scholarly journals Diagnostics of infrapatellar saphenous neuralgia—a reversible cause of chronic anteromedial pain following knee surgery

2021 ◽  
Author(s):  
Schu-Ren Yang ◽  
Michael T. Hirschmann ◽  
Alain Schiffmann ◽  
Balazs K. Kovacs ◽  
Julian Gehweiler ◽  
...  
Keyword(s):  
Pain Relief ◽  
Knee Joint ◽  
Knee Pain ◽  
Nerve Block ◽  
Joint Instability ◽  
Clinical Signs ◽  
Knee Surgery ◽  
Concomitant Surgery ◽  
The Impact

Abstract Objectives To evaluate the impact of diagnostic nerve block and ultrasound findings on therapeutic choices and predict the outcome after concomitant surgery in patients with suspected neuropathy of the infrapatellar branch of the saphenous nerve (IPBSN). Methods Fifty-five patients following knee surgery with suspicion of IPBSN neuralgia were retrospectively included. Ultrasound reports were assessed for neuroma and postsurgical scarring (yes/no). Responders and non-responders were assigned following anesthetic injection of the IPBSN. The type of procedure (neurectomy/interventional pain procedure/other than nerve-associated therapy) and pain score at initial follow-up were recorded and patients were assigned as positive (full pain relief) or negative (partial/no pain relief) to therapeutic nerve treatment. Factors associated with a relevant visual analog scale (VAS) reduction were assessed using uni- and multivariate logistic regression models and chi-square for quantitative and qualitative variables (p ≤ 0.05). Results Responders (37/55) more often had an entrapment or an evident neuroma of the IPBSN (97% vs. 6%). A positive Hoffmann-Tinel sign (p = 0.002) and the absence of knee joint instability (p = 0.029) predicted a positive response of the diagnostic nerve block (90%; 26/29). In the follow-up after therapeutic nerve treatment, all patients with full pain relief showed neuromas or entrapment of the IPBSN. Patients negatively responding to therapeutic nerve treatment more frequently showed an additional knee joint instability (25% vs. 4%). Conclusion Selective denervation for neuropathic knee pain is beneficial in selected patients with significant VAS reduction after diagnostic nerve block. Non-responders following diagnostic nerve block but sonographic evidence of IPBSN pathologies need to be evaluated for other causes such as knee joint instability. Key Points • Sonographic diagnosis of neuroma or entrapment of the IPBSN is frequently seen in patients with anteromedial knee pain and leads to a good response to diagnostic nerve block following knee surgery. • The vast majority of patients with clinical signs of IPBSN neuropathy and response to a diagnostic nerve block sustained full pain relief following therapeutic nerve treatment. • Patients not responding to therapeutic IPBSN treatment have to be evaluated for other causes of anteromedial knee pain such as knee joint instability.

scholarly journals The Long Term Effectiveness of Genicular Nerve Blocks for Chronic Knee Pain: A Retrospective Study

2018 ◽  
pp. 75-77
Author(s):  
Laura Anne Lynem
Keyword(s):  
Retrospective Study ◽  
Radiofrequency Ablation ◽  
Pain Relief ◽  
Knee Pain ◽  
Nerve Block ◽  
Nerve Blocks ◽  
Chronic Knee Pain ◽  
Post Procedure

