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Deviandri R, Yuliana V, Irawan D, Rahman A. Genicular nerve radiofrequency ablation for pain control following anterior cruciate ligament reconstruction - A case report. Trauma Case Rep 2022; 40:100661. [PMID: 35665197 PMCID: PMC9157187 DOI: 10.1016/j.tcr.2022.100661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 12/01/2022] Open
Abstract
Adequate postoperative pain control is an essential factor for the success of rehabilitation programs after anterior cruciate ligament reconstruction (ACLR). The genicular nerve radiofrequency ablation (GNRF) is a recently developed method. This study aimed to evaluate the use of GNRF in patients who underwent ACLR. We performed GNRF guided by ultrasonography for patients who underwent ACLR with aggravated pain. GNRF was performed following ACLR a day after surgery. The pain was evaluated using the Visual Analogue Scale (VAS), and the Euroqol-5 Dimension (EQ-5D) measured the quality of life on the day of one, three, and seven after surgery. Results In this study, two patients participated. In the postoperative days first, third, and seventh, the mean VAS was decreased after providing the intervention (from 8 to 5, 2, and 1, respectively). The mean EQ5D improved from 0.48 to 0.52, 0.56, 0.66, respectively. We concluded that GNRF is an adequate and safe procedure for managing postoperative pain after ACLR. It may enhance the postoperative rehabilitation program.
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Affiliation(s)
- R. Deviandri
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Physiology, Faculty of Medicine, Universitas Riau, Division of Orthopaedic, Arifin Achmad Hospital, Pekanbaru, Indonesia
- Corresponding author at: Faculty of Medicine, Universitas Riau, Diponegoro street no 1, Pekanbaru 28133, Indonesia.
| | - V. Yuliana
- Department of Sport and Rehabilitation, Fit Centrum, Pekanbaru, Indonesia
| | - D. Irawan
- Department of Anesthesia, Arifin Achmad Hospital, Pekanbaru, Indonesia
| | - A.N. Rahman
- Department of Orthopedic and Pain Intervention, Sentra Medika Hospital, Cisalak, Indonesia
- Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
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Efficacy and Safety of Ultrasound-Guided Radiofrequency Treatment for Chronic Pain in Patients with Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Pain Res Manag 2020; 2020:2537075. [PMID: 33014212 PMCID: PMC7520688 DOI: 10.1155/2020/2537075] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/23/2020] [Indexed: 12/18/2022]
Abstract
Background Knee osteoarthritis (KOA) is a common degenerative disease associated with joint dysfunction and pain. Ultrasound-guided radiofrequency (RF) may be a promising therapy in the treatment of chronic pain for KOA patients. Objective To evaluate the efficacy and safety of ultrasound-guided RF treatment for chronic pain in patients with KOA. Design A systematic review was conducted, and a meta-analysis was carried out when possible. Setting. We examined the studies evaluating the clinical efficiency of ultrasound-guided RF on chronic pain in KOA population. Method A systematic review for the efficacy and safety of ultrasound-guided RF treatment for pain management of KOA patients was carried out in PubMed, EMBASE, Cochrane Library, Web of Science, Wanfang Data, and China National Knowledge Infrastructure (CNKI) from the date of inception to February 2020, and a meta-analysis was conducted. The primary outcomes of pain intensity (visual analogue scale or numerical rating scale) and knee function [the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)] were evaluated from baseline to various follow-up times by random-effects model. Heterogeneity was assessed by I 2 statistic and the potential sources of heterogeneity by subgroup and metaregression analyses, respectively. Results Eight publications with 256 patients were included in the meta-analysis. RF could relieve pain with -4.196 of pooled mean difference and improve knee function by decreasing 23.155 points in WOMAC. Three patients had ecchymosis, two with hypoesthesia and one with numbness after the procedure, and improved within 6 months. Furthermore, study design and treatment target were the sources of heterogeneity by subgroup and metaregression analyses, accounting for 37% and 74% of variances, respectively. Target of genicular nerve achieved better pain relief than intra-articular or sciatic nerve. Sensitivity analysis showed that removal of any single study was unlikely to overturn the findings. Limitations. There were some limitations in the study. Firstly, the small number of relevant studies limited the confidence level of the meta-analysis. Also, the significant heterogeneity may not be explained due to the limited data. Secondly, the direct comparison of two different guidance methods (ultrasound vs. fluoroscopy) for RF therapy is lacking. In addition, the outcomes were blindly assessed in the meta-analysis from all studies according to evaluation of bias, which could affect the reality of the data. Finally, most of the studies only provided short follow-up times, so we could not analyze the long-term effectiveness of ultrasound-guided RF in the treatment of patients with KOA. Conclusions Ultrasonography is an effective, safe, nonradiative, and easily applicable guidance method for RF in pain relief and functional improvement in KOA patients.
