Efficacy of Ultrasound-Guided Pulsed Radiofrequency for Recalcitrant Metatarsalgia

2018 ◽  
Vol 108 (6) ◽  
pp. 532-534
Author(s):  
Tsung-Yen Ho ◽  
Ming-Jen Ke ◽  
Liang-Cheng Chen ◽  
Yung-Tsan Wu
Keyword(s):  
Pain Relief ◽  
Visual Analogue Scale ◽  
Analogue Scale ◽  
Adhesive Capsulitis ◽  
Tarsal Tunnel ◽  
Pulsed Radiofrequency ◽  
Ultrasound Guided ◽  
First Case ◽  
Patient Reported ◽  
Tunnel Syndrome

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.

scholarly journals Predictive Outcome Modeling of Preoperative Clinical Symptoms and Electrodiagnostic Data in Tarsal Tunnel Surgery

2021 ◽  
Vol 16 (01) ◽  
pp. e37-e45
Author(s):  
Geoffrey K. Seidel ◽  
Salma Al Jamal ◽  
Eric Weidert ◽  
Frederick Carington ◽  
Michael T. Andary ◽  
...  
Keyword(s):  
Surgical Outcome ◽  
Clinical Symptoms ◽  
Tibial Nerve ◽  
Outcome Measurement ◽  
Tarsal Tunnel ◽  
Patient Reported ◽  
Peripheral Polyneuropathy ◽  
Tunnel Syndrome ◽  
Phalen's Test ◽  
Surgical Release

Abstract Background The relationship between tarsal tunnel syndrome (TTS), electrodiagnostic (Edx) findings, and surgical outcome is unknown. Analysis of TTS surgical release outcome patient satisfaction and comparison to Edx nerve conduction studies (NCSs) is important to improve outcome prediction when deciding who would benefit from TTS release. Methods Retrospective study of 90 patients over 7 years that had tarsal tunnel (TT) release surgery with outcome rating and preoperative tibial NCS. Overall, 64 patients met study inclusion criteria with enough NCS data to be classified into one of the following three groups: (1) probable TTS, (2) peripheral polyneuropathy, or (3) normal. Most patients had preoperative clinical provocative testing including diagnostic tibial nerve injection, tibial Phalen's sign, and/or Tinel's sign and complaints of plantar tibial neuropathic symptoms. Outcome measure was percentage of patient improvement report at surgical follow-up visit. Results Patient-reported improvement was 92% in the probable TTS group (n = 41) and 77% of the non-TTS group (n = 23). Multivariate modeling revealed that three out of eight variables predicted improvement from surgical release, NCS consistent with TTS (p = 0.04), neuropathic symptoms (p = 0.045), and absent Phalen's test (p = 0.001). The R 2 was 0.21 which is a robust result for this outcome measurement process. Conclusion The best predictors of improvement in patients with TTS release were found in patients that had preoperative Edx evidence of tibial neuropathy in the TT and tibial nerve plantar symptoms. Determining what factors predict surgical outcome will require prospective evaluation and evaluation of patients with other nonsurgical modalities.

scholarly journals Comparison of Pulsed Radiofrequency, Oxygen-Ozone Therapy and Epidural Steroid Injections for the Treatment of Chronic Unilateral Radicular Syndrome

Medicina ◽  
2021 ◽  
Vol 57 (2) ◽  
pp. 136
Author(s):  
Pavel Ryska ◽  
Jiri Jandura ◽  
Petr Hoffmann ◽  
Petr Dvorak ◽  
Blanka Klimova ◽  
...  
Keyword(s):  
Pain Relief ◽  
Analogue Scale ◽  
Pulsed Radiofrequency ◽  
Ozone Therapy ◽  
Ct Guided ◽  
The Third ◽  
Vas Score ◽  
Radicular Syndrome ◽  
Epidural Steroid

