Management of neuropathic pain induced by cubital tunnel syndrome using pulsed radiofrequency: Two case reports

The Use of Physiotherapy in the Conservative Treatment of Cubital Tunnel Syndrome: A Critical Review of the Literature

BACKGROUND

The lack of a clear answer regarding the efficacy of physiotherapy in the treatment of cubital tunnel syndrome (CuTS) has led to attempts to critically assess the scientific studies conducted to date.

MATERIALS AND METHODS

Two databases (MEDLINE via PubMed and PEDro) and Google Scholar were used to search for papers. The inclusion criteria were randomized controlled trials, case series, and case reports that evaluate the effects of physiotherapy in the treatment of patients with CuTS.

RESULTS

A total of 18 studies met the eligibility criteria, capturing a total of 425 participants. Seven papers were randomized controlled trials, three more described prospective studies without a control group, and eight papers contained case reports. An analysis of the literature evaluating the effectiveness of various forms of broadly defined physiotherapy indicates that their use can have a beneficial effect in reducing many subjective and objective symptoms and improving function. In the majority of papers included in this review, their authors indicated positive therapeutic effects. Only one randomized controlled trial reported no change following therapy. It can therefore be stated that the results of the research conducted so far are optimistic. However, only 7 of the 18 papers were randomized controlled trials, while 3 were prospective studies, and 8 papers were case studies, in which 23 people with CuTS were studied.

CONCLUSIONS

The small number of randomized clinical trials and their considerable heterogeneity do not allow firm conclusions to be drawn about the effectiveness of physiotherapy in the conservative treatment of CuTS.

The Unpredictable Ulnar Nerve-Ulnar Nerve Entrapment from Anatomical, Pathophysiological, and Biopsychosocial Aspects

Peripheral nerves consist of delicate structures, including a rich microvascular system, that protect and nourish axons and associated Schwann cells. Nerves are sensitive to internal and external trauma, such as compression and stretching. Ulnar nerve entrapment, the second most prevalent nerve entrapment disorder after carpal tunnel syndrome, appears frequently at the elbow. Although often idiopathic, known risk factors, including obesity, smoking, diabetes, and vibration exposure, occur. It exists in all adult ages (mean age 40-50 years), but seldom affects individuals in their adolescence or younger. The patient population is heterogeneous with great co-morbidity, including other nerve entrapment disorders. Typical early symptoms are paresthesia and numbness in the ulnar fingers, followed by decreased sensory function and muscle weakness. Pre- and postoperative neuropathic pain is relatively common, independent of other symptom severity, with a risk for serious consequences. A multimodal treatment strategy is necessary. Mild to moderate symptoms are usually treated conservatively, while surgery is an option when conservative treatment fails or in severe cases. The decision to perform surgery might be difficult, and the outcome is unpredictable with the risk of complications. There is no consensus on the choice of surgical method, but simple decompression is relatively effective with a lower complication rate than transposition.

Tremor Induced by Focal Peripheral Nerve Entrapment: A Case Series

Little is known about tremors caused by peripheral nerve entrapment. We report two cases of tremors caused by peripheral nerve compressions. Two patients presented with intentional tremors combined with peripheral nerve compression symptoms on their affected hand. Based on the clinical findings and evaluations, the first patient was diagnosed with double-crush compression of the ulnar nerve at the cubital tunnel and Guyon canal, and the second patient was diagnosed with lacertus syndrome. The first patient underwent surgical release of the cubital tunnel and Guyon canal in two stages. The second patient underwent release of the lacertus fibrosus. At the 1-month follow-up after surgery, the tremors had completely resolved, and neurological symptoms improved. Peripheral nerve entrapment should be considered a potential cause of tremors in patients with tremors combined with symptoms of peripheral neuropathy. Surgical release can be curative.