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Boudier-Revéret M, Thu AC, Hsiao MY, Shyu SG, Chang MC. The Effectiveness of Pulsed Radiofrequency on Joint Pain: A Narrative Review. Pain Pract 2019; 20:412-421. [PMID: 31782970 DOI: 10.1111/papr.12863] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/03/2019] [Accepted: 11/25/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Pulsed radiofrequency (PRF) stimulation has been safely and effectively applied for controlling various types of pain. PURPOSE We reviewed the literature on the efficacy of PRF for controlling pain in joint disorders. METHODS We searched PubMed for papers published prior to September 7, 2019, that used PRF to treat pain due to joint disorders. The key search phrases for identifying potentially relevant articles were (PRF AND joint) OR (PRF AND arthritis) OR (PRF AND arthropathy). The following inclusion criteria were applied for the selection of articles: (1) patients' pain was caused by joint disorders; (2) PRF stimulation was applied to manage joint-origin pain; and (3) after PRF stimulation, follow-up evaluation was performed to assess the reduction in pain intensity. Moreover, joints with more than 3 reported PRF studies were included in our review. RESULTS The primary literature search yielded 141 relevant papers. After reading their titles and abstracts and assessing their eligibility based on the full-text articles, we finally included 34 publications in this review. Based on the positive therapeutic outcomes of previous studies, PRF stimulation seems to be an effective treatment for cervical and lumbar facet, sacroiliac, knee, and glenohumeral joint pain. PRF appears to be beneficial. For confirmation of the effectiveness of PRF on joint pain, more high-quality studies are needed. CONCLUSIONS Our review provides insights on the degree of evidence according to pain in each joint, which will help clinicians make informed decisions for using PRF stimulation in various joint pain conditions.
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Affiliation(s)
- Mathieu Boudier-Revéret
- Department of Physical Medicine and Rehabilitation, University of Montreal Health Center, Montreal, Québec, Canada
| | - Aung Chan Thu
- Department of Physical Medicine and Rehabilitation, University of Medicine, Mandalay, Myanmar
| | - Ming-Yen Hsiao
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shaw-Gang Shyu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Min Cheol Chang
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Korea
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A rare complication of knee hematoma after genicular nerve radiofrequency ablation. Pain Rep 2019; 4:e736. [PMID: 31583351 PMCID: PMC6749903 DOI: 10.1097/pr9.0000000000000736] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/04/2019] [Accepted: 02/13/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Genicular nerve radiofrequency ablation (RFA) is an intervention to treat patients with chronic knee pain who have failed previous conservative, pharmacologic, and surgical interventions. Vascular complications following interventional procedures of the knee are extremely rare. A delay in diagnosis may be detrimental for the viability of the affected limb and may ultimately require amputation. Case Presentation: A 76-year-old man with a history of severe bilateral knee osteoarthritis and grade 4 chondromalacia presented to our clinic with refractory, severe bilateral knee pain and received a bilateral genicular nerve RFA. He returned 4 days later with right medial thigh pain and a magnetic resonance imaging study revealing a hematoma along the anteromedial aspect of the right distal femoral diaphysis measuring 13.3 × 4.5 × 3.0 cm. After collaboration between pain medicine and orthopedic surgery services, decision was made to treat patient conservatively with rest, compression, elevation, ice application, tramadol, and gabapentin, but with close follow-up and a low threshold to intervene with diagnostic and therapeutic angiography with embolization if bleeding worsened; he reported resolution of his pain after a 4-day and 1-month follow-up. Conclusion: This is the first report describing iatrogenic vascular injury in the knee after a genicular RFA procedure. Pain medicine physicians should be aware of the vascular anatomy of the knee, particularly paying close attention to variations after previous surgeries. Future trials should investigate modalities that minimize vascular complications including concomitant use of ultrasonography with fluoroscopy and other forms of RFA including pulsed or cooled RFA.