Background and objectives: For the treatment of chronic unilateral radicular syndrome, there are various methods including three minimally invasive computed tomography (CT)-guided methods, namely, pulsed radiofrequency (PRF), transforaminal oxygen ozone therapy (TFOOT), and transforaminal epidural steroid injection (TFESI). Despite this, it is still unclear which of these methods is the best in terms of pain reduction and disability improvement. Therefore, the purpose of this study was to evaluate the short and long-term effectiveness of these methods by measuring pain relief using the visual analogue scale (VAS) and improvement in disability (per the Oswestry disability index (ODI)) in patients with chronic unilateral radicular syndrome at L5 or S1 that do not respond to conservative treatment. Materials and Methods: After screening 692 patients, we enrolled 178 subjects, each of whom underwent one of the above CT-guided procedures. The PRF settings were as follows: pulse width = 20 ms, f = 2 Hz, U = 45 V, Z ˂ 500 Ω, and interval = 2 × 120 s. For TFOOT, an injection of 4–5 mL of an O2-O3 mixture (24 μg/mL) was administered. For the TFESI, 1 mL of a corticosteroid (betamethasone dipropionate), 3 mL of an anaesthetic (bupivacaine hydrochloride), and a 0.5 mL mixture of a non-ionic contrast agent (Iomeron 300) were administered. Pain intensity was assessed with a questionnaire. Results: The data from 178 patients (PRF, n = 57; TFOOT, n = 69; TFESI, n = 52) who submitted correctly completed questionnaires in the third month of the follow-up period were used for statistical analysis. The median pre-treatment visual analogue scale (VAS) score in all groups was six points. Immediately after treatment, the largest decrease in the median VAS score was observed in the TFESI group, with a score of 3.5 points (a decrease of 41.7%). In the PRF and TFOOT groups, the median VAS score decreased to 4 and 5 points (decreases of 33% and 16.7%, respectively). The difference in the early (immediately after) post-treatment VAS score between the TFESI and TFOOT groups was statistically significant (p = 0.0152). At the third and sixth months after treatment, the median VAS score was five points in all groups, without a statistically significant difference (p > 0.05). Additionally, there were no significant differences in the Oswestry disability index (ODI) values among the groups at any of the follow-up visits. Finally, there were no significant effects of age or body mass index (BMI) on both treatment outcomes (maximum absolute value of Spearman’s rank correlation coefficient = 0.193). Conclusions: Although the three methods are equally efficient in reducing pain over the entire follow-up, we observed that TFESI (a corticosteroid with a local anaesthetic) proved to be the most effective method for early post-treatment pain relief.

Tarsal Tunnel Syndrome Associated with a Pulsating Artery

2010 ◽  
Vol 100 (3) ◽  
pp. 209-212 ◽  
Author(s):  
Eunkuk Kim ◽  
Martin K. Childers
Keyword(s):  
High Resolution ◽  
Ultrasound Imaging ◽  
Tibial Nerve ◽  
Tarsal Tunnel ◽  
Posterior Tibial Nerve ◽  
Tarsal Tunnel Syndrome ◽  
Ultrasound Guided ◽  
Nerve Ultrasound ◽  
Posterior Tibial ◽  
Tunnel Syndrome

We describe a patient with tarsal tunnel syndrome in whom ultrasound imaging revealed compression of the posterior tibial nerve by a pulsating artery. High-resolution ultrasound showed a round pulsating hypoechoic lesion in contact with the posterior tibial nerve. Ultrasound-guided injection of 0.5% lidocaine temporarily resolved the paresthesia. These findings suggest an arterial etiology of tarsal tunnel syndrome. (J Am Podiatr Med Assoc 100(3): 209–212, 2010)

scholarly journals Effects of ultrasound-guided suprascapular nerve pulsed radiofrequency on chronic shoulder pain

2018 ◽  
Vol 20 (4) ◽  
pp. 461 ◽  
Author(s):  
Tolga Ergonenc ◽  
Serbulent Gokhan Beyaz
Keyword(s):  
Shoulder Pain ◽  
External Rotation ◽  
Adhesive Capsulitis ◽  
Suprascapular Nerve ◽  
Pulsed Radiofrequency ◽  
Ultrasound Guided ◽  
Duration Of Action ◽  
Vas Score ◽  
Long Duration ◽  
Chronic Shoulder Pain

