Changes in Maximal Isometric Quadriceps Strength after the Application of Ultrasound-Guided Percutaneous Neuromodulation of the Femoral Nerve: A Case Series

Abstract Introduction For those individuals who have suffered an injury to the knee or undergone a surgical intervention, the early recovery of the muscle strength contraction properties of the quadriceps is essential for a favorable recovery and for a return to the activities of daily living and other work- or sports-related activities. Objectives To evaluate the changes in maximal isometric strength (MIS) of the quadriceps muscle after the application of ultrasound-guided percutaneous neuromodulation (US-guided PNM) on the femoral nerve. Materials and Methods A case series involving subjects who had previously presented unilateral knee pathology and were in the stage of recovery of quadriceps strength. The subjects were pain-free at the time of the dynamometry measurements, which were performed before and after the application of the US-guided PNM technique. The isometric measurement was performed using the KINEO dynamometry system, performing a preintervention measurement of the mean maximal isometric strength (mMIS) based on 3 repetitions (3 seconds contraction and 6 seconds relaxation). The US-guided PNM technique was performed on the femoral nerve, using the Physio Invasiva CE0120 device (Prim Physio, Madrid, Spain) and a GE Logiq e R7 ultrasound (GE Healthcare, Chicago, IL, USA). Results In total, 13 subjects participated in the present study. Significant changes were obtained (p < 0.001) in the mMIS of the quadriceps of the affected knee, which progressed from a mean strength of 25.91 kg (standard deviation [SD]: 7.17 kg) to a mean strength of 29.98 kg (SD: 9.06 kg). Discussion In subjects with knee pathology, the quadriceps muscle is inhibited despite being pain-free during the strength measurements. This process of inhibition can improve with the application of low frequency percutaneous electrical stimulation on the femoral nerve. This technique represents a complementary strategy for the recovery of the normal strength values in pathological knees with or without prior surgery. Conclusions Ultrasound-guided PNM is an effective technique for the reestablishment of quadriceps strength in inhibited muscles.

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Effects of ultrasound-guided percutaneus neuromodulation in chronic shoulder pain in the hemiplegic patient. A case series

Revista Fisioterapia Invasiva ◽

10.1055/s-0039-3401886 ◽

2019 ◽

Vol 02 (02) ◽

pp. 065-065

Author(s):

Ventero Gómez A. ◽

Martín-Macho Martínez M. ◽

Carrió Font M. ◽

Martín Buigues A.

Keyword(s):

Quality Of Life ◽

Shoulder Pain ◽

Case Series ◽

Low Frequency ◽

Ultrasound Guided ◽

Post Intervention ◽

Therapy Technique ◽

The Us ◽

The Mean

Abstract Background and Aims Hemiplegic shoulder pain (HSP) is a very common complaint among patients affected with cerebrovascular accident (CVA). This type of pathology is related with a neuropathic type of pain. Ultrasound-guided percutaneous neuromodulation (US-guided PNM) is a physical therapy technique consisting of low-frequency electric stimulation of peripheral nerves via an acupuncture needle under ultrasound guidance. Because of the relationship between the suprascapular and axillary nerves with the shoulder joint, these represent the target structure for US-guided PNM. This study aimed to observe the effects of the application of US-guided PNM in HSP and to evaluate the possible changes in variables such as pain, functionality and quality of life of patients. Material and Methods This study was a case series. Patients with HSP were selected between the months of April and June 2018 in the Hospital of Denia. Seven patients were interviewed, after which the experimental group was reduced to five participants. These patients received weekly PNM treatment during three weeks. The parameters used were: frequency (10Hz), pulse width (250 μs), intensity (pain threshold) and time (10 min). The main clinical variables examined were pain, measured using the VAS scale, functionality, via the SPADI scale and physical and mental components of quality of life using the SF12 scale. Results The results of the VAS scale, expressed as the mean (SD) was 7.2 (1.3) pre-intervention; 3.6 (0.89) post-intervention week 3; and 4 (1.23) post intervention week 5. The results revealed significant changes in the VAS scale which continued until week 5 (p < 0.05). The mean obtained in the SPADI scale, expressed as the mean (SD) was 72.4 (1.3) pre-intervention, 55.7 (19.72) post-intervention in week 3 and 59.8 (20.66) post intervention week 5. The changes observed between the pre-intervention sample and the measurements obtained in week 3 and 5 were significant (p < 0.05). Conclusions The US-guided PNM technique was effective in the sample under study for improvement of the patient's sensation of pain. The US-guided PNM technique improves functionality of HSP, as well as the emotional status of patients.

