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Ultrasound-guided cubital tunnel hydrodissection: A cross-sectional study of patient-centered outcomes
Tyra L Swanson1, Chloe A Jensen2, Courtney R Carlson Strother3
1Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA.
Background:
Ultrasound (US)-guided hydrodissection is a minimally invasive treatment for cubital tunnel syndrome (CuTS) with promising early results. However, data on patient-perceived outcomes, durability of relief, and impact on surgical need remain limited.
Objective:
To assess the effectiveness of US-guided cubital tunnel hydrodissection in improving CuTS symptoms via patient-centered outcomes.
Design:
Retrospective chart review with cross-sectional telephone follow-up.
Setting:
Quaternary medical center multidisciplinary outpatient hand clinic.
Participants:
Seventeen patients (19 arms) with clinical CuTS who received US-guided hydrodissection from one physician.
Interventions:
Patients were contacted by telephone for cross-sectional outcome assessment.
Main Outcome Measures:
Patient-reported improvements in weakness, paresthesias, and/or pain, percent pain relief, symptom improvement duration, adverse events, and Patient Global Impression of Change (PGIC) scores.
Results:
At mean 7 ± 5 month follow-up, improvement in weakness, paresthesia, and pain was reported in 12 (63%) extremities (95% confidence interval [CI] 41%-85%; p < .001) . Pain relief ≥50% occurred in 12 (63%) and ≥75% in 8 (42%) extremities, with mean duration 4 months. PGIC scores showed 14 (74%; 95% CI 54%-94%; p < .001) at least "minimally improved" and 8 (42%) (95% CI 20%-64%; p < .001) "much improved." No adverse events occurred. Two patients without improvement underwent surgical decompression with anterior transposition at 1 and 3 months after hydrodissection, achieving 90%-100% pain relief and "much or very much improved" PGIC scores. Of 19 extremities, 7 (37%) were McGowan Grade I and 12 (63%) Grade II; none were Grade III. Grade II extremities showed significantly greater overall symptom relief (p = .004) and pain relief ≥50% (p = .004). PGIC scores did not differ significantly between grades (both p > .062).
Conclusion:
US-guided cubital tunnel hydrodissection was associated with meaningful symptom improvement and no adverse events. Limitations include small sample size, no control group, single operator, and potentially time-limited relief. The procedure appears safe and a potential nonoperative treatment option.