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Abstract
PURPOSE OF REVIEW Chronic pain of the lower extremity remains challenging to manage. Radiofrequency ablation procedure applies heat to nerve fibers with the goal of mitigating chronic pain conditions of the knee. However, the clinical efficacy has not yet been adequately established. The goal of this review paper is to report the use of radiofrequency ablations in the treatment of osteoarthritis of the knee. RECENT FINDINGS PubMed and the Cochrane Controlled Trials Register were searched (final search 28 February 2018) using the MeSH terms "radiofrequency ablation," "neurolysis," "radiofrequency therapy," "pain syndrome," "analgesia," and "pain" in the English literature. Bibliographies of the published papers were screened for relevance to lower extremity radiofrequency ablation therapies. The quality of selected publications was assessed using the Cochrane risk of bias instrument. Of the 923 papers screened, 317 were further investigated for relevance. Our final search methodology yielded 19 studies that investigated the use of radiofrequency ablation at the knee. Of these 19 studies, there were four randomized control trials, two non-randomized control trials, three prospective studies, two retrospective studies, one case-control study, one technical report, and seven case reports. In summary, the data available suggests radiofrequency ablation as a promising and efficacious with all 19 studies revealing significant short- and long-term pain reductions in patients with knee pain.
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Imani F, Patel VB. Therapeutic Challenges for Knee Osteoarthritis. Anesth Pain Med 2019; 9:e95377. [PMID: 31497526 PMCID: PMC6712428 DOI: 10.5812/aapm.95377] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 06/18/2019] [Indexed: 12/19/2022] Open
Affiliation(s)
- Farnad Imani
- Pain Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Vikram B. Patel
- Phoenix Interventional Center for Advanced Learning, Algonquin, Illinois, USA
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Ho TY, Ke MJ, Chen LC, Wu YT. Efficacy of Ultrasound-Guided Pulsed Radiofrequency for Recalcitrant Metatarsalgia A Case Report. J Am Podiatr Med Assoc 2018; 108:532-534. [PMID: 30742516 DOI: 10.7547/17-147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Metatarsalgia is characterized by pain in the forefoot, which is associated with increased stress over the metatarsal head region. Despite the availability of a variety of conservative or surgical treatments for this condition, a few cases have demonstrated relapse or poor response to treatment. Pulsed radiofrequency (PRF) can provide pain relief in patients with diverse chronic conditions without causing neural injury. Recently, studies have shown that ultrasound-guided PRF may be beneficial for adhesive capsulitis, carpal tunnel syndrome, tarsal tunnel syndrome, and recalcitrant plantar fasciitis. Here, we describe a successful case of significant pain relief achieved by using ultrasound-guided PRF targeting the posterior tibial nerve (PTN) at the ankle of a 67-year-old woman with recalcitrant metatarsalgia. Ten minutes after ultrasound-guided PRF was applied at the PTN, the patient reported decreased pain (from 8 to 3 on a visual analogue scale) and did not exhibit any particular side effects. Three months after PRF application, the patient's visual analogue scale score remained more than 50% below the baseline, and she did not need additional conservative treatment during the follow-up period. To the best of our knowledge, we present the first case report using ultrasound-guided PRF at the PTN for treatment of recalcitrant metatarsalgia. We hypothesize that ultrasound-guided PRF at the PTN may be a potentially novel approach for treating recalcitrant metatarsalgia.
