Ultrasound-guided therapeutic injection of the surgically transposed ulnar nerve at the elbow: sonographic appearances, technique and clinical follow-up

Christopher John Burke; Vinh Tran; Allison Weinstock; Dhruv Shankar; Ronald Adler

doi:10.15557/jou.2026.0011

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Ultrasound-guided therapeutic injection of the surgically transposed ulnar nerve at the elbow: sonographic appearances, technique and clinical follow-up

Journal of Ultrasonography

Volume 26 (2026): Issue 105 (June 2026)

By: Christopher John Burke , Vinh Tran, Allison Weinstock, Dhruv Shankar and Ronald Adler

Open Access

|Jun 2026

Figures & Tables

Grading system for ultrasound imaging evaluation with transverse images of the ulnar nerve (white arrows). 0 – Non-enlarged nerve with preserved echogenic internal fascicles. 1 – Non-enlarged or mildly enlarged nerve with low-grade (<50%) loss of normal fascicular morphology. 2 – Enlarged nerve with deformed nerve fascicles and partial loss (>50%) of normal fascicular morphology. 3 – Enlarged nerve with deformity/constrictions and complete loss of normal fascicular morphology

Transverse ultrasound image of a transposed ulnar nerve prior to injection, with cross-sectional area measured at 15 mm2. The nerve is enlarged and deformed with complete loss of normal fascicular morphology (grade 3)

63-year-old male with ulnar neuropathy treated with subcutaneous transposition. Short-axis ultrasound images demonstrate the ulnar nerve (white arrows) at the time of injection (A), at 2-month follow-up (B), and at 6-month post-injection. Hypoechoic enlargement and mild distortion of fascicles are present at all time points

56-year-old male with a history of ulnar nerve transposition and persistent ulnar neuropathy. Ultrasound-guided injection of the transposed ulnar nerve at the level of the medial condyle. The needle (hollow arrows) is introduced with the tip adjacent to the epineurium, and injectate consisting of corticosteroid and local anesthetic is administered around the nerve (asterisk). The nerve (white arrowheads) demonstrates complete loss of normal fascicular morphology

Ulnar nerve grading among patients who had symptom relief at various time points following their initial injection

	Nerve grade	Duration of symptom relief
	Nerve grade	At the time of injection	Within 3 months following injection	>3 months following injection
Reader 1	0 (n = 1)	1 (100.0%)	1 (100.0%)	0 (0%)
	1 (n = 6)	6 (100.0%)	6 (100.0%)	4 (66.7%)
	2 (n = 3)	2 (66.7%)	2 (66.7%)	1 (33.3%)
	3 (n = 5)	5 (100.0%)	3 (60.0%)	2 (40.0%)
	All grades (n = 15)	14 (93.3%)	12 (80.0%)	7 (46.7%)
Reader 2	0 (n = 1)	1 (100.0%)	1 (100.0%)	0 (0%)
	1 (n = 5)	5 (100.0%)	5 (100.0%)	3 (60.0%)
	2 (n = 4)	3 (75.0%)	3 (75.0%)	2 (50.0%)
	3 (n = 5)	5 (100.0%)	3 (60.0%)	2 (40.0%)
	All grades (n = 15)	14 (93.3%)	12 (80.0%)	7 (46.7%)

Ulnar nerve grading among patients who underwent further injections and/or surgery following their initial injection

	Nerve grade	Subsequent injection	Subsequent surgery
Reader 1	0 (n = 1)	1 (100.0%)	0 (0%)
	1 (n = 6)	1 (16.7%)	1 (16.7%)
	2 (n = 3)	1 (33.3%)	1 (33.3%)
	3 (n = 5)	2 (40.0%)	1 (20.0%)
	All grades (n = 15)	5 (33.3%)	3 (20.0%)
Reader 2	0 (n = 1)	1 (100.0%)	0 (0%)
	1 (n = 5)	1 (20.0%)	1 (20.0%)
	2 (n = 4)	1 (25.0%)	2 (50.0%)
	3 (n = 5)	2 (40.0%)	0 (0%)
	All grades (n = 15)	5 (33.3%)	3 (20.0%)

Comparison of ulnar nerve abnormality grading and cross-sectional area at the injection site on ultrasound by need for subsequent injection, subsequent surgery, and symptom relief at various time points

Subsequent injection?	No (n = 10)	Yes (n = 5)	p-value
Reader 1 nerve grade	1.5 (2.0)	2.0 (2.0)	1.000
Reader 2 nerve grade	2.0 (2.0)	2.0 (2.0)	1.000
Cross-sectional area (mm²)	12.0 (5.0)	12.0 (4.0)	0.758
Subsequent surgery?	No (n = 12)	Yes (n = 3)	p-value
Reader 1 nerve grade	1.5 (2.0)	2.0 (2.0)	0.760
Reader 2 nerve grade	2.0 (2.0)	2.0 (1.0)	0.705
Cross-sectional area (mm²)	10.5 (4.5)	15.0 (3.0)	0.217
Relief at the time of injection?	No (n = 1)	Yes (n = 14)	p-value
Reader 1 nerve grade	2.0 (0)	1.5 (2.0)	0.903
Reader 2 nerve grade	2.0 (0)	2.0 (2.0)	1.000
Cross-sectional area (mm²)	15.0 (0)	11.5 (4.0)	0.352
Relief within 3 months of injection?	No (n = 3)	Yes (n = 12)	p-value
Reader 1 nerve grade	3.0 (1.0)	1.0 (1.5)	0.109
Reader 2 nerve grade	3.0 (1.0)	1.5 (1.5)	0.130
Cross-sectional area (mm²)	15.0 (4.0)	10.5 (4.0)	0.049^*
Relief for >3 months after injection?	No (n = 8)	Yes (n = 7)	p-value
Reader 1 nerve grade	2.0 (2.0)	1.0 (2.0)	0.760
Reader 2 nerve grade	2.0 (2.0)	2.0 (2.0)	0.952
Cross-sectional area (mm²)	13.0 (5.0)	11.0 (5.0)	0.560

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DOI: https://doi.org/10.15557/jou.2026.0011 | Journal eISSN: 2451-070X | Journal ISSN: 2084-8404

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Language: English

Submitted on: Jul 16, 2025

Accepted on: Mar 16, 2026

Published on: Jun 30, 2026

Published by: MEDICAL COMMUNICATIONS Sp. z o.o.

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

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Basic medical science,

Basic medical science, other

© 2026 Christopher John Burke, Vinh Tran, Allison Weinstock, Dhruv Shankar, Ronald Adler, published by MEDICAL COMMUNICATIONS Sp. z o.o.
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Volume 26 (2026): Issue 105 (June 2026)

Ultrasound-guided therapeutic injection of the surgically transposed ulnar nerve at the elbow: sonographic appearances, technique and clinical follow-up

Figures & Tables

Fig. 1.

Fig. 2.

Fig. 3.

Fig. 4.

Ulnar nerve grading among patients who had symptom relief at various time points following their initial injection

Ulnar nerve grading among patients who underwent further injections and/or surgery following their initial injection

Comparison of ulnar nerve abnormality grading and cross-sectional area at the injection site on ultrasound by need for subsequent injection, subsequent surgery, and symptom relief at various time points

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