The video demonstrates a guided ultrasound procedure for treating deep branch radial nerve (DBRN) adhesions. It covers patient preparation, ultrasound scanning techniques, and adhesion release methods, followed by injection therapy with corticosteroid and lidocaine. Results indicate significant improvements in finger joint movement and reduction of DBRN adhesions over time.

instrument setup, patient preparation, ultrasound examination, and treatment of supinator syndrome

超声引导下穿刺松解术联合皮质类固醇注射

The radial nerve (RN) splits into two main branches at the elbow level: the deep branch (DBRN) and the superficial branch (SBRN). The DBRN originates from the main trunk of the RN at the level of the lateral epicondyle of the humerus1. The DBRN curves around the neck of the radius and then goes through under the tendinous arch of the superficial edge of the supinator muscle, which is called the arcade of Frohse2. This anatomical site is the most common entrapment site of the DBRN at the forearm3,4. In some rare cases, the DBRN can be compressed from the entrance to the exit of supinator5. The entrapment of the DBRN can cause pain in the lateral-dorsal proximal forearm and weakness of the wrist extensor muscles6,7,8.
When a nerve is injured, nerve conduction studies (NCS) and electromyography (EMG) sometimes show abnormal results indicating that the nerve is damaged. Although EMG is an established method and provides functional information about nerve disease, it lacks the ability to detect anatomical and morphological information related to the nerve9. Besides that, the sensitivity and specificity of EMG are not very high at early stages of nerve injury. Ultrasound can easily detect peripheral nerves and show them in sonographic imaging. Many studies have reported the value of high-frequency ultrasound in diagnosing the entrapment of peripheral nerves5. It has great potential as a diagnostic method for finding peripheral nerves. Babaei-Ghazani et al. reported ultrasonographic values for the DBRN at the arcade of Frohse, and they concluded that age was associated with the cross-sectional area (CSA) of DBRN, while other features such as height or gender were not1. Some studies have reported that corticosteroid injections are effective in treating musculoskeletal diseases10,11. However, until now, there have been no reports on ultrasound-guided needle release plus a corticosteroid injection in the DBRN for treating adhesion. Here, we report a method that can separate the adhesion without open surgery. A male patient who had a dorsiflexion limitation in his left ring and little fingers was treated using this method. This patient had injured his left forearm 1 month prior to the treatment. Multiple muscles of the forearm (the extensor digitorum, extensor digiti minimi, and extensor carpi ulnaris) were sutured in another hospital. His DBRN had edema and was thickened, and the exit point of DBRN was deeply adhered to the surrounding tissue. After treatment using US-guided needle release and corticosteroid injection of the DBRN, the patient&#39;s dorsal extension of the ring and the little finger was normal when the joints of the fingers were fully straightened.

作者聚焦： 超声引导下松针联合皮质类固醇注射治疗旋后综合征  

超声引导下穿刺释放联合皮质类固醇注射治疗后导管综合征

Our research, direction is for Corticosteroid ultrasound. So protocol showed our process of ultrasound data needed to be combined with a corticosteroid in injector trait several syndrome. With the help of realtime ultrasound guidance we can observe the syndrome and it surrounding.Teachers'article written and the safety compared with the conversation syndrome. The entire treatment is combinated with the supinator syndrome. The deep branch of the radial nerve can easily be compressed at the arcade of frost due to its anatomical features.Ultrasound-guided needle release combined with corticosteroid injection is infective and safe treatment for deep branch radio nerve at hassium. Ultrasound-guided needle release plus corticosteroid injection for treating the supinator syndrome provides smaller incision, less cost, less treatment time and faster recovery than open surgery. Ultrasound-guided needle release plus corticosteroid injection is better for clinical application.In the future. We will use ultrasound data, needle release, post corticosteroid injection in treated more peripheral neuropathy.

Watch this Scientific Journal Video about Instrument Setup, Patient Preparation, Ultrasound Examination, and Treatment of Supinator Syndrome at JoVE.com

Instrument Setup, Patient Preparation, Ultrasound Examination, and Treatment of Supinator Syndrome  

仪器设置、患者准备、超声检查和 Supinator 综合征的治疗

通过输入患者ID号和患者姓名开始设置超声仪器以保存图像。使用设备消毒湿巾对超声探头进行消毒。用外科手套覆盖探头执行所有程序。要将 DBRN 的图像设置在屏幕中间，请沿患者的后旋肌进行横截面扫描以找到 DBRN。然后将探头旋转90度以获得长轴截面。在连续超声引导下，分离后旋肌周围组织和DBRN之间的粘附。要求患者坐下，并将患者的手臂以弯曲的 20 度姿势放在检查床上。进行超声检查DBRN是否粘附在周围组织上。要开始超声检查，请使用复合碘对患者的皮肤进行三次消毒。然后将无菌手术毛巾放在患者的手臂上。提供局部麻醉后，通过在肱骨外上髁水平横向使用探针来识别桡神经。桡神经位于肱骨肌和肱肌之间。然后将探头向远端移动，以找到桡神经的深分支，位于后部的深层和浅层之间。在连续超声引导下，使用五毫升注射器分离后旋肌肉周围组织与DBRN之间的粘附。从DBRN远端区域到近端区域进行针头释放。用尖端来回刺破粘附组织。准确控制探头和针头，并确保在整个操作过程中尖端可见。如果注射器和DBRN周围的组织之间存在阻力，请停止，以避免损坏DBRN。手术后，将一毫升皮质类固醇倍他米松和两毫升2%利多卡因的混合物注射到DBRN的浅表区域。治疗一个月后，手指关节完全拉直。手指完全伸直后，无名指和小指的背侧伸展分别明显改善了零下15度和零下25度。治疗后三个月，与治疗前的DBRN粘连相比，DBRN粘连的范围显着减小。无名指和小指的背侧伸展也分别改善了负10度和零下15度。第二次进行相同治疗一个月后，无名指和小指零度完全伸直手指关节，表明戒指和小指的背部伸展正常。

instrument-setup-patient-preparation-ultrasound-examination-treatment

Research

JoVE Journal

Neuroscience

Instrument Setup, Patient Preparation, Ultrasound Examination, and Treatment of Supinator Syndrome

