Cooled Radio Frequency Ablation for the Treatment of Osteoarthritis-Related Knee Pain: Evidence, Indications, and Outcomes

AbstractKnee osteoarthritis (OA) is a common condition associated with pain and physical impairment in a large segment of the population. The traditional treatment algorithm progresses from conservative modalities to nonsurgical options to surgical intervention. Surgical intervention often provides reliable pain relief but not all patients are surgical candidates and there are some patients who prefer not to have surgery. Cooled radio frequency ablation (C-RFA) is a treatment with the potential to provide pain relief for patients who no longer benefit from noninvasive modalities and who desire an alternative to surgery. The objective of this review article is to provide the rationale, available evidence, indications, and outcomes associated with C-RFA for the treatment of chronic knee OA. A total of eight reports that use C-RFA in the treatment of chronic knee pain were identified and analyzed. There were two prospective trials, one retrospective cohort study, and five case reports or case series. C-RFA is an emerging procedure with encouraging early results; however, additional long-term prospective clinical trials are necessary to further characterize how C-RFA can best be used to treat chronic knee pain.

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Ultrasound-Guided Peripheral Nerve Stimulation for Knee Pain: A Mini-Review of the Neuroanatomy and the Evidence from Clinical Studies

Pain Medicine ◽

10.1093/pm/pnz318 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

pp. S56-S63

Author(s):

Chih-Peng Lin ◽

Ke-Vin Chang ◽

Wei-Ting Wu ◽

Levent Özçakar

Keyword(s):

Peripheral Nerve ◽

Knee Pain ◽

Nerve Stimulation ◽

Case Reports ◽

Case Series ◽

Peripheral Nerve Stimulation ◽

Present Review ◽

Chronic Knee Pain ◽

Catheter Dislodgement ◽

Continuous Nerve Block

Abstract Objectives Peri- and postoperative pain frequently develops after joint replacement for severe knee osteoarthritis. A continuous nerve block is commonly used for pain relief, but the risks of infection and catheter dislodgement should be considered. The present mini-review aimed to brief the innervation and neural sonoanatomy of the knee joint and summarize the newest evidence of peripheral nerve stimulation (PNS) use in the management of knee pain. Methods We used a systematic approach to search for relevant articles. We used the combination of “peripheral nerve stimulation” and “knee pain” as the key words for the literature search using the electronic database without language or article type restriction. The search period was from the earliest record to August 2019. Results The present review identified six studies, four of which were related to PNS for management of postoperative knee pain and two of which probed neuropathic pain. Most of the studies were either case series or case reports. Based on our search result, PNS is likely to be a feasible and safe treatment for knee pain, but its effectiveness remains uncertain. Conclusions The present review reveals that PNS is feasible for the management of knee pain, especially in the postoperative period. The procedure is safe under ultrasound guidance used for proper placement of the electrodes near the target nerves. In the future, more prospective randomized controlled trials are needed to validate the effectiveness of PNS in acute and chronic knee pain.

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Radiofrequency Ablation of the SupraOrbital Nerve in the Treatment Algorithm of Hemicrania Continua

January 2018 - Pain Physician ◽

10.36076/ppj.2012/15/e719 ◽

2012 ◽

Vol 5;15 (5;9) ◽

pp. E719-E724

Author(s):

Leena Mathew

Keyword(s):

