ULTRASOUND-GUIDED CONTINUOUS RADIOFREQUENCY ABLATION OF PAINFUL RESIDUAL LIMB NEUROMA IN INDIVIDUALS WITH LIMB AMPUTATION- A RETROSPECTIVE CASE SERIES

Abstract

BACKGROUND: Residual limb neuromas are a significant cause of post-amputation pain. There is little knowledge concerning ultrasound-guided (US) radiofrequency ablation (RFA) as treatment. OBJECTIVE: To investigate US-guided RFA for neuroma associated pain in individuals with limb amputation. METHODOLOGY: The notes of nine consecutive patients were retrospectively reviewed. Information obtained included neuroma size and nerve, RFA duration/temperature, pain scores, analgesic requirements and ease/comfort of prosthetic use. Eight patients had lower-limb amputations and one had a trans-radial amputation. All except one, underwent diagnostic US-guided steroid injection to confirm the neuroma as the source of pain, prior to RFA. RESULTS: Six patients reported significant reduction in pain scores (defined as at least 50% reduction) and an improvement in comfort/ease of wearing their prosthetic limb, with no adverse effects. Three of these six patients also reported a reduction in analgesic requirements. Of the three remaining patients – one had a large sciatic nerve neuroma that was eventually surgically excised, another had confounding pain from an adjacent bony spur, whilst the third patient did not receive a routine diagnostic steroid injection prior to RFA. CONCLUSIONS: Our findings suggest that US-guided RFA is safe and effective for small to medium-sized residual limb neuroma associated pain in individuals with limb amputation. It can reduce pain and analgesic requirements, improve comfort/ease of wearing the prosthesis and potentially avoid surgical excision. We recommend patients should undergo a diagnostic steroid injection prior to RFA to confirm that the neuroma is the source of pain. LAYMAN’S ABSTRACTAfter amputation, many patients can get a neuroma which can cause significant pain leading to discomfort wearing the prosthetic limb. Ultrasound-guided radiofrequency ablation can successfully treat painful residual limb neuromas in individuals with limb amputation which in turn can reduce the patient’s pain medications and improve the comfort of wearing the prosthetic limb. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/33061/25509 How to Cite: Guo S, Mansour R, Henderson Slater D. Ultrasound-guided continuous radiofrequency ablation of painful residual limb neuroma in individuals with limb amputation- A retrospective case series. Canadian Prosthetics & Orthotics Journal. 2019; volume2, Issue1, No.4. https://doi.org/10.33137/cpoj.v2i1.33061 CORRESPONDING AUTHOR:Shigong Guo,LLM MSc(Orth Eng) MRCS, Specialty Registrar in Rehabilitation Medicine Oxford Centre for Enablement, Nuffield Orthopaedic Centre, Oxford, UK.Email: shigong@doctors.org.uk