195 次观看.  Hangzhou Medical College. 通过输入患者ID号和患者姓名开始设置超声仪器以保存图像。使用设备消毒湿巾对超声探头进行消毒。用外科手套覆盖探头执行所有程序。要将 DBRN 的图像设置在屏幕中间，请沿患者的后旋肌进行横截面扫描以找到 DBRN。然后将探头旋转90度以获得长轴截面。在连续超声引导下，分离后旋肌周围组织和DBRN之间的粘附。要求患者坐下，并将患者的手臂以弯曲的 20 度姿?...

视频: Instrument Setup, Patient Preparation, Ultrasound Examination, and Treatment of Supinator Syndrome  

Ultrasound-Guided Needle Release Combined with Corticosteroid Injection for the Treatment of Supinator Syndrome

The two main branches of the radial nerve (RN) are the deep branch (DBRN) and the superficial branch (SBRN). The RN splits into two main branches at the elbow. The DBRN runs between the deep and shallow layers of the supinator. The DBRN can be easily compressed at the arcade of Frohse (AF) due to its anatomical features. This work focuses on a 42-year-old male patient who had injured his left forearm 1 month prior. Multiple muscles of the forearm (extensor digitorum, extensor digiti minimi, and extensor carpi ulnaris) were sutured in another hospital. After that, he had dorsiflexion limitations in his left ring and little fingers. The patient was reluctant to undergo another operation because he had undergone suture surgeries for multiple muscles 1 month prior. Ultrasound revealed that the deep branch of the radial nerve (DBRN) had edema and was thickened. The exit point of the DBRN had deeply adhered to the surrounding tissue. To relieve this, ultrasound-guided needle release plus a corticosteroid injection were performed on the DBRN. Nearly 3 months later, the dorsal extension in the patient's ring and little fingers was significantly improved (ring finger: &#8722;10&#176;, little finger: &#8722;15&#176;). Then, the same treatment was done for the second time. Nearly 1 month after that, the dorsal extension of the ring and the little finger was normal when the joints of the fingers were fully straightened. Ultrasound could evaluate the condition of the DBRN and its relationship with the surrounding tissues. Ultrasound-guided needle release combined with corticosteroid injection is an effective and safe treatment for DBRN adhesion.

The deep branch of the radial nerve can easily be compressed at the arcade of Frohse due to its anatomical features. Ultrasound-guided needle release combined with corticosteroid injection is an effective and safe treatment for deep branch radial nerve adhesion.

The two main branches of the radial nerve (RN) are the deep branch (DBRN) and the superficial branch (SBRN). The RN splits into two main branches at the ...

科研

神经科学

Begin the ultrasound instrument set up by entering the patient ID number and the patient's name to save the images. Sanitize the ultrasound probe using equipment disinfectant wipes. Perform all the procedures with the probe covered with surgical gloves.To set the image of the DBRN in the middle of the screen, perform cross-sectional scanning along the patient's supinator muscle to find the DBRN. Then rotate the probe at 90 degrees to obtain a long axis section. Under continuous ultrasound guidance, separate the adhesion between the surrounding tissue of the posterior spin muscles and the DBRN.Ask the patient to sit and place the patient's arm in a flexed 20 degrees position on the examination bed. Perform ultrasound to check for DBRN adhesion to the surrounding tissue. To begin the ultrasound examination, disinfect the patient's skin three times using complex iodine.Then place a sterile surgical towel on the patient's arm. After providing the local anesthesia, identify the radial nerve by transversely using the probe at the level of the lateral epicondyle of the humerus. The radial nerve is located between the humerus muscle and the brachioradial muscle.Then move the probe distally to find the deep branch of the radial nerve between the deep and superficial layers of the supinator. Use a five milliliter syringe to separate the adhesion between the surrounding tissue of the posterior spin muscles and the DBRN under continuous ultrasound guidance. Perform needle release from the DBRN distal area to the proximal area.Prick the adhesion tissue back and forth with the tip. Control the probe and the needle accurately and ensure the tip is visible during the entire operation. Stop if there is resistance between the syringe and the tissues around the DBRN to avoid damaging the DBRN.After the procedure, inject a mixture of one milliliter of corticosteroid betamethasone and two milliliters of 2%lidocaine into the superficial area of the DBRN. One month after the treatment, the finger joints were fully straightened. Upon fully straightening the fingers, the dorsal extension of the ring and little fingers was significantly improved by minus 15 degrees and minus 25 degrees respectively.Three months after the treatment, the range of DBRN adhesions was significantly reduced compared to DBRN adhesions before the treatment. The dorsal extension of the ring and little fingers was also improved by minus 10 degrees and minus 15 degrees respectively. After one month when the same treatment was performed for the second time, the joints of the fingers were fully straightened with the ring finger and little finger at zero degrees, indicating the dorsal extensions of the ring and the little fingers were normal.