Radiofrequency Ablation ◽

Radio Frequency ◽

Medical Management ◽

Treatment Algorithm ◽

Case Series ◽

Primary Headache ◽

Hemicrania Continua ◽

Radio Frequency Ablation ◽

Invasive Technique ◽

Supraorbital Nerve

Hemicrania continua (HC) is an uncommon primary headache disorder in which the diagnosis centers on unilaterality and its absolute responsiveness to indomethacin. We describe 3 patients with a long standing history of headache diagnosed as hemicrania continua. There was profound response to indomethacin which was limited by side effects. In one patient the therapy with indomethacin was limited secondary to comorbidities. Initial diagnostic blockade provided significant relief of symptoms based on which radio-frequency ablation of the supraorbital nerve was performed with substantial improvement in symptoms. Traditionally, hemicrania continua has been managed exclusively with oral analgesics and is defined by its singular response to indomethacin. Radio-frequency ablation (RFA) has been reported in the literature for multiple indications. This case series is unique in that it describes 3 patients diagnosed with hemicrania continua with pain referred in the supraorbital nerve distribution, who underwent radiofrequency ablation of the supraorbital nerve with resultant resolution of headaches. Traditionally, hemicrania continua has been managed exclusively with oral analgesics and is defined by its singular response to indomethacin. This report is unique in that it describes three patients diagnosed with hemicrania continua with pain referred in the supraorbital nerve distribution who underwent radiofrequency ablation of the supraorbital nerve with resultant resolution of headaches. After the RFA medical management was minimal to none in both patients. Though the utility and cost efficacy of RFA of peripheral nerves needs to be confirmed in well-designed trials we present these cases as an example of how this minimally invasive technique can safely provide analgesia in a difficult to treat cephalgia. Moreover if precise anatomical localization of the headache is possible then diagnostic blockade of the appropriate peripheral nerve may be performed followed by radiofrequency ablation to provide potentially more sustained analgesia in patients where medical management is ineffective or poorly tolerated. Key words: Headache, hemicrania continua, radio-frequency ablation

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SHORT TO MEDIUM RESULTS USING THE REMOTION TOTAL WRIST REPLACEMENT FOR RHEUMATOID ARTHRITIS

Hand Surgery ◽

10.1142/s0218810413500202 ◽

2013 ◽

Vol 18 (02) ◽

pp. 175-178 ◽

Cited By ~ 7

Author(s):

A. S. C. Bidwai ◽

F. Cashin ◽

A. Richards ◽

D. J. Brown

Keyword(s):

Rheumatoid Arthritis ◽

Pain Relief ◽

Surgical Intervention ◽

Case Series ◽

High Rate ◽

Wound Breakdown ◽

Radial Forearm ◽

Skin Coverage

We present the clinical outcome of patients who underwent RE-MOTION Total Wrist Replacement (TWR) for the treatment of Rheumatoid arthritis involving the wrist. Ten patients were available for follow-up, ranging from one to five years after index surgery. Two patients required surgical intervention for wound breakdown, including one patient who required a radial forearm flap for skin coverage. No patients required revision surgery or conversion to fusion. Patients who did not have complications gained statistically significant pain relief and improvement in mean overall flexion. In this small case series with short to medium results patients reported an improvement in terms of flexion and pain. Despite this, the question of efficacy of TWR compared to fusion in the long term remains unanswered due to the high rate of complications.

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Evidence-based management of epistaxis in hereditary haemorrhagic telangiectasia

The Journal of Laryngology & Otology ◽

10.1017/s0022215115000365 ◽

2015 ◽

Vol 129 (5) ◽

pp. 410-415 ◽

Cited By ~ 8

Author(s):

I Syed ◽

V S Sunkaraneni

Keyword(s):

Assessment Tool ◽

Case Reports ◽

Treatment Algorithm ◽

Case Series ◽

Team Approach ◽

Hereditary Haemorrhagic Telangiectasia ◽

Questionnaire Studies ◽

Randomised Controlled ◽

Specific Management

AbstractBackground:There are currently no guidelines in the UK for the specific management of hereditary haemorrhagic telangiectasia related epistaxis. The authors aimed to review the literature and provide an algorithm for the management of hereditary haemorrhagic telangiectasia related epistaxis.Method:The Medline and Embase databases were interrogated on 15 November 2013 using the search items ‘hereditary haemorrhagic telangiectasia’ (title), ‘epistaxis’ (title) and ‘treatment’ (title and abstract), and limiting the search to articles published in English.Results:A total of 46 publications were identified, comprising 1 systematic review, 2 randomised, controlled trials, 27 case series, 9 case reports, 4 questionnaire studies and 3in vitrostudies.Conclusion:There is a lack of high-level evidence for the use of many of the available treatments for the specific management of epistaxis in hereditary haemorrhagic telangiectasia. Current management should be based on a multidisciplinary team approach involving both a hereditary haemorrhagic telangiectasia physician and an ENT surgeon, especially when systemic therapy is being considered. The suggested treatment algorithm considers that the severity of epistaxis merits intervention at different levels of the treatment ladder. The patient should be assessed using a reproducible validated assessment tool, for example an epistaxis severity score, to guide treatment. More research is required, particularly in the investigation of topical agents targeting the development and fragility of telangiectasiae in hereditary haemorrhagic telangiectasia.