Aim: Pulsed radiofrequency (PRF) therapy has become increasingly popular in the treatment of chronic shoulder pain due to its long duration of action and non-destructive method. The aim of the study was to reveal the effects of PRF therapy of the suprascapular nerve (SSN) under ultrasound guidance (UG) in patients with chronic shoulder pain on both shoulder pain and function.Material and methods: This study included 74 patients diagnosed with at least one of the following: adhesive capsulitis, rotator cuff syndrome and impingement syndrome of shoulder. The PRF therapy of the SSN under UG was performed in those patients with a reduction of 50% or more Visual Analog Scale (VAS) score and those that reported healing in the active range of motion (AROM) in the diagnostic SSN block. The resting, motion and sleeping shoulder pain assessments of the patients were done with VAS score. The shoulder joint function was assessed with the Shoulder Pain and Disability Index (SPADI) questionnaire and the AROM of the joint was measured using a goniometer.Results: In 70 of the 74 patients a 50% or more reduction was found in the VAS score with diagnostic SSN block. After the PRF therapy of the SSN, the 15thday, 1st month, 3rd month, and 6th month follow-up VAS averages, SPADI averages and the flexion, internal rotation, external rotation, and abduction values were statistically significantly lower than the baseline values (p<0.05).Conclusion: This study is the largest series in the literature evaluating the efficacy of PRF therapy of the SSN under UG and has shown that pain canbe controlled quickly, for a long period of time, using ultrasound guided PRF therapy of the SSN in chronic shoulder pain.

scholarly journals Surgical Outcome of Microvascular Decompression for Trigerminal Neuralgia in Terms of Pain Control Using Visual Analogue Scale

2020 ◽  
Vol 24 (3) ◽  
Author(s):  
RIAZ-UR- REHMAN ◽  
MUHAMMAD NAWAZ KHAN ◽  
ATTIYA NASIR SIDDIQUE ◽  
AKBAR JAMAL
Keyword(s):  
Pain Relief ◽  
Visual Analogue Scale ◽  
Trigeminal Neuralgia ◽  
Pain Control ◽  
Analogue Scale ◽  
Visual Analogue Score ◽  
Definitive Treatment ◽  
Inclusion Criteria ◽  
Good Pain Relief ◽  
Vascular Decompression

Objective:  The aim of conducting this study was to evaluate the outcome of a Micro vascular Decompression procedure for the definitive treatment of Trigeminal Neuralgia in our setup. Material and Methods:  This observational prospective study was carried out in Neurosurgery unit Hayatabad Medical Complex, Peshawar. A total of 50 patients operated for micro vascular decompression surgeries were enrolled in the study, both genders and any age were in inclusion criteria. Patients previously operated for trigeminal neuralgia were excluded from the study. Post operatively all patients were followed for 1year to calculate the outcome in terms of pain control using visual analogue score (VAS). Immediate pain relief during the first post-operative week and trigeminal neuralgia pain at 1 year post op were recorded and  graded into three categories based on Visual Analogue Scale (VAS) such as Excellent: 0-2 , Good: 3-6, Fail/Poor: 7 – 10. Results:  50 patients fulfilled the inclusion criteria. 22 were male & 28 were female with an age range from 42-78 years. Average duration of disease was 5 years. In 30 patients, clinically v2-v3 were predominantly involved, in remaining 14 patient v1-v2 were involved & only in 6 patients all three branches were involved. Among all operated 50 patients 18(36%) had excellent pain relief, 26 (52%) had good pain relief & 6 (12%) had fail/poor pain relief. Conclusion:  From this data it was concluded that micro vascular decompression is an effective surgical procedure in relieving pain of trigeminal neuralgia in patients who are refractive to medical treatment.

Checkmate 577:Health-related quality of life (HRQoL) in a randomized, double-blind phase III study of nivolumab (NIVO) versus placebo (PBO) as adjuvant treatment in patients (pts) with resected esophageal or gastroesophageal junction cancer (EC/GEJC).

