tissue. A small hematoma occurred at week 1 and resorbed spontaneously. No other delayed complication was observed. The procedure appeared effective with improved invasiveness compared to existing techniques. Real-time monitoring with ultrasound may improve the safety. The technique could be regarded as a new ultrasound-guided alternative to surgery. CONCLUSION: Performed superficial to the pronator teres muscle under WALANT anesthesia, the microinvasive percutaneous ultrasound-guided release of the lacertus fibrosus may be an effective treatment of pronator syndrome.
PURPOSE: The aim of this technical note is to present a microinvasive percutaneous ultrasound-guided release of the lacertus fibrosus of the biceps brachii for pronator syndrome, i.e., entrapment of the median nerve at the elbow. METHODS: Fifteen consecutive patients were included. Patients showed isolated pronator syndrome including pain plus reduced strength of specific median nerve innervated muscles. The release was performed in a non-operating interventional room under wide-awake local anesthesia no tourniquet (WALANT). It was conducted superficial to the pronator teres with in-plane ultrasound guidance. The recovery of strength was first assessed peroperatively, and then systematic visits at postoperative weeks 1 and 4 included assessments of both strength and pain. RESULTS: Procedures were comfortably completed with no immediate surgical or anesthetic complication. Muscle strength returned immediately and persisted at postoperative visits. Visual analog scores for pain reduced from 6.2 to 2.5 and 0.6 at weeks 1 and 4, respectively. All working patients were able to perform in their professional activities at week 1. The millimetric skin incision healed with no hypertrophic scar tissue. A small hematoma occurred at week 1 and resorbed spontaneously. No other delayed complication was observed. The procedure appeared effective with improved invasiveness compared to existing techniques. Real-time monitoring with ultrasound may improve the safety. The technique could be regarded as a new ultrasound-guided alternative to surgery. CONCLUSION: Performed superficial to the pronator teres muscle under WALANT anesthesia, the microinvasive percutaneous ultrasound-guided release of the lacertus fibrosus may be an effective treatment of pronator syndrome.
Authors: Alexander Loizides; Sarah Honold; Elisabeth Skalla-Oberherber; Leonhard Gruber; Wolfgang Löscher; Bernhard Moriggl; Marko Konschake; Hannes Gruber Journal: Cardiovasc Intervent Radiol Date: 2021-02-24 Impact factor: 2.740