Ultrasound energy exerts important cellular, genetic, thermal, and mechanical effects. Concern about the safety of ultrasound prompted several agencies to devise regulatory limits on the machine output intensities. The visual display of thermal and mechanical indices during ultrasound imaging provides an aid to limit the output of the machine. Despite many animal studies, no human investigations conducted to date have documented major physiologic consequences of ultrasound exposed during imaging. To date, ultrasound imaging appears to be safe for use in regional anesthesia and pain medicine interventions, and adherence to limiting the output of ultrasound machines as outlined by the Food and Drug Administration may avoid complications in the future. This article reviews ultrasound-related biologic effects, the role of the regulatory agencies in ensuring safety with the use of ultrasound, and the limitations and implications of ultrasound use in humans. P IERRE Curie's discovery of the piezoelectric effect in 1880 launched the ultrasound technology revolution. This technology was first applied in ships for depth detection and in metallurgy for fracture identification, but medical applications were soon appreciated shortly thereafter.1 Medical ultrasound imaging has been used extensively for more than five decades, and the variety of uses for which this technology is used expanded rapidly. For example, the use of ultrasound for interventions during regional anesthesia and pain medicine allows the practitioner to reliably see the target, needle, and injectate with good resolution. 2 The primary advantages of ultrasound in these settings include real-time assessment, absence of radiation, decreased cost, and portability.2
Neuromas develop as part of a normal reparative process following peripheral nerve injury. Painful neuromas can induce intense pain resulting in immense suffering and disability. MRI aids the diagnosis, but, ultrasound imaging allows cost effective accurate diagnosis and localization of neuromas by demonstrating their direct contiguity with the nerve of origin. Management options for painful neuromas include pharmacotherapy, prosthetic adjustments, steroid injection, chemical neurolysis, cryoablation, and radiofrequency ablation. Ultrasound imaging guidance has improved the success in localizing and targeting the neuromas. This review discusses the patho-physiology and accumulated evidence for various therapies and the current percutaneous interventional management options for painful neuromas.
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