Any suggestions?
Have already tried LFCN block, lidoderm, neurontin, loose clothing. Sent patient to PT today to try TENS unit.
Have already tried LFCN block, lidoderm, neurontin, loose clothing. Sent patient to PT today to try TENS unit.
Any suggestions?
Have already tried LFCN block, lidoderm, neurontin, loose clothing. Sent patient to PT today to try TENS unit.
concur with what you have tried already. Was there relief during the anesthetic phase of the block? If yes, then cryo, pulse RF or botox the nerve. If that fails, could try L2 and L3 transforaminals or pulsed RF of the DRG.
If no response to block, did you use a nerve stimulator to localize the nerve? Are you certain of the diagnosis?
I've done US guided pulsed RF with mixed results.
Any suggestions?
Have already tried LFCN block, lidoderm, neurontin, loose clothing. Sent patient to PT today to try TENS unit.
I did consider L2,L3 TFESI but his pain pattern almost completely fits classic meralgia paresthetica.
Any suggestions?
Have already tried LFCN block, lidoderm, neurontin, loose clothing. Sent patient to PT today to try TENS unit.
Just to clarify, I am not implying that it is L2/L3 radiculopathy, but rather the LFCN originates from the L2 and L3 roots. Therefore, you can sometimes treat pain of the LFCN by blocking its contributing branches which are L2 and L3.
Similarly, I have had some successes blocking L1 and L2 to treat genitofemoral neuropathy.
I am amused and disturbed at proximal treatments for distal entrapment neuropathies. I will wager that all who got better with this treatment were destined to get better with tincture of time.
Can someone refute this is the exact same thing as doing a CESI for carpal tunnel? Proximal treatment for distal entrapment. Makes no sense to me, but I'm willing to learn.
I am amused and disturbed at proximal treatments for distal entrapment neuropathies. I will wager that all who got better with this treatment were destined to get better with tincture of time.
Can someone refute this is the exact same thing as doing a CESI for carpal tunnel? Proximal treatment for distal entrapment. Makes no sense to me, but I'm willing to learn.
.Not too crazy when you think about it...Why does a proximal sympathetic block help for a CRPS II patient? What about radiosurgery at the trigeminal nucleus for trigeminal neuralgia?
Besides, CTS and MP are not always secondary to an entrapment phenomemon or else they would have all gotten better after surgery and......I would not have to see them .
Can someone refute this is the exact same thing as doing a CESI for carpal tunnel?
I believe cts and mp are always defined as entrapment neuropathoes whereas the tn and crps 2 are entirely different neuropathic phenomenon with no entrapment. Similar, but different.
Would not treat peripheral neuropathies with any procedures.
CTS and MP, as well as other neuropathies are not always secondary to entrapment....I would submit other etiologies: RA, leprosy, Raynaud's, dysproteinemia, DM, and vitamin deficiencies to name a few.
Besides, CTS and MP are not always secondary to an entrapment phenomemon or else they would have all gotten better after surgery and......I would not have to see them
I guess I could also add that I sometimes do a series of diagnostic blocks to figure out where a lesion is located, then I pulse proximal to that lesion. Most nerves are n = 1-2, but I do have a series of saphenous neuralgia patients (s/p TKA or knee scope) that get better when I pulse the nerve at the mid-thigh.
I've got a few patients I could try this on. Where do you pulse drf? You do it the same as a saphenous nerve block? What's your techniques/landmarks? Thanks
A ring block is fine for ankle surgery. However it will miss the infrapatellar branches of the saphenous nerve for knee pain.
i agree, which is why i said in the situation you are describing, for knee pain, but the article is for U/S guided block for ankle surgery, unless i read it wrong...
I believe cts and mp are always defined as entrapment neuropathoes whereas the tn and crps 2 are entirely different neuropathic phenomenon with no entrapment. Similar, but different.
Would not treat peripheral neuropathies with any procedures.
My technique:
For pRF I poke at the nerve at two locations and pulse for 4 minutes each.