Pain
Kyle Francis Cullin, DO
Research Assistant
N/A
Mount Sinai, New York, United States
Faruk Razzak, DO
Interventional Pain, Spine, Sports Medicine
Independent Practice
East Meadow, New York, United States
Kyle Francis Cullin, DO
NYU Langone
Mount Sinai, New York, United States
57 yo right-hand dominant, female presented for evaluation of motor and sensory deficits after ORIF distal radius fracture. EMG demonstrated very severe, mostly motor axonal neuropathic process affecting the left median nerve at or about the wrist. Additionally, there was decreased amplitude at the wrist, increased amplitude on NCV distal to the wrist. Furthermore, there was no voluntary motor units upon contraction of the APB. Diagnostic Ultrasound demonstrated presence of a flap of epineurium of the median nerve. Neuroplasty and blood clot epineurium repair was utilized to maintain the flap in anatomic position. Patient went on to see significant improvements of weakness, pain, and numbness after Neuroplasty.
Discussions: Neuroplasty, in this case epineural repair, is intended to assist the body’s normal axonal regeneration by approximating the injured structures. The use of sutures in traditional surgical repair can prove counterproductive due to the trauma as well as additional fibrosis introduced with aforementioned trauma when suturing these delicate structures. For this patient, a blood clot was introduced to maintain the reapproximation, in addition to the percutaneous neuroplasty performed to further reduce the amount of additional trauma to the patient. This is especially important for this specific patient due to her demographics, a middle-aged female with distal radius fracture, as these patients have higher rates of developing Complex Regional Pain Syndrome, especially with the direct nerve injury the patient sustained. The patient demonstrated remarkable improvements compared to initial post-surgical EMG and physical exam, highlighting the potential efficacy of percutaneous neuroplasty in the hands of a skilled interventionalist.
Conclusions: Peripheral nerve lacerations can have severe, lasting sequelae if not addressed in a timely manner. Without intervention, this process often results in incomplete regeneration. Percutaneous Neuroplasty can serve as a powerful tool to facilitate this process and treat such injuries in the outpatient setting.