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Changes in isometric quadriceps strength after the application of ultrasound-guided percutaneous neuromodulation. A case study

Revista Fisioterapia Invasiva ◽

10.1055/s-0039-3401859 ◽

2019 ◽

Vol 02 (02) ◽

pp. 076-077

Author(s):

Carvajal-Fernández O. ◽

Álvarez Prats D. ◽

Pérez Mallada N.

Keyword(s):

Standard Deviation ◽

Femoral Nerve ◽

Quadriceps Strength ◽

Isometric Strength ◽

Assessment Tools ◽

Lower Limbs ◽

Ultrasound Guided ◽

Post Intervention ◽

Retrospective Case

Abstract Background Ultrasound-guided percutaneous neuromodulation (US-guided PNM) is an invasive physiotherapy technique which is employed for neurofunctional improvement and treatment of pain. To date, no study has related this technique with muscle stimulation and dynamometry changes. Within the functional assessment tools, dynamometry tests were performed with devices which enable the calculation of variables related with isometric and isokinetic movement. Aim To assess the changes in maximum isometric strength after the application of US-guided PNM. Material and Methods A retrospective case study comprising 13 subjects (26 lower limbs) receiving US-guided PNM, with pre and post-intervention measurements.The inclusion criteria comprised subjects without pain at the time of study, with coefficients of variation (COV) below 15% and in the process of improving loading work. We excluded subjects with pathology provoking pain at the time of the measurements and with contraindications for dynamometry or US-guided PNM. An isometricmeasurement was performed using the KINEO dynamometry system with 90° hip flexion and 45° knee extension, without strapping and with manual grips in lateral supports of the system. The lever arm was placed at 2 cm of the malleoli in the ventral aspect without strapping the ankle and a pre-intervention measurement was performed of the maximum isometric strength based on a mean of 3 repetitions (3 seconds' contraction and 6 seconds' relaxation). Subsequently, the US-guided PNM technique was performed on the femoral nerve, using the Physio Invasiva device and the PES modality (10 Hz frequency, 240 μs pulse width). Ten maximal and pain free stimulations were performed lasting 10 seconds each, with a 10 second rest between each contraction. After the intervention, a post intervention measurement was performed, in the same manner as the previous measurement. Results In total, 13 volunteer subjects participated in the study, aged between 27 and 59 years, of which, 2 were women and 11 were men. After the application of US-guided PNM on the femoral nerve, changes were observed in the maximum mean isometric strength of the quadriceps, which increased from 26.75 kg in the pre-intervention mean with a standard deviation of 7.42 kg to 30.05 kg for the post-intervention mean, with a standard deviation of 9.23 kg. The results were statistically significant with p < 0.000. Conclusion US-guided PNM applied to the femoral nerve is able to produce changes in maximum isometric strength measured using dynamometry.