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Affiliation(s)
- Tsung-Yen Ho
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, 11490 Taipei, Taiwan
| | - Ming-Jen Ke
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, 11490 Taipei, Taiwan
| | - Liang-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, 11490 Taipei, Taiwan
| | - Yung-Tsan Wu
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, 11490 Taipei, Taiwan
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Jamison DE, Cohen SP. Radiofrequency techniques to treat chronic knee pain: a comprehensive review of anatomy, effectiveness, treatment parameters, and patient selection. J Pain Res 2018; 11:1879-1888. [PMID: 30271194 PMCID: PMC6151104 DOI: 10.2147/jpr.s144633] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background The use of radiofrequency ablation (RFA) procedures to treat chronic knee pain has surged in the past decade, though many questions remain regarding anatomical targets, selection criteria, and evidence for effectiveness. Methods A comprehensive literature review was performed on anatomy, selection criteria, technical parameters, results of clinical studies, and complications. Databases searched included MEDLINE and Google Scholar, with all types of clinical and preclinical studies considered. Results We identified nine relevant clinical trials, which included 592 patients, evaluating knee RFA for osteoarthritis and persistent postsurgical pain. These included one randomized, placebo-controlled trial, one randomized controlled trial evaluating RFA as add-on therapy, four comparative-effectiveness studies, two randomized trials comparing different techniques and treatment paradigms, and one non-randomized, controlled trial. The results of these studies demonstrate significant benefit for both reduction and functional improvement lasting between 3 and 12 months, with questionable utility for prognostic blocks. There was considerable variation in the described neuroanatomy, neural targets, radiofrequency technique, and selection criteria. Conclusion RFA of the knee appears to be a viable and effective treatment option, providing significant benefit to well-selected patients lasting at least 3 months. More research is needed to better identify neural targets, refine selection criteria to include the use of prognostic blocks, optimize treatment parameters, and better elucidate relative effectiveness compared to other treatments.
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Affiliation(s)
- David E Jamison
- Department of Anesthesiology, Walter Reed National Military Medical Center (WRNMMC), Bethesda, MD, USA, .,Department of Anesthesiology, Uniformed Services University of Health Sciences (USUHS), Bethesda, MD, USA,
| | - Steven P Cohen
- Department of Anesthesiology, Walter Reed National Military Medical Center (WRNMMC), Bethesda, MD, USA, .,Department of Anesthesiology, Uniformed Services University of Health Sciences (USUHS), Bethesda, MD, USA, .,Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA, .,Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA, .,Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, USA, .,Department of Physical Medicine and Rehabilitation, USUHS, Bethesda, MD, USA,
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Abstract
PURPOSE OF REVIEW The increasing number of publications on pulsed radiofrequency (PRF) treatment of chronic pain reflects the interest for this technique. We summarize the literature for PRF in five indications: radicular pain, trigeminal neuralgia (TN), occipital neuralgia, shoulder and knee pain. RECENT FINDINGS The efficacy and safety of PRF adjacent to the dorsal root ganglion was documented on cervical and on lumbar level.PRF has been used for the treatment of TN. The observed duration of effect is shorter than that of conventional radiofrequency, but no neurological complications are reported with PRF.PRF of the nervi occipitales is superior to steroid injections in occipital neuralgia.Several studies showed that PRF of the nervus suprascapularis may relief shoulder pain and can improve mobility of the shoulder joint.For the treatment of knee pain, different nerves have been targeted for PRF treatment. SUMMARY PRF treatment has progressively gained a place in the management of chronic pain syndromes. The concept is appealing because long-lasting effects are reported without complications. Future research is needed with high quality randomized controlled trials and identification of the optimal parameters of PRF in clinical practice.
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Mata J, Valentí P, Hernández B, Mir B, Aguilar JL. Study protocol for a randomised controlled trial of ultrasound-guided pulsed radiofrequency of the genicular nerves in the treatment of patients with osteoarthritis knee pain. BMJ Open 2017; 7:e016377. [PMID: 29102985 PMCID: PMC5722097 DOI: 10.1136/bmjopen-2017-016377] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION The goals for the management of patients with osteoarthritis (OA) of the knee are to control pain and to minimise disability. Because the number of patients will increase as the population ages, alternative approaches to alleviate their joint pain other than conventional treatments are necessary. The purpose of this article is to present a refined protocol to determine if there is long-term improvement in pain and function after ultrasound-guided pulsed radiofrequency treatment of the genicular nerves (GNs) in patients with chronic painful knee OA. METHODS AND ANALYSIS This study is a randomised, double-blind, placebo-controlled, parallel design trial. One hundred and forty-two outpatients with OA of the knee will be recruited from Mallorca, Spain. Participants will be randomly allocated into two groups: ultrasound-guided sham GN pulsed radiofrequency without active treatment and ultrasound-guided real GN pulsed radiofrequency. The primary outcome measures will be the observed changes from baseline pain intensity based on visual analogue scale (VAS). The possible changes in the secondary efficacy variables from the baseline as assessed by the Goldberg Anxiety and Depression Scale, pain medication use, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC subscales) and VAS pain intensity are also to be included in the study. These variables will be assessed at baseline, 1 month, 3 months, 6 months and 1 year after treatment. ETHICS AND DISSEMINATION The protocol was approved by the Research Ethic Committee of the Balearic Islands (IB 3223/16 PI). The results will be disseminated in peer-reviewed journals and at scientific conferences. TRIAL REGISTRATION Trial registration numberNCT02915120; Pre-results.