Chronic knee pain is a leading cause of chronic disability and its symptoms have a profound impact on the lives of those suffering from it. Current treatment modalities for chronic knee pain include pharmacologic and nonpharmacologic interventions. Genicular nerve blocks are a new therapeutic alternative that have been shown to relieve chronic knee pain and may provide significant relief in patients who are either poor surgical candidates or are unwilling to accept the risks associated with surgery. Genicular nerve blocks may provide long term pain relief for chronic knee pain and radiofrequency ablation (RFA) may not be necessary. This Institutional Review Board (IRB) approved retrospective study conducted at a single center university hospital involved 44 patients aged 43 to 87 who received genicular nerve blocks for chronic knee pain. The primary purpose of this study was to determine if genicular nerve blocks provide effective long term pain relief for patients with chronic knee pain. The numeric rating scale was used to measure the patient’s knee pain at baseline, 30, 90, and 120 days post procedure. Patients experienced a mean pain level of 7.43 out of 10 before the genicular nerve block and 4.02 afterward representing an average improvement of 42.6% in pain relief overall post procedure follow-up. A t-test revealed a statistically significant difference between the mean pain score before and after the blocks (t = 8.534, P < 0.01). Overall, the patients experienced significant pain relief of an average of 111.9 days resulting in an average of 42.6 percent pain relief post procedure follow-up. Out of the 44 patients, 15 (34.1%) underwent a RFA after receiving a genicular nerve block procedure to further manage their chronic knee pain symptoms. In conclusion, we have found statistically significant evidence that genicular nerve blocks provide effective long-term pain relief for patients with chronic knee pain. Therefore, for patients who are not surgical candidates, genicular nerve blocks represent a viable alternative treatment for knee pain. Key words: Genicular nerve blocks, chronic knee pain, genicular nerves, genicular nerve radiofrequency ablation

scholarly journals A Prospective Randomized Comparison of the Efficacy of Ultrasound- vs FluoroscopyGuided Genicular Nerve Block for Chronic Knee Osteoarthritis

2019 ◽  
Vol 2 (22.2) ◽  
pp. 139-146
Author(s):  
Seong-Soo Choi
Keyword(s):  
Pain Relief ◽  
Knee Osteoarthritis ◽  
Knee Pain ◽  
Nerve Block ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Pain Clinic ◽  
Nerve Blocks ◽  
Numeric Rating

Background: Recently, genicular nerve block and radiofrequency ablation were introduced to alleviate knee pain in patients with chronic knee osteoarthritis. Both ultrasound- and fluoroscopyguided genicular nerve blocks have been used. However, whether one is superior to the other remains unknown. Objectives: The present study compares the efficacy of ultrasound- vs fluoroscopy-guided genicular nerve blocks. Study Design: This research used a prospective randomized comparison design. Setting: The study took place at a single pain clinic within a tertiary medical center in Seoul, Republic of Korea. Methods: From July 2015 to September 2017, a randomized controlled study was performed to analyze the difference in the efficacy of ultrasound- vs fluoroscopy-guided genicular nerve blocks. The Numeric Rating Scale (NRS-11), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Global Perceived Effect Scales (GPES), and complications were evaluated preprocedure, and 1 and 3 months after genicular nerve block. Results: A total of 80 patients were enrolled and randomly distributed to groups U (ultrasoundguided, n = 40) and F (fluoroscopy-guided, n = 40). Those who were lost to follow-up or had undergone other interventions were excluded, resulting in 31 and 30 patients in groups U and F, respectively. No differences in NRS-11 or WOMAC were observed between the 2 groups at baseline or during the follow-up period. GPES and complication rates were also similar between both groups. Limitations: We were unable to perform double-blind randomization and did not evaluate patients’ baseline emotional states. Conclusions: Pain relief, functional improvement, and safety were similar between groups receiving ultrasound- and fluoroscopy-guided genicular nerve blocks. Therefore, either of the 2 imaging devices may be utilized during a genicular nerve block for chronic knee pain relief. However, considering radiation exposure, ultrasound guidance may be superior to fluoroscopic guidance. The study protocol was approved by our institutional review board (2015-0369), and written informed consent was obtained from all patients. The trial was registered with the Clinical Research Information Service (KCT 0002846). This work was presented in part as D-H Kim’s MS thesis at the University of Ulsan College of Medicine (2018). Key words: Genicular nerve block, ultrasound, fluoroscopy, knee osteoarthritis, Numeric Rating Scale, The Western Ontario and McMaster Universities Osteoarthritis Index

scholarly journals SARS-CoV-2/DENV co-infection: a series of cases from the Federal District, Midwestern Brazil

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Heidi Luise Schulte ◽  
José Diego Brito-Sousa ◽  
Marcus Vinicius Guimarães Lacerda ◽  
Luciana Ansaneli Naves ◽  
Eliana Teles de Gois ◽  
...  
Keyword(s):  
Clinical Signs ◽  
Federal District ◽  
Therapeutic Interventions ◽  
Diagnostic Process ◽  
The Novel ◽  
Prevention Measures ◽  
Laboratory Findings ◽  
Novel Coronavirus ◽  
The Impact