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Experiences with an intra-articular pain catheter in approx. 3.000 TKR over a period of 6.5 years

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00015 ◽

2018 ◽

Vol 6 (4_suppl2) ◽

pp. 2325967118S0001

Author(s):

Burkhard Mai

Keyword(s):

Muscle Power ◽

Pain Treatment ◽

Femoral Nerve ◽

Case Series ◽

Pain Reduction ◽

Quadriceps Muscle ◽

Turnover Time ◽

Soft Tissue Coverage ◽

Autonomous Mobility ◽

Pain Catheter

The optimal pain treatment after a TKR has been under discussion for a long time. With the use of pain catheters you can save analgesics and opiates. A femoral and sciatic nerve catheter became already established. Disadvantages are a the time-consuming application of the catheter with neuro-tracer or ultrasound as well as facing possible palsy, especially of the extension muscle of the knee, which disturbs the autonomous mobility of the patients. Would it be possible to treat the postoperative pain sufficiently and preserve the active mobility of the patients by using an intraarticular pain catheter, that will not influence the muscle power, which can also be used time-sparing during TKR surgeries in combination with an external, continuous local anesthesia from a portable valve-controlled reservoir? We report on case series of our clinic from July 2010 till October 2017, which included more than 3.000 TKRs. We made use of 4 different catheter and pump systems (for example the Painbuster). The LA used was Ropivacaine. With a postoperative rate of fluid flow of 10-15 ml/h in a concentration of 3,75 mg/ml (0,375%) Ropivacaine Hydrochloride over a period of 2-3 days, we achieved a good pain reduction comparable to a femoral catheter and perfusor application of 2,0 mg/ml (0,2%) Ropivacaine. Most patients feel strong pain following a TKR due to the special vulnerability of the knee joints with large inner surface of the joint and thin soft-tissue coverage. The established pain catheters positioned beside the femoral nerve need a relative long turnover time (the time from the end of the previous surgical procedure to the beginning of the next) and have an important disadvantage of palsy of the quadriceps muscle with the risk of falling due to the immobilization of the patient. The intra-articular painbuster systems lead to excellent pain reduction and fast mobilization of the patient with full control of muscle power. The application of the catheter during the operation is not time consuming and you will not face longer turnover and surgery times.

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145: Ultrasound guided femoral nerve sheath catheters in primary knee arthroplasty: a case series

Regional Anesthesia and Pain Medicine ◽

10.1016/j.rapm.2007.06.292 ◽

2007 ◽

Vol 32 (5) ◽

pp. 141-141

Author(s):

C ROLLASON ◽

G FOXALL ◽

N BEDFORTH ◽

J HARDMAN ◽

M BROWN

Keyword(s):

Knee Arthroplasty ◽

Femoral Nerve ◽

Case Series ◽

Ultrasound Guided ◽

Nerve Sheath ◽

Primary Knee Arthroplasty

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Ultrasound guided femoral nerve sheath catheters in primary knee arthroplasty: a case series

Regional Anesthesia and Pain Medicine ◽

10.1097/00115550-200709001-00272 ◽

2007 ◽

Vol 32 (Suppl. 1) ◽

pp. 141

Author(s):

C. A.J. Rollason ◽

G. L. Foxall ◽

N. M. Bedforth ◽

J. G. Hardman ◽

M. M. Brown

Keyword(s):

Knee Arthroplasty ◽

Femoral Nerve ◽

Case Series ◽

Ultrasound Guided ◽

Nerve Sheath ◽

Primary Knee Arthroplasty

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Analgesic evaluation of ultrasound-guided Pericapsular Nerve Group (PENG) block for emergency hip surgery in fragile patients: a case series

Arthroplasty ◽

10.1186/s42836-019-0018-0 ◽

2019 ◽

Vol 1 (1) ◽

Author(s):

Tommaso Pagano ◽

Fulvio Scarpato ◽

Gianmaria Chicone ◽

Domenico Carbone ◽

Carlo Blandina Bussemi ◽

...

