Precision of Ultrasound-Guided versus Anatomical Palpation-Guided Needle Placement of the Ulnar Nerve at the Cubital Tunnel: A Cadaveric Study

Abstract

Percutaneous electrical stimulation has been performed for years with only the assistance of anatomical landmarks. The development of real-time ultrasonography guidance has improved the precision and safety of these percutaneous interventions. Despite ultrasound-guided and palpation-guided procedures being performed routinely for targeting nerve tissues in the upper extremity, the precision and safety of these techniques are unknown. The aim of this cadaveric study was to determine and compare the precision and safety of ultrasound-guided versus palpation-guided needling procedure with and without the handpiece of the ulnar nerve on a cadaveric model. Five physical therapists performed a series of 20 needle insertion tasks each (n = 100), 10 palpation-guided (n = 50) and 10 ultrasound-guided (n = 50) on cryopreserved specimens. The purpose of the procedure was to place the needle in proximity to the ulnar nerve at the cubital tunnel. The distance to target, time performance, accurate rate, number of passes, and unintentional puncture of surrounding structures were compared. The ultrasound-guided procedure was associated with higher accuracy (66% vs. 96%), lower distance from needle to the target (0.48 ± 1.37 vs. 2.01 ± 2.41 mm), and a lower frequency of perineurium puncture (0% vs. 20%) when compared with the palpation-guided procedure. However, the ultrasound-guided procedure required more time (38.33 ± 23.19 vs. 24.57 ± 17.84 s) than the palpation-guided procedure (all, p < 0.001). Our results support the assumption that ultrasound guidance improves the accuracy of needling procedures on the ulnar nerve at the cubital tunnel when compared with palpation guidance.

The Precision and Safety of Ultrasound-Guided versus Palpation-Guided Needle Placement on the Plantar Fascia and Flexor Digitorum Brevis Interface: An Anatomical Study

“…Nevertheless, to achieve this accuracy, the ultrasound-guided approach required significantly more time (mean: 53.8 ± 18.9 s) than the landmark-guided approach (mean: 19.1 ± 6.5 s). Again, these results are also similar to those in previous studies conducted on the knee [13] and elbow [24] regions. Differences in outcomes might occur since ultrasound guidance offers visual cues regarding needle placement, allowing therapists to refine and enhance their technique until reaching the exact target point, thus potentially prolonging the necessary time of the approach.…”

“…Previous studies using ultrasound-guidance approaches had attained accuracies ranging from 1.5 to 3.27 mm with different phantoms [17,22,23]. Thus, previous studies performed with a similar methodology but in other body areas such the knee [13] or the elbow [24] also yielded a higher accuracy with ultrasound-guided approaches. In fact, Arias-Buría et al [13] also evaluated the accuracy of inserting a needle into the interface between the patellar tendon and Hoffa's fat pad and obtained similar results as in the current study.…”

“…Differences in outcomes might occur since ultrasound guidance offers visual cues regarding needle placement, allowing therapists to refine and enhance their technique until reaching the exact target point, thus potentially prolonging the necessary time of the approach. Moreover, it has been demonstrated that using a handpiece also requires additional time and more passes to properly reach the targeted point [13,24].…”

The Precision and Safety of Ultrasound-Guided versus Palpation-Guided Needle Placement on the Plantar Fascia and Flexor Digitorum Brevis Interface: An Anatomical Study

“…Nevertheless, to achieve this accuracy, the ultrasound-guided approach required significantly more time (mean: 53.8 ± 18.9 s) than the landmark-guided approach (mean: 19.1 ± 6.5 s). Again, these results are also similar to those in previous studies conducted on the knee [13] and elbow [24] regions. Differences in outcomes might occur since ultrasound guidance offers visual cues regarding needle placement, allowing therapists to refine and enhance their technique until reaching the exact target point, thus potentially prolonging the necessary time of the approach.…”

“…Previous studies using ultrasound-guidance approaches had attained accuracies ranging from 1.5 to 3.27 mm with different phantoms [17,22,23]. Thus, previous studies performed with a similar methodology but in other body areas such the knee [13] or the elbow [24] also yielded a higher accuracy with ultrasound-guided approaches. In fact, Arias-Buría et al [13] also evaluated the accuracy of inserting a needle into the interface between the patellar tendon and Hoffa's fat pad and obtained similar results as in the current study.…”

“…Differences in outcomes might occur since ultrasound guidance offers visual cues regarding needle placement, allowing therapists to refine and enhance their technique until reaching the exact target point, thus potentially prolonging the necessary time of the approach. Moreover, it has been demonstrated that using a handpiece also requires additional time and more passes to properly reach the targeted point [13,24].…”

The Precision and Safety of Ultrasound-Guided versus Palpation-Guided Needle Placement on the Plantar Fascia and Flexor Digitorum Brevis Interface: An Anatomical Study

“…Nevertheless, to achieve this accuracy, the ultrasound-guided approach required significantly more time (mean: 53.8 ± 18.9 s) than the landmark-guided approach (mean: 19.1 ± 6.5 s). Again, these results are also similar to those in previous studies conducted on the knee [13] and elbow [24] regions. Differences in outcomes might occur since ultrasound guidance offers visual cues regarding needle placement, allowing therapists to refine and enhance their technique until reaching the exact target point, thus potentially prolonging the necessary time of the approach.…”

“…Previous studies using ultrasound-guidance approaches had attained accuracies ranging from 1.5 to 3.27 mm with different phantoms [17,22,23]. Thus, previous studies performed with a similar methodology but in other body areas such the knee [13] or the elbow [24] also yielded a higher accuracy with ultrasound-guided approaches. In fact, Arias-Buría et al [13] also evaluated the accuracy of inserting a needle into the interface between the patellar tendon and Hoffa's fat pad and obtained similar results as in the current study.…”

“…Differences in outcomes might occur since ultrasound guidance offers visual cues regarding needle placement, allowing therapists to refine and enhance their technique until reaching the exact target point, thus potentially prolonging the necessary time of the approach. Moreover, it has been demonstrated that using a handpiece also requires additional time and more passes to properly reach the targeted point [13,24].…”

The Precision and Safety of Ultrasound-Guided versus Palpation-Guided Needle Placement on the Plantar Fascia and Flexor Digitorum Brevis Interface: An Anatomical Study

“…Nevertheless, to achieve this accuracy, the ultrasound-guided approach required significantly more time (mean: 53.8 ± 18.9 s) than the landmark-guided approach (mean: 19.1 ± 6.5 s). Again, these results are also similar to those in previous studies conducted on the knee [13] and elbow [24] regions. Differences in outcomes might occur since ultrasound guidance offers visual cues regarding needle placement, allowing therapists to refine and enhance their technique until reaching the exact target point, thus potentially prolonging the necessary time of the approach.…”

“…Previous studies using ultrasound-guidance approaches had attained accuracies ranging from 1.5 to 3.27 mm with different phantoms [17,22,23]. Thus, previous studies performed with a similar methodology but in other body areas such the knee [13] or the elbow [24] also yielded a higher accuracy with ultrasound-guided approaches. In fact, Arias-Buría et al [13] also evaluated the accuracy of inserting a needle into the interface between the patellar tendon and Hoffa's fat pad and obtained similar results as in the current study.…”

“…Differences in outcomes might occur since ultrasound guidance offers visual cues regarding needle placement, allowing therapists to refine and enhance their technique until reaching the exact target point, thus potentially prolonging the necessary time of the approach. Moreover, it has been demonstrated that using a handpiece also requires additional time and more passes to properly reach the targeted point [13,24].…”