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Immunoglobulin G4-related hypertrophic pachymeningitis

Neurology Neuroimmunology & Neuroinflammation ◽

10.1212/nxi.0000000000000568 ◽

2019 ◽

Vol 6 (4) ◽

pp. e568 ◽

Cited By ~ 6

Author(s):

Michaël Levraut ◽

Mikaël Cohen ◽

Saskia Bresch ◽

Caroline Giordana ◽

Fanny Burel-Vandenbos ◽

...

Keyword(s):

Steroid Therapy ◽

Case Reports ◽

Treatment Algorithm ◽

Elevated Serum ◽

Case Series ◽

Hypertrophic Pachymeningitis ◽

Immunoglobulin G4 ◽

Systemic Involvement ◽

Meningeal Involvement ◽

Serum Igg4

ObjectiveMeningeal involvement in Immunoglobulin G (IgG)-4-related disease is rare and only described in case reports and series. Because a review into the disease is lacking, we present 2 cases followed by a literature review of IgG4-related hypertrophic pachymeningitis (IgG4-HP).MethodsTwo IgG4-HP cases were reported, one involving the spinal cord and responding to surgical management and a second involving the brain and responding to Rituximab therapy. We then review clinical cases and case-series of histologically proven IgG4-HP that were published in the PubMed-NCBI database.ResultsForty-two case reports and 5 case-series were studied (60 patients, 20 women). The median age was 53. Eighteen patients had systemic involvement and 24 had single-organ IgG4-HP. Fifty-five percent of patients had an elevated serum IgG4. Treatment was surgical in 20/53 cases. Steroid therapy and immunosuppressors were effective in 85% and more than 90% of the cases, respectively. The rate of disease relapse was 42.1% after steroid therapy was discontinued.Discussion/conclusionIgG4-HP is characterized by the lack of extra-neurologic organ-involvement and systemic signs. Histopathologic studies should be performed as it is crucial for diagnosis because serum markers are rarely informative. 18F-FDG positon tomography can be useful to characterize systemic forms. There is no specific CSF marker for IgG4-HP and the diagnostic value of CSF IgG4 levels needs to be studied with larger samples. We provide a treatment algorithm for IgG4-HP. Such treatment strategies rely on early surgery, steroids, and early immunosuppressive therapy to prevent neurologic complications.

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Genicular Nerve Radiofrequency Ablation for Chronic Knee Pain Using a Three-Tined Electrode: A Technical Description and Case Series

Pain Medicine ◽

10.1093/pm/pnaa204 ◽

2020 ◽

Vol 21 (12) ◽

pp. 3344-3349

Author(s):

Edvin Koshi ◽

Cole W Cheney ◽

Beau P Sperry ◽

Aaron Conger ◽

Zachary L McCormick

Keyword(s):