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Affiliation(s)
- Javier Mata
- Department of Anaesthesia, Son Llàtzer University Hospital, Palma de Mallorca, Spain
| | - Pedro Valentí
- Department of Anaesthesia, Son Llàtzer University Hospital, Palma de Mallorca, Spain
| | - Beatriz Hernández
- Department of Anaesthesia, Son Llàtzer University Hospital, Palma de Mallorca, Spain
| | - Bartolome Mir
- Department of Anaesthesia, Son Llàtzer University Hospital, Palma de Mallorca, Spain
| | - Jose Luis Aguilar
- Department of Anaesthesia, Son Llàtzer University Hospital, Palma de Mallorca, Spain
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Lee DG, Cho YW, Cho KH, Chang MC. Management of refractory sciatic neuropathic pain using ultrasound-guided pulsed radiofrequency. J Back Musculoskelet Rehabil 2017; 30:1141-1145. [PMID: 28946529 DOI: 10.3233/bmr-169724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Nowadays, pulsed radiofrequency (PRF) is being used to control several types of musculoskeletal pain. Herein, we report a successful application of ultrasound (US)-guided PRF for a patient with refractory sciatic neuropathic pain. CASE REPORT We applied US-guided PRF to a 50-year-old man, suffering from refractory neuropathic pain on the left foot following sciatic neuropathy for a period of approximately 6 months. We performed PRF on the level of piriformis muscle because the lesion of the sciatic nerve was presented digitally from the level of piriformis muscle on the magnetic resonance images. Under US guidance, the catheter needle was placed close to the left sciatic nerve, and dysesthesia and tingling sensation were reported to be less than 0.2 V. The PRF treatment was administered at 5 Hz and 5 ms pulsed width for 360 seconds at 45 V. After PRF on the left sciatic nerve, pain intensity - based on a numeric rating scale - decreased from 8 to 2. The reduction of pain was sustained for at least 6 months after the PRF procedure. CONCLUSION We concluded that the PRF treatment is a very useful treatment technique for patients with refractory sciatic neuropathy.
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Affiliation(s)
- Dong Gyu Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Korea
| | - Yun Woo Cho
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Korea
| | - Kil-Ho Cho
- Department of Radiology, College of Medicine, Yeungnam University, Daegu, Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Korea
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Maida E, Chiavaras MM, Jelsing EJ, O'Driscoll SW, Pawlina W, Smith J. Sonographic Visualization of the Posterior Cutaneous Nerve of the Forearm: Technique and Validation Using Perineural Injections in a Cadaveric Model. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1627-1637. [PMID: 28390161 DOI: 10.7863/ultra.16.08027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 10/21/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To determine the ability to sonographically identify the posterior cutaneous nerve of the forearm (PCNF) and its distal epicondylar branches using sonographically guided perineural injections in an unembalmed cadaveric model. METHODS A single experienced operator used a 12-3-MHz linear array transducer to identify the PCNF and its distal epicondylar region branches in 10 unembalmed cadaveric specimens (6 right and 4 left) obtained from 10 donors. Sonographically guided perineural PCNF injections were then completed with a 22-gauge, 38-mm stainless steel needle to deliver 0.25 mL of 50% diluted colored latex at 3 points along the PCNF. The latex location was then confirmed via dissection. RESULTS The 10 donors included 4 male and 6 female cadavers aged 48 to 94 years (mean, 73 years) with body mass indices of 19 to 37 kg/m2 (mean, 26 kg/m2 ). The operator sonographically identified the PCNF and several distal branches traversing over or directly adjacent to the lateral epicondyle in all 10 specimens. Only 7 of 10 specimens showed a distinct PCNF bifurcation into anterior and posterior divisions, and all 7 were accurately identified and localized on sonography. There was no evidence of latex overflow to clinically relevant adjacent structures or injury to regional vessels or nerves. CONCLUSIONS High-resolution sonography can identify the PCNF and its distal epicondylar branches. Sonographic evaluation of the PCNF should be included in the evaluation of patients presenting with refractory or atypical lateral elbow pain syndromes. Diagnostic and therapeutic sonographically guided procedures targeting the PCNF or its lateral epicondylar branches are feasible and warrant further investigation.
