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22nd Annual Pain Medicine Meeting 2023
November 10 - 11, 2023 | New Orleans Marriott | New Orleans, Louisiana, USA
4811
ULTRASOUND BASED MACROARCHITECTURE DELINEATION AND INJECTION OF COMPLEX RESIDUAL LIMB NEUROMA
Poster Presenter
Part of Topic
Regional Anesthesia
Ultrasound based macroarchitecture delineation and injection of complex residual limb neuroma
Ranjeev Chabra, M.D., Neelesh Anand, M.D., Andrew Gray M.D., Behnum Habibi, M.D., Arthur Wood, M.D.
Neuroma’s are difficult to treat. Using ultrasound, intraneural mechanical disruption of peripheral nerves feeding into the neuroma via hydrodissection achieved long lasting relief.
43-year-old woman with a history of GSW to the RUE had constant, reproducible stump pain for 12 years managed by opioids.
Combination of the injury mechanism, history and physical exam findings suggested stump neuroma diagnosis with associated neuropathic pain (Fig. A)
Scheduled for ultrasound-guided steroid injection.
Novel case of a patient with stump pain who underwent two ultrasound-guided neuroma injections via different approaches with each producing different durations of analgesia.
An ovoid hypoechoic structure was revealed maximally at 1 cm × 2 cm with the ulnar nerve in close approximation to and eventually transitioning into the neuroma (Fig. B-D).
The solution was injected surrounding the ulnar nerve stalk and partially dissecting it away from the neuroma (Fig. E+F).
Lost to follow-up for 2.5 years, represented to the pain clinic requesting second injection and reported 24 months of 100% pain relief
Injectate deposited peribulbarly without mechanical nerve stalk disruption.
Patient reported 100% pain relief within 20 min but subsequently reported her pain returned to 50% of her pre-procedure level after 24 hr.
Separating physiologic nerve from areas of disorganized axonal regeneration may have disrupted pain transmission on the first injection.
On the second injection, the shorter duration of relief suggests that mechanical disruption between normal and abnormal nerve may be required to achieve long-lasting results.