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 167-167
Author(s):  
Eric Van Cutsem ◽  
Prianka Singh ◽  
James M. Cleary ◽  
Ronan Joseph Kelly ◽  
Markus H. Moehler ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Visual Analogue Scale ◽  
Repeated Measures ◽  
Analogue Scale ◽  
Gastroesophageal Junction ◽  
Neoadjuvant Chemoradiotherapy ◽  
Phase Iii ◽  
Meaningful Improvement ◽  
Utility Index ◽  
Patient Reported

167 Background: NIVO is the first adjuvant therapy to provide a statistically significant and clinically meaningful improvement in disease-free survival (DFS) versus PBO in resected EC/GEJC following neoadjuvant chemoradiotherapy as demonstrated by CheckMate 577. NIVO was well tolerated with an acceptable safety profile. This analysis provides additional information on the exploratory HRQoL endpoints in this clinical trial. Methods: The effect of NIVO versus PBO on HRQoL, including general and disease-related symptoms, functioning, disease burden, and overall QoL, was assessed using FACT-E and EQ-5D-3L patient-reported outcome (PRO) questionnaires administered at baseline (BL), every 4 weeks during the 12-month treatment period, and at post-treatment follow-up visits (up to 2 years after last dose). Longitudinal change from BL in PRO scores over 12 months was assessed using descriptive statistics. Additionally, mixed model for repeated measures and time to deterioration analyses evaluated the difference between treatment with NIVO and PBO (data not shown). Results: 794 pts with EC/GEJC were randomized 2:1 to NIVO (n = 532) or PBO (n = 262). PRO completion rates were ≥ 95% at BL and ~ 90% at 12 months on treatment. Mean (SD) BL HRQoL scores were similar between treatment arms for the FACT-E total score (NIVO: 133.40 [20.97]; PBO: 134.03 [20.40]); esophageal cancer subscale (ECS; NIVO: 50.2 [9.3]; PBO: 50.1 [8.9]); EQ-5D Visual Analogue Scale (NIVO: 70.4 [22.3]; PBO: 69.1 [24.1]); and EQ-5D Utility Index (NIVO: 0.820 [0.179]; PBO: 0.831 [0.163]) based on the UK value set. Descriptive analyses showed a trend for increases from baseline at most time points through week 49 for both NIVO and PBO treatment groups for FACT-E total score, ECS, and EQ-5D Visual Analogue Scale and Utility Index. Conclusions: Preliminary results from CheckMate 577 demonstrated that pts on NIVO treatment showed trends of improvement in both esophageal-specific and general HRQoL. Similar trends were also observed in pts treated with PBO over 1 year. Pts treated with NIVO did not experience a reduction in HRQoL, further supporting clinical data to demonstrate treatment benefit and tolerability for adjuvant NIVO in pts with resected EC/GEJC. Clinical trial information: NCT02743494.

scholarly journals The effects of photobiomodulation therapy for the treatment of dentin hypersensitivity

2020 ◽  
Author(s):  
Erika Michele dos Santos Araújo ◽  
Bárbara Fávero Araújo Lima ◽  
Júlia Gomes Lúcio de Araújo ◽  
Fernanda Cristina Nogueira Rodrigues ◽  
Stella Ferreira do Amaral ◽  
...  
Keyword(s):  
Case Report ◽  
Visual Analogue Scale ◽  
Low Power ◽  
Diode Laser ◽  
Male Patient ◽  
Analogue Scale ◽  
Dentin Hypersensitivity ◽  
Cervical Lesions ◽  
Patient Reported ◽  
Power Diode

Objective: This case report proposes a treatment for dentin hypersensitivity (DH) using photobiomodulation (PBT) with low power diode laser. Methods and Results: Male patient, 28 years old, reporting “dental sensitivity,” diagnosed by anamnesis and intraoral examination, with non-carious cervical lesions (NCCL) and DH on teeth 15 to 25, with different pain intensities, measured with visual analogue scale (VAS). For DH treatment, a PBT was proposed, with 808nm, 100mW, 20s and 2J of energy, applied during 3 sessions, with one-week interval and reevaluation after 30 days. After the first session, the patient reported improvement of sensitivity in all teeth, except for 15, that remained sensitive even during the reevaluation. Conclusion: PBT was effective in DH treatment, with desensitization being observed for 30 days in 90% of treated teeth.

scholarly journals Full-length silicone insoles versus ultrasound-guided corticosteroid injection in the management of plantar fasciitis: A randomized clinical trial