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Affiliation(s)
- Eugene Maida
- Departments of Physical Medicine and Rehabilitation, McMaster University, Hamilton, Ontario, Canada
| | - Mary M Chiavaras
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Elena J Jelsing
- Departments of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Shawn W O'Driscoll
- Department of Orthopedics, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Wojciech Pawlina
- Department of Anatomy, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Jay Smith
- Departments of Physical Medicine and Rehabilitation, Radiology, and Anatomy, Mayo Clinic College of Medicine, Mayo Clinic Sports Medicine Center, Rochester, Minnesota, USA
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Wu YT, Chang CY, Chou YC, Yeh CC, Li TY, Chu HY, Chen LC. Ultrasound-Guided Pulsed Radiofrequency Stimulation of Posterior Tibial Nerve: A Potential Novel Intervention for Recalcitrant Plantar Fasciitis. Arch Phys Med Rehabil 2017; 98:964-970. [DOI: 10.1016/j.apmr.2017.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 01/10/2017] [Accepted: 01/11/2017] [Indexed: 11/25/2022]
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Sarı S, Aydın ON, Turan Y, Özlülerden P, Efe U, Kurt Ömürlü İ. Which one is more effective for the clinical treatment of chronic pain in knee osteoarthritis: radiofrequency neurotomy of the genicular nerves or intra-articular injection? Int J Rheum Dis 2016; 21:1772-1778. [DOI: 10.1111/1756-185x.12925] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Sinem Sarı
- Department of Anesthesiology; Medical Faculty; Adnan Menderes University; Aydin Turkey
| | - Osman N. Aydın
- Department of Algology; Medical Faculty; Adnan Menderes University; Aydin Turkey
| | - Yasemin Turan
- Department of Physical Medicine and Rehabilitation; Medical Faculty; Adnan Menderes University; Aydin Turkey
| | - Pınar Özlülerden
- Department of Algology; Medical Faculty; Adnan Menderes University; Aydin Turkey
| | - Ufuk Efe
- Department of Anesthesiology; Medical Faculty; Adnan Menderes University; Aydin Turkey
| | - İmran Kurt Ömürlü
- Department of Biostatistics; Medical Faculty; Adnan Menderes University; Aydin Turkey
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Oh DS, Kang TH, Kim HJ. Pulsed radiofrequency on radial nerve under ultrasound guidance for treatment of intractable lateral epicondylitis. J Anesth 2016; 30:498-502. [PMID: 26896944 DOI: 10.1007/s00540-016-2146-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 01/30/2016] [Indexed: 11/27/2022]
Abstract
Lateral epicondylitis is a painful and functionally limiting disorder. Although lateral elbow pain is generally self-limiting, in a minority of people symptoms persist for a long time. When various conservative treatments fail, surgical approach is recommended. Surgical denervation of several nerves that innervate the lateral humeral epicondyle could be considered in patients with refractory pain because it denervates the region of pain. Pulsed radiofrequency is a minimally invasive procedure that improves chronic pain when applied to various neural tissues without causing any significant destruction and painful complication. This procedure is safe, minimally invasive, and has less risk of complications relatively compared to the surgical approach. The radial nerve can be identified as a target for pulsed radiofrequency lesioning in lateral epicondylitis. This innovative method of pulsed radiofrequency applied to the radial nerve has not been reported before. We reported on two patients with intractable lateral epicondylitis suffering from elbow pain who did not respond to nonoperative treatments, but in whom the ultrasound-guided pulsed radiofrequency neuromodulation of the radial nerve induced symptom improvement. After a successful diagnostic nerve block, radiofrequency probe adjustment around the radial nerve was performed on the lateral aspect of the distal upper arm under ultrasound guidance and multiple pulsed treatments were applied. A significant reduction in pain was reported over the follow-up period of 12 weeks.
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Affiliation(s)
- Dae Seok Oh
- Yongho Center of Onnuri Pain Clinic, 147 Yongho-ro, Nam-gu, Busan, 608-834, Korea.
| | | | - Hyae Jin Kim
- Department of Anesthesia and Pain Medicine, Pusan National University Hospital, Busan, Korea
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