Radiofrequency Ablation ◽

Knee Osteoarthritis ◽

Knee Pain ◽

Rating Scale ◽

Case Series ◽

Numeric Rating Scale ◽

Vastus Medialis ◽

The Novel ◽

Chronic Knee Pain ◽

Numeric Rating

Abstract Background Genicular nerve radiofrequency ablation (RFA) for the treatment of chronic knee pain has traditionally targeted the superomedial, superolateral, and inferomedial genicular nerves. However, recent cadaveric studies of knee neuroanatomy demonstrate varied locations of these specific nerves as well as additional articular nerves. This work suggests that traditional genicular nerve RFA lesion locations may be inadequate. Objective 1) To describe a novel protocol utilizing a three-tined RFA electrode to target the superomedial (SMGN), superolateral (SLGN), and inferomedial genicular nerves (IMGN), as well as the terminal articular branches of the nerves to the vastus medialis (NVM), intermedius (NVI), and lateralis (NVL). 2) To assess the ability of this technique to reduce chronic knee pain. Methods Case series of consecutive patients with six or more months of refractory knee pain who underwent genicular nerve RFA according to the novel protocol described. Seven discrete RFA lesions were placed to target the SMGN, NVM, NVI, NVL, SLGN, and IGMN. Results Eleven patients underwent RFA, nine with knee osteoarthritis and two postarthroplasty. At one month, 91% (95% CI = 59–100%), 82% (95% CI = 48–98%), and 9% (95% CI = 2–41%), of patients reported ≥50%, ≥80%, and 100% improvement in knee pain on the numeric rating scale, respectively. These results were sustained at six months. There were no complications. Discussion/Conclusions These preliminary data suggest the feasibility and possible effectiveness of genicular nerve RFA using the described novel protocol including a three-tined electrode. Larger-scale studies with comparative groups are warranted.

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Facial schwannoma: results of a large case series and review

The Journal of Laryngology & Otology ◽

10.1017/s0022215107000667 ◽

2008 ◽

Vol 122 (11) ◽

pp. 1139-1150 ◽

Cited By ~ 65

Author(s):

B McMonagle ◽

A Al-Sanosi ◽

G Croxson ◽

P Fagan

Keyword(s):

Facial Nerve ◽

Current Literature ◽

Clinical Observation ◽

Surgical Intervention ◽

Treatment Algorithm ◽

Case Series ◽

Tertiary Referral ◽

Management Algorithm ◽

Facial Function ◽

Facial Rehabilitation

AbstractObjectives and hypothesis:To report a series of 53 cases of facial schwannoma, to review the current literature, addressing contentious issues, and to present a management algorithm.Study design:Retrospective case review combined with review of current literature.Materials and methods:A review of the case notes of 53 patients with intracranial and intratemporal facial schwannoma, from two tertiary referral centres, was undertaken. This represents the largest series of facial schwannomas with clinical correlations in the literature. Data relating to epidemiological, clinical and management details were tabulated and compared with other large series. A review of the current literature was performed, and a management algorithm presented.Results:There were 23 (43 per cent) female and 30 (57 per cent) male patients. Patients' ages at presentation ranged from five to 84 years, with a mean of 49 years. Twenty-five (47 per cent) of the tumours were present on the left side and 28 (53 per cent) on the right side. Hearing loss was the most common presenting symptom, being present in 31/53 (58 per cent) patients, followed by facial weakness in 27/53 (51 per cent). Two patients (4 per cent) were completely asymptomatic, and their facial neuromas were diagnosed incidentally. The schwannoma extended along more than one segment of the facial nerve in 39 patients (74 per cent), with the mean number of segments involved being 2.5. A conservative approach of clinical observation was undertaken in 20 patients (38 per cent). Thirty-three patients (62 per cent) underwent surgery, with a total of 36 procedures. The translabyrinthine approach was most common, being utilised in 17 of the 36 procedures. Two patients underwent revision surgery for residual or recurrent disease on three occasions. There was total removal of tumour in 21 cases; the remainder had subtotal or no removal with drainage or decompression of the tumours. Twenty-one nerve reconstructions were performed, and 18 facial rehabilitation procedures were performed on 14 patients.Discussion:The results of this case series are similar to those of other reported series. The diagnosis of facial schwannoma is now generally made pre-operatively, due to improved imaging techniques and heightened awareness. Clinical assessment of facial function and imaging form the mainstays of surveillance for these tumours. These tumours are managed via clinical observation or surgical intervention; the latter can range from simple procedures (such as drainage of cystic components) to aggressive tumour removal and facial nerve reconstruction. Facial rehabilitation procedures may also be applied. The timing of intervention is contentious; surgical intervention is indicated when facial function deteriorates to a House–Brackmann grade IV level.Conclusion:Facial schwannomas are rare lesions, and reported series are generally small. Due to the complex management issues involved, these tumours are best managed in a tertiary referral setting. Observation is preferred until facial function deteriorates to a House–Brackmann grade III level, at which time surgery is considered. When facial function deteriorates to House–Brackmann grade IV, surgical intervention is indicated. We advocate surgical management based on the treatment algorithm described.

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