Ultrasound-guided injection of the elbow: Cadaveric description for the proximal to distal approach

Ricci V., Mezian K., Chang K., Mittal N., Kara M., Naňka O., ...More

PM and R, 2023 (SCI-Expanded) identifier identifier

  • Publication Type: Article / Article
  • Publication Date: 2023
  • Doi Number: 10.1002/pmrj.12966
  • Journal Name: PM and R
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, MEDLINE
  • Hacettepe University Affiliated: Yes


Background: Ultrasound (US) guided intra-articular elbow injections are commonly performed in clinical practice. Objective: To describe a proximal to distal approach for US-guided intra-articular elbow injection. Design: Cadaveric study. Settings: Academic institution. Methods: Both elbows of a single cadaver were injected with green-colored water-diluted latex dye using the US-guided proximal to distal approach. In the left elbow, the needle was kept in situ; in the right elbow, the needle was removed. Subsequently, a layer-by-layer anatomical dissection was performed in both elbows. Main Outcome Measures: Presence and distribution of the latex dye and location of the needle tip within the elbow joint capsule. Results: Anatomical dissection of both elbows confirmed the correct intra-articular position of the needle tip in the left elbow as well as correct placement of the latex dye bilaterally. During layer-by-layer dissection of the left elbow, the position of the radial nerve was observed anterior to the needle. Conclusions: This cadaveric observation demonstrated that the US-guided proximal to distal approach is a convenient technique to access the elbow joint. Compared to the previously described techniques, the in-plane, proximal to distal approach may provide excellent needle visibility during the entire procedure, precisely targeting the articular space. The preliminary data need to be validated in additional clinical studies.