Platelet Releasate Injection for a Novel Treatment of Ulnar Neuritis at the Elbow

Date

2023

Authors

Bejarano, Michael
Martinez, Richard
Clearfield, Daniel

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Abstract

Background: Ulnar neuritis is a common entrapment neuropathy in the upper extremity that results from chronic compression of the ulnar nerve. Typical conservative treatment includes activity modification or brace immobilization. Platelet-rich plasma (PRP), an autologous product of concentrated platelets, has yet to be thoroughly investigated as a treatment option for ulnar neuritis. Platelet releasate, the supernatant of thrombin activated PRP, has potential to accelerate healing in injured peripheral nerves by releasing growth factors that promote nerve repair.

Case Report: This case presentation discusses a novel treatment of ulnar neuritis with platelet releasate injection in a 42-year-old female patient presenting with right-sided neurogenic thoracic outlet syndrome and ulnar nerve entrapment. Initial imaging at the right elbow demonstrated ulnar nerve entrapment within the Arcade of Struthers. The patient’s symptoms were first managed with home exercise and and dextrose 5% in water (D5W) hydrodissection at the elbow, which decreased but did not resolve her pain. Intraneural and perineural platelet releasate injection of the ulnar nerve at the elbow was subsequently performed. Six weeks post-procedure, the patient reported her pain was 80% better and continuing to improve. Provocative tests at the elbow were negative and imaging demonstrated a normal appearing ulnar nerve. Despite these results, the patient was not completely symptom-free; continued symptoms were attributed to her concomitant neurogenic thoracic outlet syndrome. While platelet releasate injection has not previously been explored as a treatment option for ulnar neuritis, this case demonstrates how platelet releasate injection may facilitate healing in an ulnar nerve injured by entrapment.

Conclusion: This case report investigated the use of ultrasound-guided nerve hydrodissection and platelet releasate injection for treating ulnar nerve entrapment. Although D5W hydrodissection proved useful in reducing the patient’s pain and paresthesia, platelet releasate injection was instrumental in resolving the patient’s localized entrapment. As current literature supports platelet releasate as a key driver of nerve regeneration, it is likely that the platelet releasate injection played a role in reducing the patient’s pain by enhancing the healing response of the injured ulnar nerve. Further research is indicated to determine if the clinical application of platelet releasate injection may be solidified as an efficacious treatment modality for ulnar neuritis and other peripheral nerve entrapments. Given the outcome for this patient, this case illustrates the prospect for platelet releasate treatment to continue to be studied as a monotherapy or synergistically with D5W hydrodissection for ulnar nerve entrapment and similar compression neuropathies.

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