II. Indications

  1. Anesthesia of Ulnar Nerve distribution distal to elbow

III. Precautions

  1. Avoid injecting directly into Ulnar Nerve

IV. Anatomy: Landmarks

  1. Medial Epicondyle
  2. Ulnar Nerve
  3. Olecranon

V. Preparation

  1. Needle: 27 gauge 1.5 inch
  2. Anesthetic
    1. See Regional Anesthesia for Anesthetic options
    2. Local Anesthetic 2-5 ml (Ultrasound) or 5-10 ml (landmark)
  3. Skin preparation (e.g. Hibiclens or Betadine)
    1. See Regional Anesthesia
  4. Position
    1. Patient supine
    2. Arm abducted 90 degrees, resting against table
    3. Flex elbow to 90 degrees
    4. Supinate Forearm

VI. Technique: Ultrasound-Guided (Preferred)

  1. Images
    1. ulnarNerveBlockElbowUltrasound.jpg
  2. Position patient as above
  3. Ultrasound probe
    1. Transverse to Forearm at level of medial epicondyle
  4. Injection
    1. Advance needle in-plane to Ultrasound probe

VII. Technique: Landmark

  1. Images
    1. ulnarNerveBlockElbowLandmark.jpg
  2. Higher risk procedure due to risk of Ulnar Nerve injury
  3. Position patient as above
  4. Injection
    1. Insert needle between olecranon and medial epicondyle
    2. Direct needle distally at 30 degree angle
    3. Advance needle 0.5 cm deep
    4. Remain superficial to ulnar groove to avoid entering the Ulnar Nerve
    5. Inject 3-5 ml of Anesthetic

VIII. References

  1. Pfenninger (1994) Procedures, Mosby, p. 1036-54
  2. Warrington and Sanders (2018) Crit Dec Emerg Med 32(7): 41
  3. Salam (2004) Am Fam Physician 69(4):896 [PubMed]
  4. Yurgil (2020) Am Fam Physician 101(11):654-64 [PubMed]

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