Ultrasound-guided ethyl alcohol injection to the deep branch of the ulnar nerve to relieve hand spasticity in stroke patients: A case series

Abstract

Hand spasticity with a flexor pattern is a common problem affecting stroke patients and can result in pain, contractures, esthetic concerns, skin maceration, and overall loss of function. Poststroke (≥6 months) hemiparetic adult patients having a Modified Ashworth Scale (MAS) score of ≥1 for metacarpophalangeal flexion and thumb adduction spasticity were selected to receive an ultrasound-guided 20% ethyl alcohol block performed perineurally at the level of the deep branch of the ulnar nerve. Their MAS scores were evaluated pretreatment at 1 month and the change in MAS scores was assessed using Wilcoxon’s test. The threshold for statistical significance was set at p < 0.05. The mean MAS score for the flexor muscles of the 5 MCP joints and for thumb adduction was reduced from 3.3 ± 0.5 at pretreatment to 0.9 ± 0.5 at 1 month after the injection for the 10 patients. One month after the injection, the MAS scores were significantly reduced compared with those at pretreatment (p < 0.001), without complications. These are encouraging results showing that ultrasound-guided alcohol blocks of the deep branch of the ulnar nerve are safe and can help chronic stroke patients with metacarpophalangeal flexion and thumb adduction spasticity at 1 month.

Safety and effectiveness of ethanol neurolysis with and without onabotulinumtoxinA in children with cerebral palsy

“…19 Previous studies examining ethanol or phenol-only injections found pain and dysesthesia among 5%-22% of patients. 7,14,15,20,21 No patients in our cohort experienced potentially life-threatening complications such as severe respiratory infection as a result of motor weakness. The use of ultrasound, in addition to electrical stimulation, may have helped limit the adverse events in our study.…”

“…Other potential adverse effects noted in the literature include nausea and vomiting, 5,12 distal swelling, 13,14 and irritation/ bruising/swelling at the injection site. However, the use of ultrasound guidance in addition to electrical stimulation may increase accuracy and effectiveness of needle placement, avoiding inadvertent injury to sensory branches, [15][16][17] and thus decreasing the adverse effects of ethanol neurolysis.…”

“…6,7,9,10,[12][13][14] Ethanol neurolysis was effective at reducing spasticity as evidenced by decreased Modified Ashworth Scale scores and had a good safety profile in these retrospective cohort studies. 6,11,13,15,18 The goal of this study was to prospectively examine the safety and effectiveness defined by the perceived magnitude of improvement of combined ethanol peripheral nerve blocks and BTX-A injections versus BTX-A injections alone using both electrical stimulation and ultrasound guidance in the treatment of spasticity in children with cerebral palsy. We hypothesized that the addition of ethanol nerve blocks under ultrasound and electrical stimulation guidance to increase the number of spastic muscles treated would result in a similar effectiveness and side effect profile as BTX-A alone.…”