Cryoneurolysis for Digital Neuralgia in Professional Baseball Players: A Case Series

Neurology ◽  
2021 ◽  
Vol 98 (1 Supplement 1) ◽  
pp. S7.3-S8
Author(s):  
Johnathon Patrick Shaffer ◽  
Vernon B. Williams ◽  
Steven Shin
Keyword(s):  
Local Anesthetic ◽  
Ultrasound Guidance ◽  
Sensory Nerve ◽  
Case Series ◽  
Nerve Tissue ◽  
Professional Baseball ◽  
Digital Nerve ◽  
Baseball Players ◽  
Small Probe ◽  
Skin Marker

ObjectiveWe describe a non-surgical approach to refractory digital neuralgia using cryoneurolysis in a series of 3 professional baseball players.BackgroundThumb injuries are common in baseball players and can sometimes be challenging to effectively manage. Depending on the injury, current treatments include anti-inflammatories, immobilization, physical therapy, corticosteroid injections, and/or surgery. A subset of patients, however, fail nonoperative management yet do not have a clear indication for surgery. Cryoneurolysis or cyroanalgesia is an FDA-approved form of neuromodulation, which has been used safely and effectively on a variety of peripheral nerves. The mechanism of action involves percutaneous introduction of a small probe under local anesthetic to nerve tissue using ultrasound guidance. The probe is then cooled to −88°C using nitrous oxide, which results in secondary Wallerian degeneration. Axonal and myelin regeneration occurs completely in 3–6 months.Design/MethodsVisualization of the superficial radial sensory and ulnar digital nerve were obtained under ultrasound. The skin was prepared in sterile fashion. A 22-gauge 1-½ inch needle was then advanced with ultrasound guidance, and local anesthetic was applied. Both treatment sites were marked with skin marker. Cryoneurolysis was employed using a 5 mm tip. 60-second treatment cycles were performed at each site. Each of the cycles resulted in a 5 × 7 mm lesion visible as hypoechoic signal.ResultsAll 3 players endorsed significant and prolonged relief and were able to return to an elite level of play.ConclusionsThis manuscript is subject to all of the limitations of a case series, and larger rigorous studies are needed to illuminate causal inferences. Novel, complex technologies may also be more susceptible to placebo effect. Nonetheless, we are able to report marked efficacy and safety from cryoneurolysis of the ulnar digital nerve and the superficial radial sensory nerve in a small group of elite baseball players with refractory digital neuralgia.

Upper Extremity and Hip Range of Motion Changes Throughout a Season in Professional Baseball Players

2019 ◽  
Vol 48 (2) ◽  
pp. 481-487
Author(s):  
Justin M. Chan ◽  
John Zajac ◽  
Brandon J. Erickson ◽  
David W. Altchek ◽  
Christopher Camp ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Range Of Motion ◽  
External Rotation ◽  
Significant Risk ◽  
Case Series ◽  
Significant Risk Factor ◽  
Professional Baseball ◽  
Level Of Evidence ◽  
Baseball Players ◽  
Shoulder Flexion

Background: Loss of upper and lower extremity range of motion (ROM) is a significant risk factor for injuries in professional baseball players. Purpose/Hypothesis: The purpose was to determine changes in ROM in professional baseball players over the course of a single season and their careers. We hypothesized that pitchers and position players would lose ROM, specifically total shoulder motion (total ROM [TROM]) and hip internal rotation (IR), over the course of a season and their careers. Study Design: Case series; Level of evidence, 4. Methods: Upper and lower extremity ROM measurements were recorded during pre-, mid-, and postseason on all professional baseball players for a single organization between 2011 and 2018. ROM measurements were compared for pitchers and position players over the course of the season and their careers. Also, ROM measurements over the pre-, mid-, and postseason were compared between pitchers and position players. Results: A total of 166 professional baseball players (98 pitchers, 68 position players) were included. Pitcher hip external rotation (ER; P < .001), IR ( P = .010), and TROM ( P < .001) for lead and trail legs decreased over the course of the season. Pitcher shoulder ER ( P = .005), TROM ( P = .042), and horizontal adduction ( P < .001) significantly increased over the course of the season. Position player shoulder flexion ( P = .046), hip ER ( P < .001, lead leg; P < .001, trail leg), and hip TROM ( P = .001; P = .002) decreased over the course of the season. Position player shoulder ER ( P = .031) and humeral adduction ( P < .001) significantly increased over the course of the season. Over the course of pitchers’ careers, there was decreased shoulder IR ( P = .014), increased shoulder horizontal adduction ( P < .001), and hip IR ( P = .042) and hip TROM ( P = .027) for the lead leg. Position players experienced loss of hip TROM ( P = .010, lead leg; P = .018, trail leg) over the course of their careers. Pitchers started with and maintained more shoulder ER and gained more shoulder TROM over a season as compared with position players. Conclusion: Pitchers and position players saw overall decreases in hip ROM but increases in shoulder ROM over the course of the season and career.

scholarly journals Muscle Strains in the Lower Extremity of Japanese Professional Baseball Players

2020 ◽  
Vol 8 (10) ◽  
pp. 232596712095656
Author(s):  
Takeshi Kokubu ◽  
Yutaka Mifune ◽  
Noriyuki Kanzaki ◽  
Yuichi Hoshino ◽  
Kenichiro Kakutani ◽  
...  
Keyword(s):  
Lower Extremity ◽  
High Intensity ◽  
Case Series ◽  
Return To Play ◽  
Professional Baseball ◽  
Mri Findings ◽  
Level Of Evidence ◽  
Baseball Players ◽  
Musculotendinous Junction ◽  
Lower Extremity Muscle

Background: Predicting when athletes can return to play after muscle strains is not always simple because of difficulties in evaluating the severity of such injuries. Purpose/Hypothesis: The purpose of this study was to evaluate the use of magnetic resonance imaging (MRI) to classify lower extremity muscle strains in Japanese professional baseball players. The hypothesis was that MRI grading can be used to diagnose the severity of muscle strains in the lower extremity and predict return to play in athletes. Study Design: Case series; Level of evidence, 4. Methods: A total of 55 muscle strains occurred in the lower extremity of players on a professional baseball team between the 2006 and 2015 seasons; all players had undergone MRI examination. Age, player position, location of injury, cause of injury, and duration until return to play (in days) were extracted from the medical records. MRI scans were classified using the following system: grade 0, no abnormal findings; grade 1a, T2-weighted high intensity only between muscles; grade 1b, T2-weighted high intensity between muscles and in muscle belly; grade 2, injury of musculotendinous junction; and grade 3, rupture of tendon insertion. Results: The sites of injuries were distributed as follows: hamstrings (n = 33), quadriceps (n = 6), hip adductors (n = 6), and calves (n = 10). MRI findings revealed 9 muscle strains (16%), 19 grade 1a (34%), 19 grade 1b (34%), and 8 grade 2 muscle strains (16%). The length of time until return to training and competition, respectively, was 15 and 26 days for grade 1a injuries, 19 and 36 days for grade 1b injuries, and 55 and 69 days for grade 2 injuries. Conclusion: Players with grade 1 injuries took 4 to 5 weeks to return to play, whereas players with grade 2 injuries took 10 weeks to return. MRI can be useful for diagnosing lower extremity muscle strains and predicting the time to return to play.

Career Length and Performance Among Professional Baseball Players Returning to Play After Hip Arthroscopy

2018 ◽  
Vol 46 (11) ◽  
pp. 2588-2593 ◽  
Author(s):  
Salvatore J. Frangiamore ◽  
Sandeep Mannava ◽  
Karen K. Briggs ◽  
Shannen McNamara ◽  
Marc J. Philippon
Keyword(s):  
Performance Measures ◽  
Hip Arthroscopy ◽  
Case Series ◽  
Return To Play ◽  
Professional Baseball ◽  
Study Cohort ◽  
Baseball Players ◽  
Career Length ◽  
The Mean ◽  
And Performance

Background: Hip arthroscopy has been shown to be effective for management of symptomatic femoroacetabular impingement (FAI) in professional athletes; however, it is unclear how hip arthroscopy affects career length and performance when professional baseball players return to play. Purpose: To determine the career length, performance, and return-to-play rates of professional baseball players after undergoing arthroscopy for symptomatic FAI. Study Design: Case series; Level of evidence, 4. Methods: Forty-four professional baseball players (51 hips) underwent hip arthroscopy for FAI between 2000 and 2015 by a single surgeon. Data were retrieved for each player from MLB.com , MiLB.com , Baseballreference.com , and individual team websites. Age, surgical procedure, and intraoperative findings were also used in analysis. Return to play was defined as playing in a preseason or regular season major or minor league game after arthroscopy. Career length was measured as total years played before and after arthroscopy. Performance measures included earned run average for pitchers, batting average for position players, and games played for all players. Results: Of the 44 players, there were 21 pitchers and 23 position players. Ninety-five percent (n = 42) were able to return to professional baseball after hip arthroscopy. The mean career length for all players was 9.5 years. The mean career length after return to play was 3.6 seasons (range, 1-14 seasons). Pitchers had a mean career length of 8.7 years (3.3 after surgery), and position players averaged a career length of 10 years (3.9 after surgery). There were no differences in performance measures between preinjury and postoperative values. Conclusion: Professional baseball players undergoing hip arthroscopy for FAI returned to sport and had similar performance as they did before injury. The average career length was 9.5 years. In our study cohort, more pitchers than position players underwent hip arthroscopy. Hip arthroscopy appears to be an effective surgical intervention, allowing for return to play after complete recovery.

scholarly journals Subparaneural injection in popliteal sciatic nerve blocks evaluated by MRI

Open Medicine ◽  
2019 ◽  
Vol 14 (1) ◽  
pp. 346-353
Author(s):  
Benedikt Büttner ◽  
Alexander Schwarz ◽  
Caspar Mewes ◽  
Katalin Kristof ◽  
José Hinz ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Local Anesthetic ◽  
Ultrasound Guidance ◽  
Resonance Imaging ◽  
Nerve Blocks ◽  
Cross Sectional ◽  
Neurological Sequelae ◽  
Patient Reported ◽  
Study Population ◽  
Intraneural Injection

AbstractIntraneural injection of a local anesthetic can damage the nerve, yet it occurs frequently during distal sciatic block with no neurological sequelae. This has led to a controversy about the optimal needle tip placement that results from the particular anatomy of the sciatic nerve with its paraneural sheath.The study population included patients undergoing lower extremity surgery under popliteal sciatic nerve block. Ultrasound-guidance was used to position the needle tip subparaneurally and to monitor the injection of the local anesthetic. Sonography and magnetic resonance imaging were used to assess the extent of the subparaneural injection.Twenty-two patients participated. The median sciatic cross-sectional area increased from 57.8 mm2 pre-block to 110.8 mm2 immediately post-block. An intraneural injection according to the current definition was seen in 21 patients. Two patients had sonographic evidence of an intrafascicular injection, which was confirmed by MRI in one patient (the other patient refused further examinations). No patient reported any neurological symptoms.A subparaneural injection in the popliteal segment of the distal sciatic nerve is actually rarely intraneural, i.e. intrafascicular. This may explain the discrepancy between the conventional sonographic evidence of an intraneural injection and the lack of neurological sequelae.

Short-Term Radiographic Outcomes of Calcaneus Fractures Treated With 2-Incision, Minimally Invasive Approach

2019 ◽  
Vol 40 (9) ◽  
pp. 1060-1067
Author(s):  
Snow B. Daws ◽  
Kaitlin Neary ◽  
Gregory Lundeen
Keyword(s):  
Minimally Invasive ◽  
Sensory Nerve ◽  
Case Series ◽  
Fracture Reduction ◽  
Minimally Invasive Approach ◽  
Invasive Treatment ◽  
Level Of Evidence ◽  
Invasive Approach ◽  
Calcaneus Fractures ◽  
Böhler’S Angle

Background: The treatment of displaced, intra-articular calcaneus fractures is controversial. The extensile lateral approach has been historically preferred because it provides excellent exposure and visualization for fracture reduction. However, soft tissue complications with this approach can lead to poor outcomes for patients. Recently, there has been an interest in the minimally invasive treatment of calcaneus fractures. The purpose of the present study was to determine the radiographic reduction of displaced, intra-articular calcaneus fractures and the rate of complications using a 2-incision, minimally invasive approach. Methods: A dual-incision, minimally invasive approach with plate and screw fixation was utilized for the treatment of 32 patients with displaced, intra-articular calcaneus fractures. Preoperative and postoperative calcaneal measurements were taken to assess fracture reduction. Additionally, a retrospective chart review was performed to assess for complications. Results: The mean preoperative Bohler’s angle measurement was 12.9 (range, –5 to 36) degrees and the final postoperative Bohler’s angle was 31.7 (range, 16-40) degrees. One patient (3.1%) had postoperative numbness related to the medial incision in the calcaneal branch sensory nerve distribution. Two patients (6.2%) had a wound infection treated with local wound care and oral antibiotics, while 1 patient (3.1%) had a deep infection that required a secondary surgery for irrigation and debridement. Two patients (6.2%) returned to the operating room for removal of symptomatic hardware. Conclusion: Operative fixation of displaced, intra-articular calcaneus fractures treated with a 2-incision, minimally invasive approach resulted in acceptable fracture reduction with a minimal rate of complications. Level of Evidence: Level IV, retrospective case series.

scholarly journals Comparative Analysis of the Nonoperative Treatment of Elbow Ulnar Collateral Ligament Injuries in Professional Baseball Players with and without Platelet-Rich Plasma

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0008 ◽  
Author(s):  
Peter Douglas McQueen ◽  
Christopher L. Camp ◽  
Aakash Chauhan ◽  
Brandon J. Erickson ◽  
Hollis G. Potter ◽  
...  
Keyword(s):  
Recovery Time ◽  
Platelet Rich Plasma ◽  
Ulnar Collateral Ligament ◽  
Nonoperative Treatment ◽  
Return To Play ◽  
Professional Baseball ◽  
Collateral Ligament ◽  
Baseball Players ◽  
Minor League Baseball ◽  
Minor League

Objectives: In the setting of ulnar collateral ligament (UCL) injury, surgical reconstruction of the UCL is not always selected, as it leads to a prolonged recovery time and return to play rates between 67-95%. To date, there is limited data on outcomes following nonoperative treatment in this population. Orthobiologics, such as platelet-rich plasma (PRP), have recently been used as an adjunct therapy for standard nonoperative treatment including rest and physical therapy for UCL injuries. The objective of this study was to determine if the addition of PRP injections in professional baseball players with UCL injuries reduces recovery time, lowers the likelihood of surgery, and increases the return to play rate compared to traditional nonoperative treatment. Methods: The Health and Injury Tracking System (HITS) database was searched from 2011-2015 for Major and Minor league baseball players with Grade I, II or III UCL injuries. Standard demographic, injury, and return to play data was obtained for all players. MRI’s for 353 athletes were reviewed by a musculoskeletal radiologist and graded accordingly. Outcomes were compared between players who received PRP injections in addition to traditional nonoperative treatment (PRP group) and players who received traditional nonoperative treatment alone (No PRP group). Statistical analysis was performed using Student’s T-test and Chi-square for parametric data. Kaplan Meier’s analysis was used for estimating longevity of the treatment. Results: A total of 544 Major and Minor League Baseball players with UCL tears underwent an initial course of nonoperative treatment (active rest & rehabilitation) for their injury between 2011-2015. Of these, 133 underwent PRP injections plus rehab and 411 underwent rehab alone. There was a significantly higher proportion of Major League Baseball players in the PRP group compared to the No PRP group (25.6% vs 9.0%, P<0.001). There was no difference between the two cohorts in regard to the grade of UCL tear (Figure 1). The players in the PRP group had a significantly longer time before returning to a throwing program compared to the No PRP group (64 days vs 51 days, P<0.001). The mean time from injury date to PRP injection was 14.5 days, which may explain the difference in time to return to throwing. The return to play rate in a live game without surgery was significantly lower in the PRP group compared to the No PRP group (46% vs 57%, P=0.03). There was no difference in the proportion of athletes requiring UCL reconstruction (58% vs 51%) or the time to surgery (154 days vs 178 days) between the two groups. Kaplan Meier survivor analysis showed no difference between the PRP and No PRP groups with regard to longevity of the native UCL (Figure 2). Conclusion: Among Major and Minor League Baseball players who were treated nonoperatively for a UCL injury between 2011-2015, 24% underwent PRP injections prior to rehab. Compared to traditional nonoperative rehab alone program, players who received PRP injections experienced a significantly longer time before returning to throwing, which may be in part due to the delay between the injury date and PRP injection. PRP injections did not appear to have a significant effect on the likelihood of surgical intervention.

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