Abstract Background Since the novel coronavirus disease outbreak, over 179.7 million people have been infected by SARS-CoV-2 worldwide, including the population living in dengue-endemic regions, particularly Latin America and Southeast Asia, raising concern about the impact of possible co-infections. Methods Thirteen SARS-CoV-2/DENV co-infection cases reported in Midwestern Brazil between April and September of 2020 are described. Information was gathered from hospital medical records regarding the most relevant clinical and laboratory findings, diagnostic process, therapeutic interventions, together with clinician-assessed outcomes and follow-up. Results Of the 13 cases, seven patients presented Acute Undifferentiated Febrile Syndrome and six had pre-existing co-morbidities, such as diabetes, hypertension and hypopituitarism. Two patients were pregnant. The most common symptoms and clinical signs reported at first evaluation were myalgia, fever and dyspnea. In six cases, the initial diagnosis was dengue fever, which delayed the diagnosis of concomitant infections. The most frequently applied therapeutic interventions were antibiotics and analgesics. In total, four patients were hospitalized. None of them were transferred to the intensive care unit or died. Clinical improvement was verified in all patients after a maximum of 21 days. Conclusions The cases reported here highlight the challenges in differential diagnosis and the importance of considering concomitant infections, especially to improve clinical management and possible prevention measures. Failure to consider a SARS-CoV-2/DENV co-infection may impact both individual and community levels, especially in endemic areas.

scholarly journals Combined popliteal and saphenous nerve block vs NSAIDS for post operative analgesia in below knee surgery patients: A cross-sectional study

2021 ◽  
Vol 8 (4) ◽  
pp. 556-560
Author(s):  
Amrita Gupta ◽  
Shanu Maheshwari ◽  
Avanish Kumar Saxena ◽  
Sukhdev Mishra ◽  
Aviral Pandey
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Nerve Block ◽  
Saphenous Nerve ◽  
Knee Surgery ◽  
Postoperative Pain Relief ◽  
Ratio Test ◽  
Type I ◽  
Complication Rates ◽  
Rescue Analgesia

Peripheral nerve blocks are becoming increasingly popular to control postoperative pain in orthopaedic limb surgeries. An outstanding feature of nerve block is its lack of adverse effects, reduced requirement of analgesics and better patient satisfaction. To compare the efficacy of combined popliteal and saphenous nerve block with NSAIDS for postoperative pain relief in below knee surgery patients. We performed a prospective randomized study involving seventy patients. All patients underwent an elective orthopaedic procedure below knee under spinal anaesthesia. Thirty five patients had received a combined popliteal and saphenous nerve block and the rest thirty-five received intravenous NSAIDS at the end of surgical procedure. Post operative VAS Score, time for first rescue analgesia, total diclofenac requirement, total anti-emetic requirement and complications if any were noted.: The statistical power of sample was 80% and type I error (α) of 0.05. The distribution of the data was evaluated using the Shapiro-Wilk test. For data with a non-normal distribution, the Mann-Whitney U test was used in intergroup comparisons. The data were expressed as the median, minimum and maximum (min-max). For comparison of postoperative analgesic use, the chi-square test was used, and complication rates were compared using a cross-ratio test. P-values less than 0.05 were considered to be statistically significant in all the analyses.: Patients with a combined popliteal and saphenous nerve block had significantly less pain at six hours, twelve hours and twenty four hours (p value &#60;0.001) postoperatively. Time for request of rescue analgesia was prolonged. Total diclofenac and anti emetic requirement was also reduced. Also higher level of satisfaction was achieved among this group of patients. : A combined popliteal and saphenous nerve block provides significantly better postoperative pain relief than NSAIDS in patients who underwent below knee surgeries.

