Tendon Injuries Associated With Radiofrequency Ablation For Wrist Denervation
Shailesh Agarwal, MD; Phillip Troy Henning, DO; Steven C. Haase, MD
University of Michigan Health System, Ann Arbor, MI
Introduction: Partial wrist denervation is a reasonable option for some patients with chronic wrist pain. Radiofrequency ablation is a method of minimally invasive tissue destruction which can target nerves responsible for chronic pain. Using this technique, tissue is heated by directing energy to a focused site. The probe delivering this energy can be introduced through cannulated needles which are directed towards the site of interest using fluoroscopic or ultrasound guidance. We report on 4 cases where this technology was used to ablate the posterior interosseous nerve to treat chronic wrist pain.
Methods: Four patients with chronic wrist pain who had previously reported resolution of symptoms with local anesthetic block of the posterior interosseous nerve were included in our experience. Patients gave informed consent for the RFA procedure; IRB approval was not required for this study. Immediately prior to RFA, an ultrasound-guided injection of 1% lidocaine was used to anesthetize the skin and soft tissues down to and around the PIN at the level of the distal radius. The probe was used to ablate at 80 degrees Celsius for either 150 seconds (Cases 1 & 2) or 90 seconds (Cases 3 & 4). Following ablation, triamcinolone was injected around the nerve to help minimize post-procedure pain.
Results: Radiofrequency ablation of the posterior interosseous nerve provided only short-term pain relief, never lasting more than a few months. Adverse events, specifically ruptures of the EPL (n=2) and EIP (n=1), were sustained in three of the four patients during follow-up. Recurrence of pain was noted in three patients. Additional surgical procedures were required in all patients.
Conclusions: Based on our experience, radiofrequency ablation of the posterior interosseous nerve is neither safe nor effective using current instrumentation available. Further improvements are required to reduce injury to collateral structures.
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