Ultrasound-Guided Cryoanalgesia of Peripheral Nerve Lesions

Abstract

The real-time nature of ultrasound makes it ideally suited to provide guidance for a variety of musculoskeletal interventional procedures involving peripheral nerves. Continuous observation of the needle ensures proper placement and allows continuous monitoring when performing localized ablative therapy and therefore more accurate positioning of a cryoprobe, use of smaller needles, as well as access to small structures. We describe our experience performing cryoablative procedures. Patients undergoing cryoneurolysis have largely reported varying degrees of long-term pain relief and improvement in function; no serious complications have yet been identified. Ultrasound-guided cryoneurolysis can provide a useful, safe alternative to other ablative techniques to achieve long-term analgesia from painful peripheral nerve lesions.

Keywords

cryoanalgesia - cryotherapy - peripheral neuritis - neuroma

• References

• 1 Bianchi S. Ultrasound of the peripheral nerves. Joint Bone Spine 2008; 75 (6) 643-649
• 2 Lloyd JW, Barnard JD, Glynn CJ. Cryoanalgesia. A new approach to pain relief. Lancet 1976; 2 (7992): 932-934
• 3 Friedman T, Richman D, Adler R. Sonographically guided cryoneurolysis: preliminary experience and clinical outcomes. J Ultrasound Med 2012; 31 (12) 2025-2034
• 4 Sofka CM, Adler RS, Ciavarra GA, Pavlov H. Ultrasound-guided interdigital neuroma injections: short-term clinical outcomes after a single percutaneous injection—preliminary results. HSS J 2007; 3 (1) 44-49
• 5 Rhame EE, Debonet AF, Simopoulos TT. Ultrasonographic guidance and characterization of cryoanalgesic lesions in treating a case of refractory sural neuroma. Case Rep Anesthesiol 2011; 2011: 691478
• 6 Trescot AM. Cryoanalgesia in interventional pain management. Pain Physician 2003; 6 (3) 345-360
• 7 Moore W, Kolnick D, Tan J, Yu HS. CT guided percutaneous cryoneurolysis for post thoracotomy pain syndrome: early experience and effectiveness. Acad Radiol 2010; 17 (5) 603-606
• 8 Lee J, Lee YS. Percutaneous chemical nerve block with ultrasound-guided intraneural injection. Eur Radiol 2008; 18 (7) 1506-1512
• 9 Campos NA, Chiles JH, Plunkett AR. Ultrasound-guided cryoablation of genitofemoral nerve for chronic inguinal pain. Pain Physician 2009; 12 (6) 997-1000
• 10 Morton TG. A peculiar and painful affection of the fourth metatarsophalangeal articulation. J Med Sci 1876; 71: 37-45
• 11 Kaminsky S, Griffin L, Milsap J, Page D. Is ultrasonography a reliable way to confirm the diagnosis of Morton's neuroma?. Orthopedics 1997; 20 (1) 37-39
• 12 Colgrove RC, Huang EY, Barth AH, Greene MA. Interdigital neuroma: intermuscular neuroma transposition compared with resection. Foot Ankle Int 2000; 21 (3) 206-211
• 13 Younger ASE, Claridge RJ. The role of diagnostic block in the management of Morton's neuroma. Can J Surg 1998; 41 (2) 127-130
• 14 Joplin RJ. The proper digital nerve, Vitallium stem arthroplasty, and some thoughts about foot surgery in general. Clin Orthop Relat Res 1971; 76 (76) 199-212
• 15 Merritt GN, Subotnick SI. Medial plantar digital proper nerve syndrome (Joplin's neuroma)—typical presentation. J Foot Surg 1982; 21 (3) 166-169
• 16 Melendez MM, Patel A, Dellon AL. The diagnosis and treatment of Joplin's neuroma. J Foot Ankle Surg 2016; 55 (2) 320-323
• 17 Spratt JD, Stanley AJ, Grainger AJ, Hide IG, Campbell RS. The role of diagnostic radiology in compressive and entrapment neuropathies. Eur Radiol 2002; 12 (9) 2352-2364
• 18 Bashir WA, Connell DA. Imaging of entrapment and compressive neuropathies. Semin Musculoskelet Radiol 2008; 12 (2) 170-181
• 19 Sunderland S. Nerves and Nerve Injuries. Edinburgh and London, UK: Livingstone; 1968
• 20 Fasano VA, Peirone SM, Zeme S , et al. Cryoanalgesia. Ultrastructural study on cryolytic lesion of sciatic nerve in rat and rabbit. Acta Neurochir Suppl (Wien) 1987; 39: 177-180
• 21 Hodor L, Barkal K, Hatch-Fox LD. Cryogenic denervation of the intermetatarsal space neuroma. J Foot Ankle Surg 1997; 36 (4) 311-314
• 22 Caporusso EF, Fallat LM, Savoy-Moore R. Cryogenic neuroablation for the treatment of lower extremity neuromas. J Foot Ankle Surg 2002; 41 (5) 286-290
• 23 Wang JK. Cryoanalgesia for painful peripheral nerve lesions. Pain 1985; 22 (2) 191-194
• 24 Rasmussen MR, Kitaoka HB, Patzer GL. Nonoperative treatment of plantar interdigital neuroma with a single corticosteroid injection. Clin Orthop Relat Res 1996; (326) 188-193