Functional Arthralgies of Knee Joint as a Complex Problem in the Modern Rehabilitation System

2021 ◽  
Vol 6 (5) ◽  
pp. 56-62
Author(s):  
T. G. Turitska ◽  
◽  
A. A. Vinnyk ◽  
O. S. Snisar
Keyword(s):  
Knee Joint ◽  
Knee Pain ◽  
Local Level ◽  
Pain Syndrome ◽  
Rehabilitation Program ◽  
Google Scholar ◽  
Sources Of Information ◽  
Surgical Interventions ◽  
Muscle Imbalance ◽  
The Impact

The purpose of the study was to search for and analyze data from modern sources of information on the features of the occurrence and manifestations of pain in the knee joint and approaches to treatment. Materials and methods. The paper presents an analysis and generalization of modern scientific and methodological literature of domestic and foreign authors according to the Internet and Google Scholar service on the peculiarities of arthralgia of the knee joint and concomitant manifestations of this disorder (back pain, posture, etc.). Results and discussion. The article analyzed modern views on the occurrence and development of the process of pain syndrome in the knee joint. Sources on request in the Google Scholar service were analyzed, where the overwhelming majority of publications are described by pain slander and approaches to its treatment after the occurrence of anatomical changes in the structures of bone and soft-wound structures or after surgical interventions. Thus, the prevailing approach is the purpose of non-steroidal anti-inflammatory drugs in combination with chondroprotectors. According to the authors of the article, this approach to the treatment of pain in the area of the knee joint does not take into account one of the main components of the occurrence of arthralgia – muscle imbalance, both at the local level of the lower extremities and muscular-fascial chains. According to the theory of muscular chains, the dislocation of bones forming the knee joint leads to uneven loading of the femoral and tibial bones to the metaphizar deposits, which leads to a circulatory disorder and further leads to degenerative-dystrophic diseases. Understanding this component of pathogenesis can give a specialist in physical therapy and ergotherapy a more informed approach to the development of balanced treatment tactics aimed at eliminating the primary causes of pain syndrome. Conclusion. Pain in the knee joint can be caused not only by degenerative-dystrophic changes in the bones, but also can be associated with muscle imbalance of the posterior surface line. The development of a rehabilitation program for knee pain should include not only the use of local remedies, but also take into account the impact on the relevant reflex areas in the spine. Emerging degenerative-dystrophic processes in the bones that are part of the structure of the knee joint can be caused by their dislocation due to muscle imbalance. Uncontrolled and unauthorized use of analgesics by patients with knee pain can smooth the clinical picture and reduce the effectiveness of rehabilitation measures

Gamma Knife radiosurgery for trigeminal neuralgia: the impact of magnetic resonance imaging–detected vascular impingement of the affected nerve

2010 ◽  
Vol 113 (1) ◽  
pp. 53-58 ◽  
Author(s):  
Jason P. Sheehan ◽  
Dibyendu Kumar Ray ◽  
Stephen Monteith ◽  
Chun Po Yen ◽  
James Lesnick ◽  
...  
Keyword(s):  
Pain Relief ◽  
Mr Imaging ◽  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Trigeminal Nerve ◽  
Gamma Knife Radiosurgery ◽  
Vascular Compression ◽  
Pain Intensity Score ◽  
The Impact

