II. Indications
- Anesthesia of Ulnar Nerve distribution distal to elbow
III. Precautions
- Avoid injecting directly into Ulnar Nerve
IV. Anatomy: Landmarks
- Medial Epicondyle
- Ulnar Nerve
- Olecranon
V. Preparation
- Needle: 27 gauge 1.5 inch
-
Anesthetic
- See Regional Anesthesia for Anesthetic options
- Local Anesthetic 2-5 ml (Ultrasound) or 5-10 ml (landmark)
- Skin Preparation (e.g. Hibiclens or Betadine)
- Position
- Patient supine
- Arm abducted 90 degrees, resting against table
- Flex elbow to 90 degrees
- Supinate Forearm
VI. Technique: Ultrasound-Guided (Preferred)
- Images
- Position patient as above
-
Ultrasound probe
- Transverse to Forearm at level of medial epicondyle
- Injection
- Advance needle in-plane to Ultrasound probe
VII. Technique: Landmark
- Images
- Higher risk procedure due to risk of Ulnar Nerve injury
- Position patient as above
- Injection
- Insert needle between olecranon and medial epicondyle
- Direct needle distally at 30 degree angle
- Advance needle 0.5 cm deep
- Remain superficial to ulnar groove to avoid entering the Ulnar Nerve
- Inject 3-5 ml of Anesthetic
VIII. References
- Pfenninger (1994) Procedures, Mosby, p. 1036-54
- Warrington and Sanders (2018) Crit Dec Emerg Med 32(7): 41
- Salam (2004) Am Fam Physician 69(4):896 [PubMed]
- Yurgil (2020) Am Fam Physician 101(11):654-64 [PubMed]