2013 ◽  
Vol 37 (6) ◽  
pp. 471-476 ◽  
Author(s):  
Ufuk Yucel ◽  
Sami Kucuksen ◽  
Havva T Cingoz ◽  
Emel Anlıacik ◽  
Orhan Ozbek ◽  
...  
Keyword(s):  
Visual Analogue Scale ◽  
Plantar Fasciitis ◽  
Analogue Scale ◽  
Corticosteroid Injection ◽  
Plantar Fascia ◽  
Full Length ◽  
Foot And Ankle ◽  
Ultrasound Guided ◽  
First Line ◽  
Outcome Score

Background: Plantar fasciitis often leads to disability. Optimal treatment for this clinical condition is still unknown. Objective: To compare the effectiveness of wearing a full-length silicone insole with ultrasound-guided corticosteroid injection in the management of plantar fasciitis. Study design: Randomized clinical trial. Methods: Forty-two patients with chronic unilateral plantar fasciitis were allocated randomly to have an ultrasound-guided corticosteroid injection or wear a full-length silicone insole. Data were collected before the procedure and 1 month after. The primary outcome measures included first-step heel pain via Visual Analogue Scale and Heel Tenderness Index. Other outcome measures were the Foot and Ankle Outcome Score and ultrasonographic thickness of the plantar fascia. Results: After 1 month, a significant improvement was shown in Visual Analogue Scale, Heel Tenderness Index, Foot and Ankle Outcome Score, and ultrasonographic thickness of plantar fascia in both groups. Visual Analogue Scale scores, Foot and Ankle Outcome Score pain, Foot and Ankle Outcome Score for activities of daily living, Foot and Ankle Outcome Score for sport and recreation function, and plantar fascia thickness were better in injection group than in insole group (p < 0.05). Conclusions: Although both ultrasound-guided corticosteroid injection and wearing a full-length silicone insole were effective in the conservative treatment of plantar fasciitis, we recommend the use of silicone insoles as a first line of treatment for persons with plantar fasciitis. Clinical relevance Silicone insole may be considered as a first-line treatment option in patients with plantar fasciitis.

Comparison of the PainMatcher and the Visual Analogue Scale for assessment of labour pain following administered pain relief treatment

Midwifery ◽  
2011 ◽  
Vol 27 (1) ◽  
pp. e134-e139 ◽  
Author(s):  
Ingrid H.E. Bergh ◽  
Elisabet Stener-Victorin ◽  
Gunnar Wallin ◽  
Lena Mårtensson
Keyword(s):  
Pain Relief ◽  
Visual Analogue Scale ◽  
Analogue Scale ◽  
Labour Pain

scholarly journals Double Dome Laminoplasty: A Novel Technique for C2 Decompression

Neurospine ◽  
2021 ◽  
Vol 18 (4) ◽  
pp. 882-888
Author(s):  
Dong-Ho Lee ◽  
Gian Karlo P. Dadufalza ◽  
Jong-Min Baik ◽  
Sehan Park ◽  
Jae Hwan Cho ◽  
...  
Keyword(s):  
Visual Analogue Scale ◽  
Neck Pain ◽  
Cervical Myelopathy ◽  
Analogue Scale ◽  
Japanese Orthopaedic Association ◽  
Posterior Longitudinal Ligament ◽  
Patient Reported ◽  
Laminar Fracture ◽  
Cervical Spine Alignment ◽  
New Surgical Technique

Objective: To introduce a new surgical technique - double dome laminoplasty for decompression of the entire C2 lamina and preservation of an extensor muscle insertion.Methods: Eleven consecutive cervical myelopathy patients due to ossification of the posterior longitudinal ligament involving the Axis (C2) area were contained at this study. Direct decompression was evaluated as an increasing rate in space available cord (%) and posterior cord shift (mm) at C2 level. The Japanese Orthopaedic Association (JOA) score, visual analogue scale, and C2–7 Cobb angle in a neutral lateral x-ray were analyzed.Results: The mean increase in space available for spinal cord at the C2 level, average posterior cord shift, and JOA recovery rate were 69.7%, 5.3 ± 0.15 mm, and 58.0%, respectively. Cervical lordotic angle was maintained in all patients. One patient reported neck pain (visual analogue scale 6) postoperatively. No specific complications such as C2 laminar fracture or insufficient decompression were observed.Conclusion: We recommend double dome laminoplasty for treating patients with cervical myelopathy involving the C2 area to avoid C2 laminectomy, reduce postoperative neck pain, and maintain lordotic cervical spine alignment.

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