The Effects of Physiotherapy in the Treatment of Cubital Tunnel Syndrome: A Systematic Review

Background: To date, various forms of physiotherapy are used in the treatment of cubital tunnel syndrome (CuTS). The effectiveness of physiotherapy for CuTS is inconclusive. The aim of this systematic review was to evaluate the effects of physiotherapy in the conservative treatment of CuTS. Methods: The six databases were searched from December 2020 to March 2022. The inclusion criteria were randomised controlled trials, case series, and case reports that evaluate the effects of physiotherapy in the treatment of adult participants with diagnosis CuTS. A total of 11 studies met the eligibility criteria, capturing a total of 187 participants. Results: In three types of papers, pain, muscle strength, and limitation of upper limb function were the most frequently assessed characteristics. Physiotherapy was most often based on manual therapy, neurodynamic techniques, and electrical modalities. One clinical trial rated the risk of bias “high” and the other two “some concerns”. In case-series designs, five studies rated the risk of bias as “serious” and three as “moderate”. Most of the studies showed a significant improvement in the clinical condition, also in the follow-up study. Only one clinical trial showed no therapeutic effect. Conclusion: There is no possibility of recommending the best method of physiotherapy in clinical practice for people with CuTS based on the results of this systematic review. More high-quality studies are required.

CT-guided radiofrequency treatment of trigeminal neuralgia at different temperatures through foramen rotundus

OBJECTIVE

To compare the efficacy and safety of CT-guided radiofrequency therapy in the treatment of trigeminal neuralgia (TN) through foramen rotundus at different temperatures.

METHODS

A total of 60 patients with TN in our hospital were selected and randomly divided into the control group and the observation group, with 30 cases in each group. CT or MRI was routinely performed before the operation to exclude intracranial space-occupying lesions. The round hole of both groups of patients was targeted under CT guidance. The puncture needle position and depth were determined according to CT images and radiofrequency electrical stimulation. The control group gradually increased the radiofrequency temperature to 75°C, and the observation group gradually increased to 90°C for damage treatment. Both groups of patients were treated with radiofrequency for 360 s. The clinical efficacy was evaluated by BNI classification criteria. At the same time, the visual analog scale (VAS) score, the total score of Pittsburgh sleep quality index (PSQI) and the incidence of complications were compared between the two groups. The Kaplan-Meier method in survival analysis was used to calculate the pain recurrence rate at 1 and 2 years after the operation.

RESULTS

One week after the operation, there was no significant difference in the total effective rate between the two groups (χ²=0.089, P=0.766). After 2 months, the total effective rate of the observation group was higher than that of the control group (χ²=4.043, P=0.044). One day and one week after the operation, the VAS score of the observation group was higher than that of the control group (t=7.365, 6.269; P=0.007, 0.012), and the total score of PSQI was significantly higher than that of the control group (t=8.026, 5.447; P=0.002, 0.015). There was no significant difference in VAS score and PSQI total score between the two groups 1 month and 2 months after operation (P>0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P>0.05). Kaplan-Meier survival analysis was used to calculate the recurrence rate of pain at 1 and 2 years after operation. The recurrence rate of the observation group was significantly lower than that of the control group (χ²=4.219, 4.021; P=0.039, 0.044).

CONCLUSION

CT-guided radiofrequency at 90°C through foramen rotundus is effective in the treatment of trigeminal neuralgia without increasing the incidence of complications.

Domain Heterogeneity in Radiofrequency Therapies for Pain Relief: A Computational Study with Coupled Models

The objective of the current research work is to study the differences between the predicted ablation volume in homogeneous and heterogeneous models of typical radiofrequency (RF) procedures for pain relief. A three-dimensional computational domain comprising of the realistic anatomy of the target tissue was considered in the present study. A comparative analysis was conducted for three different scenarios: (a) a completely homogeneous domain comprising of only muscle tissue, (b) a heterogeneous domain comprising of nerve and muscle tissues, and (c) a heterogeneous domain comprising of bone, nerve and muscle tissues. Finite-element-based simulations were performed to compute the temperature and electrical field distribution during conventional RF procedures for treating pain, and exemplified here for the continuous case. The predicted results reveal that the consideration of heterogeneity within the computational domain results in distorted electric field distribution and leads to a significant reduction in the attained ablation volume during the continuous RF application for pain relief. The findings of this study could provide first-hand quantitative information to clinical practitioners about the impact of such heterogeneities on the efficacy of RF procedures, thereby assisting them in developing standardized optimal protocols for different cases of interest.