Comparing Electrical Stimulation With and Without Ultrasound Guidance for Phenol Neurolysis to the Musculocutaneous Nerve.

The study was retrospective and the guidance method was not randomly assigned. The method changed over calendar time, so differences could reflect the era or practice changes rather than ultrasound guidance itself. Groups were unbalanced, with 46 first injections using ultrasound plus electrical stimulation and 121 first injections using electrical stimulation alone. Quantitative outcomes were incomplete. Only 12% had Modified Ashworth Scale documented before and after injection, and only 17% had elbow range of motion change in degrees, so the paper could not compare tone or range of motion between methods. Some patients also received botulinum toxin at the same visit, so immediate elbow range of motion improvement cannot be attributed to phenol guidance alone. Adverse effects were taken from medical records, and transient symptoms such as dysesthesias may have been missed. The ultrasound appearance comparison used archived images from one physician, included 29 measurable spasticity patients and 29 controls recruited in 2016, and the nerve could not be identified in 4 spasticity patients.

The supplied article text does not include an author conflict-of-interest declaration. The publication types list research support from NIH extramural funding.

Do not conclude that ultrasound guidance improves clinical spasticity outcomes compared with electrical stimulation alone. The study was retrospective, the groups were separated by era, and technical success and immediate elbow range of motion improvement were similar for both methods. The clear difference was lower phenol volume, and some patients also received botulinum toxin at the same visit.