Object Trigeminal neuralgia is believed to be related to vascular compression of the affected nerve. Radiosurgery has been shown to be reasonably effective for treatment of medically refractory trigeminal neuralgia. This study explores the rate of occurrence of MR imaging–demonstrated vascular impingement of the affected nerve and the extent to which vascular impingement affects pain relief in a population of trigeminal neuralgia patients undergoing Gamma Knife radiosurgery (GKRS). Methods The authors performed a retrospective analysis of 106 cases involving patients treated for typical trigeminal neuralgia using GKRS. Patients with or without single-vessel impingement on CISS MR imaging sequences and with no previous surgery were included in the study. Pain relief was assessed according to the Barrow Neurological Institute (BNI) pain intensity score at the last follow-up. Degree of impingement, nerve diameter preand post-impingement, isocenter placement, and dose to the point of maximum impingement were evaluated in relation to the improvement of BNI score. Results The overall median follow-up period was 31 months. Overall, a BNI pain score of 1 was achieved in 59.4% of patients at last follow-up. Vessel impingement was seen in 63 patients (59%). There was no significant difference in pain relief between those with and without vascular impingement following GKRS (p > 0.05). In those with vascular impingement on MR imaging, the median fraction of vessel impingement was 0.3 (range 0.04–0.59). The median dose to the site of maximum impingement was 42 Gy (range 2.9–79 Gy). Increased dose (p = 0.019) and closer proximity of the isocenter to the site of maximum vessel impingement (p = 0.012) correlated in a statistically significant fashion with improved BNI scores in those demonstrating vascular impingement on the GKRS planning MR imaging Conclusions Vascular impingement of the affected nerve was seen in the majority of patients with trigeminal neuralgia. Overall pain relief following GKRS was comparable in those with and without evidence of vascular compression on MR imaging. In subgroup analysis of those with MR imaging evidence of vessel impingement of the affected trigeminal nerve, pain relief correlated with a higher dose to the point of contact between the impinging vessel and the trigeminal nerve. Such a finding may point to vascular changes affording at least some degree of relief following GKRS for trigeminal neuralgia.

Worker compensation status increases the risk for presence of pain in the contralateral knee at final follow-up after arthroscopic knee surgery

2019 ◽  
Vol 4 (2) ◽  
pp. 82-85
Author(s):  
Carola Francisca van Eck ◽  
Drew Burleson ◽  
Daniel Fariborz Kharrazi
Keyword(s):  
Risk Factors ◽  
Knee Pain ◽  
Knee Surgery ◽  
Activity Level ◽  
Arthroscopic Knee Surgery ◽  
Worker Compensation ◽  
Contralateral Knee ◽  
Compensation Status ◽  
Arthroscopic Knee

ObjectivesIn patients undergoing arthroscopic knee surgery, it is not uncommon to complain of pain in both the ipsilateral and the contralateral knee. The primary aim of the present study was to evaluate the prevalence of contralateral knee pain in patients undergoing arthroscopic knee surgery. The secondary aim was to identify risk factors for contralateral knee pain in this population.MethodsAll patient who underwent arthroscopic knee surgery between 2015 and 2017 were included. The prevalence of pain in the contralateral knee prior to and at the final follow-up after ipsilateral knee surgery was assessed. The following potential risk factors for contralateral knee pain were evaluated: age, gender, worker comp status, duration of symptoms, pre-operative diagnosis, activity level, history of a fall, use of a walking aid and findings during surgery.ResultsA total of 142 patients met the inclusion criteria. The average age was 45±11 years, 104 patients (73%) were men. Prior to the surgery on the ipsilateral knee, only 1 patient (<1%) reported pain in the contralateral knee, which increased to 113 patients (80%) at final follow-up surgery. Of the assessed risk factors, only worker compensation status was significant for the development of contralateral knee pain (OR 2.93 95% CI 1.08 to 7.95, p=0.040).ConclusionPain in the contralateral knee is uncommon prior to arthroscopic knee surgery, but common after. The risk for the development of contralateral knee pain is increased if the index injury was workers compensation related.Level of evidenceLevel IV case series.

scholarly journals Impact of neurotherapy treatment on knee pain

2020 ◽  
Vol 1 (1) ◽  
pp. 11
Author(s):  
Ajay Gandhi ◽  
Lakhveer Singh ◽  
Mayank Pandey
Keyword(s):  
Pain Relief ◽  
Knee Pain ◽  
Whole Body ◽  
Pain Patient ◽  
Long Period ◽  
The Impact ◽  
Positive Effect

Neurotherapy is an alternative way of healing. It deals with whole body mind system. Our present study is based on the impact of Neurotherapy in pain relief in a patient who was suffering from knee Pain. Patient came to the Neurotherapy Centre Mohali for the treatment of knee pain. Patient informed us that she was already taking medications and physiotherapy for her pain, but it was incurable since a long period of time. She was self-directed to take the Neurotherapy treatment. After 82 sittings, she experienced a positive effect on pain and she felt better after taking Neurotherapy treatment.

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