Ankle RF

[jr264]

hi,

I hear a lot of people take about RF of knee pain (Genicular Nerve RF), Hip pain, Shoulder pain etc. Has anyone done any RF (Pulsed or thermal) of the articulating nerve to the Tibiotalar or Talofibular or subtalar joint? I have been seeing a lot of Patients with Ankle pain s/p trimalleolar fixation s/p removal of Hardware. Only option left is Ankle Fusion!

In addition, has anyone used cryo-ablation equipment for these procedures e.g. Iovera?

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[Timeoutofmind]

Just curious...why do u ask about cryo?

Does anyone do cryo anymore?

I thought everyone just did regular RF these days?

 

[clubdeac]

nothing has been anatomically described or done but it will probably be coming down the pipeline

 

[Ligament]

drf; do you denervate the ankle, is it possible?

 

[Pacman27]

Interesting

We do ankle blocks all the time in anesthesia but usually for surgeries distal to the ankle. I have not looked at the anatomy in awhile, but why not ablate the sensory branch's and hope it helps. The big issue is that you would have to be proximal to where you would do a traditional ankle block to get the innervation to the ankle, so not sure how you would avoid motor innervation. However, if someone has foot pain primarily I could see this working well. Figure it would be easier then the knee and you could use ultrasound as well

 

[BobBarker]

No. The saphenous nerve ablated causes long term hyperalgesia and some anesthesia dolorosa. My saphenous nerve got accidentally burned in a saph vein procedure.

 

[Ducttape]

the saphenous is a pure sensory nerve. the rest (post tib, peroneal) are mixed nerves.

(edited to initial post - sural nerve is sensory.)

 

[jr264]

You could Cryo-ablate the Sural Nerve. Wonder if there will be anesthesia dolorosa or hyperalgesia. The key is to cryoablate the nerve as it splits to enter the Joint Capsule.
There is the Iovera device you could use if you can isolate the sensory nerve to the Ankle Joint. I wonder it would affect the likelihood they will have more ankle sprain (loss of proprioception)

 

[bedrock]

No. The saphenous nerve ablated causes long term hyperalgesia and some anesthesia dolorosa. My saphenous nerve got accidentally burned in a saph vein procedure.

Sorry this happened to you, but sounds like 1- partial lesion on 2-fairly proximal portion of the nerve.

Reasonable to consider thermal RF to the distal saphenous and sural nerves just before they reach the joint.