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Inferior heel pain
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Dishan Singh, Shelain Patel, Karan Malhotra
As depicted in Figure 10.6, the medial calcaneal branches of the tibial nerve pierce the flexor retinaculum before providing sensory innervation to the medial aspect of the calcaneum. The anatomy is variable, but they usually originate in the tarsal tunnel. This may result in altered sensation or pain on the medial side of the heel although this is a rare entity. There may be an association with plantar fasciitis. Conservative management with orthotics and activity modification is the mainstay of treatment, but occasionally surgery may be required. Surgical options include release or neurotomy. In the latter case the stumps are buried to prevent recurrence. Ultrasound guided radiofrequency ablation has also been described with some success (7).
Low Back Pain and Sciatica: Pathogenesis, Diagnosis and Nonoperative Treatment
Published in Gary W. Jay, Practical Guide to Chronic Pain Syndromes, 2016
Percutaneous radiofrequency (RF) neurotomy of the medial branches causes temporary denaturing of the nerves to the painful facet, but this effect may wear off when axons regenerate (1). In a 2002 review, Manchikanti et al. cite strong evidence that RF denervation provides short-term relief (<6 months) and moderate evidence for long-term relief (>6 months) of chronic thoracic and lumbar spine pain of facet origin (91). Improvement measures have not only included reduced pain, but also reduced functional disability and physical impairment. These systematic reviews of the evidence show strong support for both short-term and long-term benefit for RF medial branch neurotomy for the treatment of lumbar facet syndrome in chronic LBP patients (1, 88, 91). RF denervation showed improvement in patients who were treated following a diagnostic intra-articular facet block with local anesthetic (83). These improvements lasted up to two months; however, another study showed no long-term difference at 12 weeks when treatment was compared with controls (83). RF neurotomy, like all spinal interventions, is one treatment method in the toolbox. Most patients require spine care education and exercise in addition to the above-mentioned procedures.
Cervicogenic Headache
Published in Gary W. Jay, Clinician’s Guide to Chronic Headache and Facial Pain, 2016
Under fluoroscopic guidance in RF procedures, the point of a special RF needle is attached to a radiofrequency generator and heated to approximately 80°C coagulating nerve fibers targeted most frequently at the facet joint or nerve innervations from C2-C3 down to C6-C7. The aim is to damage pain fibers thereby reducing the painful stimuli from the joint (30). RF, by its very nature, indicates thermal destruction unless otherwise qualified, as in pulsed RF, which uses very high density brief current pulses to allow for use of less heated probes (maximum 42°C) and no tissue destruction (105,106). According to Bogduk, significant differences exist between thermal and pulsed radiofrequency (106). These differences must be known by practitioners utilizing these techniques. To achieve a good result in the individual patient, nerve roots and disks are targets one needs to treat, in many instances, next to the facet joint (105). A placebo-controlled trial of 24 whiplash subjects showed that the effects of cervical medial branch RF neurotomy were genuine (104,107). Follow-up studies showed that in responders the median duration of complete relief from pain was over 400 days, and that if symptoms recurred, relief could be reinstated by repeat RF neurotomy (87,107). Outcome did not differ according to the operator, the type of electrode used, litigation status (108), or the type of diagnostic block used.
Three-in-one procedure for failed spinal surgery improved pain, disability scores and serum inflammatory milieu: Three-years follow-up
Published in Egyptian Journal of Anaesthesia, 2021
In line with the maintained effect of RF, Lee et al. [43] and Çetin & Yektaş [44] documented that conventional RFN of medial branch in patients with lumbar facet joint pain effectively decreases pain scores and allowed better QOL and daily activities till 12 [43] and 24 months [44], respectively. Thereafter, Ibrahim et al. [45] found RFN of sensory nerve branches along S1-3 lateral foramina and L4-S1 medial branches is minimally invasive procedure that significantly relieved lumbar back pain for 24 months. Recently, Speldewinde [46] reported sustained success rate of 69% in reduction of sacroiliac ligament/joint complex pain with improvement in physical and psychological function for 12 months after TRFN. Further, in support of safety of RF application after insertion of the pedicle and screws, Elwood et al. [47] reported no complications due to hardware temperature and Eckmann et al. [48] detected no motor weakness after thermal neurotomy.
Optic Nerve Head Drusen: An Update
Published in Neuro-Ophthalmology, 2018
Edward Palmer, Jesse Gale, Jonathan G. Crowston, Anthony P. Wells
The presentation of NAION with ONHD is sudden painless vision loss, with worsening of optic nerve function and acute optic disc swelling corresponding to the visual loss, often with flame haemorrhages. The swelling may be unusual in appearance due to the presence of ONHD. The presence of ONHD (which can mimic disc oedema) should not distract from the investigation of a sudden-onset optic neuropathy even if the acute swelling is difficult to appreciate on fundoscopy, and modern imaging tools are less important in this context than the history and clinical signs optic nerve function. Management includes identification and management of other contributing causes such as vasculitis (giant cell arteritis) or uncontrolled hypertension or diabetes. Radial optic neurotomy remains a controversial management option, with a recent case of bilateral NAION and ONHD showing limited recovery in the operated eye.125
Restoration of the penile sensory pathway through end-to-side dorsal root neurorrhaphy in rats
Published in The Journal of Spinal Cord Medicine, 2022
Hao Zhang, Shuaishuai Chai, Qiufeng Pan, Bing Li
Regeneration of the L6 DR was evaluated by morphological examination, IF, and TEM observation. To make the results comparable, we chose the distal nerve stumps (the DRG-linked end) in each group as detection objects. The nutriment of DRG neurons allowed the resection group to retain some nerve fibers 4 months after the neurotomy. Still, we found the mean number of myelinated fibers in the model group was approximately 46% of that in the sham group and was significantly higher than that in the resection group. This result was consistent with the neuron-counting results of the double-labeling tests and demonstrated the neural recovery effects of the surgical procedure.