Keyword(s):

Pain Control ◽

Ultrasound Guidance ◽

Femoral Nerve Block ◽

Femoral Nerve ◽

Case Series ◽

Hip Surgery ◽

Ultrasound Guided ◽

Analgesic Technique ◽

Fascia Iliaca Block ◽

Complications And Mortality

Abstract Background Emergency hip surgery is common especially in elderly patients. Very often we are faced with elderly and fragile patients with several comorbidities. In these cases a careful pain control is crucial to reduce length of stay, costs, postoperative complications and mortality. Currently the Fascia Iliaca Block (FIB) and the Femoral Nerve Block (FNB) are the main techniques used for this purpose. Cases presentation Recently, a new method has been described under ultrasound-guidance, the Pericapsular Nerve Group (PENG) block. In this case series we try to point out the importance of this novel, safe and effective ultrasound-guided locoregional analgesic technique as an alternative to FIB or FNB based on our clinical experience. Conclusion In this case series the PENG block has been proved to be safe and effective, but more and larger-sized studies are needed to better assess the method in future before it becomes an established analgesic technique for hip surgery.

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The Effects of Ultrasound-Guided Adductor Canal Block Versus Femoral Nerve Block on Quadriceps Strength and Fall Risk

Regional Anesthesia and Pain Medicine ◽

10.1097/aap.0b013e318295df80 ◽

2013 ◽

Vol 38 (4) ◽

pp. 321-325 ◽

Cited By ~ 134

Author(s):

M. Kwesi Kwofie ◽

Uma D. Shastri ◽

Jeff C. Gadsden ◽

Sanjay K. Sinha ◽

Jonathan H. Abrams ◽

...

Keyword(s):

Nerve Block ◽

Fall Risk ◽

Femoral Nerve Block ◽

Femoral Nerve ◽

Quadriceps Strength ◽

Ultrasound Guided ◽

Adductor Canal Block ◽

Adductor Canal

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Improvement of analgesic efficacy for total hip arthroplasty by a modified ultrasound‐guided supra‐inguinal fascia iliaca compartment block

BMC Anesthesiology ◽

10.1186/s12871-021-01296-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ting Zheng ◽

Bin Hu ◽

Chun-ying Zheng ◽

Feng-yi Huang ◽

Fei Gao ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Femoral Nerve ◽

Case Series ◽

Analgesic Efficacy ◽

Ultrasound Guided ◽

Sensory Blockade ◽

Total Hip ◽

Case Series Study ◽

Fascia Iliaca Compartment Block

Abstract Background Fascia iliaca compartment block (FICB) is an anterior approach to the lumbar plexus block and provides the effective adjunctive analgesia for total hip arthroplasty (THA). Methods As a case series study, 28 patients (≥ 65 years old) with THA were received a modified in-plane ultrasound-guided supra-inguinal (S-FICB) as an analgesic adjunct to evaluate the analgesic effectiveness and the local anesthetic diffusion with magnetic resonance imaging (MRI). A combination of propofol and sufentanil was administered to conduct target-controlled infusion. Results The pain scores were 1 (0–4), 2 (1–5), 3 (1–6) and 3 (1–6) at 4, 8, 12, and 24 h. The cumulative opioids were 8 (8–12), 18 (16–32), 28 (24–54) and 66 (48–104) mg of i.v. morphine equivalents at 4, 8, 12, and 24 h. The patient-controlled analgesia (PCA) times were 0 (0–1), 1 (0–2), 2 (0–5) and 5 (3–8) at 4, 8, 12, and 24 h. In lateral, anterior and medial part of thigh, the sensory blockade in 28 patients was 23 (82 %), 21 (75 %) and 19 (68 %) at 5 min; 28 (100 %) at 10 and 20 min. Motor blockade of femoral nerve (FN) and obturator nerve (ON) was present in 13 (46 %) and 3 (11 %) patients at 5 min, 24 (86 %) and 9 (32 %) at 10 min, 26 (93 %) and 11 (39 %) at 20 min. Injectate permeated to the FN and extended superiorly over the surface of iliac muscle (IM) and pectineus muscle (PM) in all patients. Conclusions The modified S-FICB has provided an effective postoperative analgesic adjunct after THA with the satisfactory blockade of femoral (FN), obturator (ON) and sciatic (SN) nerves, especially for ON, when compared with the existing techniques.

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