Article

Ultrasound guidance is increasingly being used for neurolytic
procedures that have traditionally been done with electrical stimulation (e-stim)
guidance alone. Ultrasound visualization with e-stim-guided neurolysis can
potentially allow adjustments in injection protocols that will reduce the volume
of neurolytic agent needed to achieve clinical improvement. This study
compared e-stim only to e-stim with ultrasound guidance in phenol neurolysis of
the musculocutaneous nerve (MCN) for elbow flexor spasticity. We also evaluated
the ultrasound appearance of the MCN in this population. DESIGN: Retrospective
review. SETTING: University hospital outpatient clinic. PARTICIPANTS: Adults (N =
167) receiving phenol neurolysis to the MCN for treatment of elbow flexor
spasticity between 1997 and 2014 and adult control subjects. METHODS: For each
phenol injection of the MCN, the method of guidance, volume of phenol injected,
technical success, improved range of motion at the elbow postinjection, adverse
effects, reason for termination of injections, and details of concomitant
botulinum toxin injection were recorded. The ultrasound appearance of the MCN,
including nerve cross-sectional area and shape, were recorded and compared
between groups. MAIN OUTCOME MEASURES: The volume of phenol injected and MCN
cross-sectional area and shape as demonstrated by ultrasound. RESULTS: The
addition of ultrasound to e-stim-guided phenol neurolysis was associated with
lower doses of phenol when compared to e-stim guidance alone (2.31 mL versus 3.69
mL, P < .001). With subsequent injections, the dose of phenol increased with
e-stim guidance (P < .001), but not with e-stim and ultrasound guidance (P =
.95). Both methods of guidance had high technical success, improved ROM at elbow
postinjection, and low rates of adverse events. In comparing the ultrasound
appearance of the MCN in patients with spasticity to that of normal controls,
there was no difference in the cross-sectional area of the nerve, but there was
more variability in shape. CONCLUSIONS: Combined e-stim and ultrasound guidance
during phenol neurolysis to the MCN allows a smaller volume of phenol to be used
for equal effect, both at initial and repeat injection. The MCN shape was more
variable in individuals with spasticity; this should be recognized so as to
successfully locate the nerve to perform neurolysis. LEVEL OF EVIDENCE: IV.
CI - Copyright (c) 2018 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS