Association of using pulsed radiofrequency with hydrodissection for treatment of entrapment peripheral nerve – six cases report

Background: Recently, clinicians have been applying pulsed radiofrequency (PRF) stimulation on various peripheral nerves to manage patients’ peripheral neuropathic pain. Objectives: To review the literature on the use and efficacy of PRF for controlling peripheral neuropathic pain. Study Design: This is a narrative review of relevant articles on the effectiveness of PRF for peripheral neuropathic pain. Methods: A PubMed search was conducted for papers published from January 1, 1980 to August 31, 2017 that used PRF to treat peripheral neuropathic pain. The key search phrase for identifying potentially relevant articles was [PRF AND pain]. The following inclusion criteria were applied for the selection of articles: 1) patients’ pain was caused by peripheral nervous system disorders; 2) PRF stimulation was applied on the peripheral nerve; and 3) after PRF stimulation, follow-up evaluation was performed to assess the reduction in pain. Review articles were excluded. Results: A total of 468 articles were found to be potentially relevant. After reading the titles and abstracts of the papers and assessing them for eligibility based on the full-text articles, 63 publications were finally included in this review. For radicular pain from spinal diseases, the evidence supports that PRF is an effective treatment. Similarly, PRF appears to be effective for postherpetic neuralgia and occipital neuralgia. On the other hand, for trigeminal neuralgia, the results of previous studies indicate that PRF is not appropriate for managing trigeminal neuralgia and less effective than conventional RF. However, data on the use of PRF for pudendal neuralgia, meralgia paresthetica, carpal tunnel syndrome, tarsal tunnel syndrome, and Morton’s neuroma, is lacking and thus the efficacy of PRF in these peripheral nerve disorders cannot be determined at this time. Limitations: This review did not include studies indexed in databases other than PubMed. Conclusions: This review will help guide clinicians in making informed decisions regarding whether PRF is the appropriate option for managing the various peripheral neuropathic pain conditions in their patients. Key words: Pulsed radiofrequency, peripheral neuropathic pain, radicular pain, postherpetic neuralgia, trigeminal neuralgia, occipital neuralgia, pudendal neuralgia, meralgia, carpal tunnel syndrome, review

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Facilitated migration of cells from a transected peripheral nerve over collagen fibers: in vivo observations

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100156420 ◽

1989 ◽

Vol 47 ◽

pp. 888-889

Author(s):

Arthur J. Wasserman ◽

Azam Rizvi ◽

George Zazanis ◽

Frederick H. Silver

Keyword(s):

Sciatic Nerve ◽

Peripheral Nerve ◽

Collagen Gel ◽

Collagen Fibers ◽

Control Group ◽

Guide Tube ◽

Sprague Dawley ◽

Silicone Tube ◽

Thin Sections

In cases of peripheral nerve damage the gap between proximal and distal stumps can be closed by suturing the ends together, using a nerve graft, or by nerve tubulization. Suturing allows regeneration but does not prevent formation of painful neuromas which adhere to adjacent tissues. Autografts are not reported to be as good as tubulization and require a second surgical site with additional risks and complications. Tubulization involves implanting a nerve guide tube that will provide a stable environment for axon proliferation while simultaneously preventing formation of fibrous scar tissue. Supplementing tubes with a collagen gel or collagen plus extracellular matrix factors is reported to increase axon proliferation when compared to controls. But there is no information regarding the use of collagen fibers to guide nerve cell migration through a tube. This communication reports ultrastructural observations on rat sciatic nerve regeneration through a silicone nerve stent containing crosslinked collagen fibers.Collagen fibers were prepared as described previously. The fibers were threaded through a silicone tube to form a central plug. One cm segments of sciatic nerve were excised from Sprague Dawley rats. A control group of rats received a silicone tube implant without collagen while an experimental group received the silicone tube containing a collagen fiber plug. At 4 and 6 weeks postoperatively, the implants were removed and fixed in 2.5% glutaraldehyde buffered by 0.1 M cacodylate containing 1.5 mM CaCl2 and balanced by 0.1 M sucrose. The explants were post-fixed in 1% OSO4, block stained in 1% uranyl acetate, dehydrated and embedded in Epon. Axons were counted on montages prepared at a total magnification of 1700x. Montages were viewed through a dissecting microscope. Thin sections were sampled from the proximal, middle and distal regions of regenerating sciatic plugs.

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Relationship between fascicle size and perineurial collagen IV content in diabetic and control human peripheral nerve

Histopathology ◽

10.1046/j.1365-2559.2000.00897.x ◽

2000 ◽

Vol 36 (6) ◽

pp. 551-555 ◽

Cited By ~ 6

Author(s):

P E Williams ◽

A Lowry ◽

R Hill ◽

E Masson

Keyword(s):

Peripheral Nerve ◽

Collagen Iv ◽

And Control

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Peripheral nerve regeneration through nerve guides seeded with adult Schwann cells

Neuropathology and Applied Neurobiology ◽

10.1046/j.1365-2990.1997.00062.x ◽

1997 ◽

Vol 23 (5) ◽

pp. 387-398 ◽

Cited By ~ 6

Author(s):

A.D. Ansselin ◽

T. Fink ◽

D.F. Davey

Keyword(s):

Peripheral Nerve ◽

Nerve Regeneration ◽

Schwann Cells ◽

Peripheral Nerve Regeneration ◽

Nerve Guides

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Peripheral Nerve and Brachial Plexus Impairment, AMA Guides, Sixth Edition

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2017.marapr01 ◽

2017 ◽

Vol 22 (2) ◽

pp. 3-5

Author(s):

James B. Talmage ◽

Jay Blaisdell

Keyword(s):

Peripheral Nerve ◽

Brachial Plexus ◽

Complex Regional Pain Syndrome ◽

Lower Extremities ◽

Pain Syndrome ◽

Upper Extremities ◽

Motor Deficits ◽

Type I ◽

Sixth Edition ◽

Nerve Entrapments

Abstract Physicians use a variety of methodologies within the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, to rate nerve injuries depending on the type of injury and location of the nerve. Traumatic injuries that cause impairment to the peripheral or brachial plexus nerves are rated using Section 15.4e, Peripheral Nerve and Brachial Plexus Impairment, for upper extremities and Section 16.4c, Peripheral Nerve Rating Process, for lower extremities. Verifiable nerve lesions that incite the symptoms of complex regional pain syndrome, type II (similar to the former concept of causalgia), also are rated in these sections. Nerve entrapments, which are not isolated traumatic events, are rated using the methodology in Section 15.4f, Entrapment Neuropathy. Type I complex regional pain syndrome is rated using Section 15.5, Complex Regional Pain Syndrome for upper extremities or Section 16.5, Complex Regional Pain Syndrome for lower extremities. The method for grading the sensory and motor deficits is analogous to the method described in previous editions of AMA Guides. Rating the permanent impairment of the peripheral nerves or brachial plexus is similar to the methodology used in the diagnosis-based impairment scheme with the exceptions that the physical examination grade modifier is never used to adjust the default rating and the names of individual nerves or plexus trunks, as opposed to the names of diagnoses, appear in the far left column of the rating grids.

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Evaluating Shoulder Impairment

Guides Newsletter ◽

10.1001/amaguidesnewsletters.1998.sepoct01 ◽

1998 ◽

Vol 3 (5) ◽

pp. 1-3

Author(s):

Richard T. Katz ◽

Sankar Perraraju

Keyword(s):

Peripheral Nerve ◽

Upper Extremity ◽

Sensory Loss ◽

Motor Deficits ◽

Nerve Lesion ◽

Fourth Edition ◽

Specific Patient ◽

Industrial Medicine ◽

Shoulder Motion ◽

Upper Extremity Impairment

Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, offers several categories to describe impairment in the shoulder, including shoulder amputation, abnormal shoulder motion, peripheral nerve disorders, subluxation/dislocation, and joint arthroplasty. This article clarifies appropriate methods for rating shoulder impairment in a specific patient, particularly with reference to the AMA Guides, Section 3.1j, Shoulder, Section 3.1k, Impairment of the Upper Extremity Due to Peripheral Nerve Disorders, and Section 3.1m, Impairment Due to Other Disorders of the Upper Extremity. A table shows shoulder motions and associated degrees of motion and can be used in assessing abnormal range of motion. Assessments of shoulder impairment due to peripheral nerve lesion also requires assessment of sensory loss (or presence of nerve pain) or motor deficits, and these may be categorized to the level of the spinal nerves (C5 to T1). Table 23 is useful regarding impairment from persistent joint subluxation or dislocation, and Table 27 can be helpful in assessing impairment of the upper extremity after arthroplasty of specific bones of joints. Although inter-rater reliability has been reasonably good, the validity of the upper extremity impairment rating has been questioned, and further research in industrial medicine and physical disability is required.

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