Comparing Electrical Stimulation With and Without Ultrasound Guidance for Phenol Neurolysis to the Musculocutaneous Nerve

Matsumoto, Mary E.; Berry, Jessica; Yung, Herbie; Matsumoto, Martha; Munin, Michael C.

doi:10.1016/j.pmrj.2017.09.006

Cited by 18 publications

(17 citation statements)

References 20 publications

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“…They also denote how the dynamic nature of ultrasound imaging can help not only optimize safety profiles by preventing vascular injury and administration, but also facilitate better outcomes by ensuring phenol delivery immediately proximal to target motor branches. This precision of phenol delivery is thought to be resultant of direct and dynamic visual identification of target motor branches with ultrasound imaging, which is not possible with EStim‐guidance alone . Thus EStim guidance may require larger phenol volumes to ensure medication spread to motor branches and achieve appropriate efficacy .…”

Section: Discussionmentioning

confidence: 99%

“…It is thought that the precise localization of neurolysis to pure motor branches may mitigate dysesthesia risk by preserving sensory nerve conduction. 2,[8][9][10][11][12][13] Dysesthesia prevention, or at the very least reduction, has been demonstrated successfully by others who utilized precise localization techniques to avoid sensory branches. [8][9][10][11][12][13]15 Deltombe et al published their experiences with equinovarus foot spasticity patterns in 12 patients being treated with EStim-guided anesthetic blocks to motor branches as identified by computerized tomography.…”

Section: Discussionmentioning

confidence: 99%

“…This precision of phenol delivery is thought to be resultant of direct and dynamic visual identification of target motor branches with ultrasound imaging, which is not possible with EStim-guidance alone. [10][11][12][13] Thus EStim guidance may require larger phenol volumes to ensure medication spread to motor branches and achieve appropriate efficacy. 13 Consequently, this imprecision in medication spread may also lead to neurolysis of nearby sensory branches.…”

Section: Discussionmentioning

confidence: 99%

“…1,2,7 There is some thought that precise localization of pure motor branches with ultrasound guidance may mitigate dysesthesia risk. [8][9][10][11][12][13] The precision of this localization may also be further enhanced with concomitant electrical stimulation (EStim) guidance. [11][12][13] Consequently, our study aimed to analyze practice patterns and adverse effects of phenol neurolysis to distal upper extremity nerves using concomitant ultrasound and EStim guidance.…”

Section: Introductionmentioning

confidence: 99%

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Phenol Neurolysis for Management of Focal Spasticity in the Distal Upper Extremity

Karri

Zhang

2019

PM&R

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Background When managing patients with focal spasticity, phenol neurolysis is often avoided largely because of its presumed poor adverse effect profile. It is suggested that dysesthesias may be more common with phenol neurolysis of the mixed sensorimotor nerves (eg, radial, median, and ulnar nerves) compared to neurolysis of pure motor nerves. However, these risks may be mitigated with precise localization of pure motor branches by ultrasound and electrical stimulation (EStim). Objective To explore practice patterns of phenol neurolysis to distal upper extremity mixed sensorimotor nerves with ultrasound and EStim guidance. Design A retrospective analysis of all neurolysis procedure records at a single institution from January 2013 to February 2018. Demographic and clinical variables including primary neurological diagnosis, concurrent spasticity treatments, nerves injected, phenol dosage and adverse events were abstracted from the electronic medical records. Participants 57 patients who received phenol neurolysis with ultrasound and EStim guidance for spasticity management to radial, median, or ulnar nerves. Main Outcome Measures Reported adverse effects. Results A total of 57 patients who collectively received neurolysis to 139 nerves across 102 encounters, met inclusion criteria. Most prevalent diagnoses included traumatic brain injury (N = 27, 47.4%) and stroke (N = 18, 31.6%), with a smaller subset having spinal cord injury (N = 10, 17.5%). Most patients received concomitant chemodenervation with botulinum toxin (N = 44, 77.2%). The average phenol dosage per nerve was 1.8 mL, with a range of 0.5‐9.0 mL. Reported adverse effects included three cases of prolonged pain, but no dysesthesias were reported during the follow‐up period (>40 days). Conclusions Phenol neurolysis with ultrasound and EStim guidance was successfully and safely used to manage focal spasticity in the distal upper extremity. Level of Evidence III.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Phenol Neurolysis for Management of Focal Spasticity in the Distal Upper Extremity

Karri

Zhang

2019

PM&R

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“…Former investigations focused on forming a shaft into a hub, for example by internal high pressure forming or by using a heated hub and a cold shaft. [1,2] Dörr and Funk examined joining by forming processes by laterally extruding a shaft into a hub. [3] Funk used several inner hub geometries such as polygons (P3G) as well as simple and complex cycloids.…”

Section: Introductionmentioning

confidence: 99%

Numerical investigations of multicomponent process lightweight design for joining gearwheels by lateral extrusion

Meissner

Liewald

2016

MATEC Web Conf.

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Abstract. Multicomponent processes for production of high performance gearwheels combines both high power density and high lightweight potential. In this paper, the focus is on manufacturing an assembled gearwheel using cold forging and simultaneously joining the gearwheel body and a gear ring. In this study, FEA results regarding the joining process of two different materials for assembled gearwheels are presented. The aim of the numerical investigation is to achieve a robust forging process and define appropriate tool parameters.

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Comparison of Ultrasound and Electrical Stimulation Guidance for Onabotulinum Toxin‐A Injections: A Randomized Crossover Study

Lungu

Nmashie

George

et al. 2022

Movement Disord Clin Pract

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BackgroundBackground: Botulinum neurotoxin (BoNT) injection is an established therapy for limb spasticity and focal limb dystonia. Comparative benefits of injection guidance procedures have not been rigorously studied. Objectives Objectives: We compared 2 targeting techniques for onabotulinumtoxin-A (onabotA) injection for the treatment of focal hand dystonia and upper limb spasticity: electrophysiologic guidance using electrical stimulation (Estim) and ultrasound (US). Methods Methods: This was a 2-center, randomized, crossover, assessor-blinded trial. Participants with focal hand dystonia or upper limb spasticity, on stable onabotA therapy for at least 2 previous injection cycles, were randomly assigned to either E-stim or US with crossover at 3 months. The primary outcome was improvement in dystonia or spasticity severity on a visual analog scale (VAS; 0-100) measured 1 month after each injection. The secondary outcome was participant discomfort assessed on a VAS. Repeated-measures analysis of covariance was used with linear mixed-model covariate selection. ResultsResults: A total of 19 participants (13 men) completed the study, 10 with upper limb spasticity and 9 with dystonia. Benefit was equivalent between the 2 techniques (VAS least-square mean [LSmean] 51.5 mm with US and 53.1 with E-stim). E-stim was perceived as more uncomfortable by participants (VAS LSmean 34.5 vs. 19.9 for E-stim and US, respectively). Procedure duration was similar with the 2 procedures. There were no serious adverse events related to either approach. Conclusions Conclusions: US and E-Stim localization guidance techniques provide equivalent efficacy in onabotA injections for spasticity and dystonia. US guidance injections are more comfortable for participants. Both techniques are effective guidance methods, with US potentially preferable based on participant comfort.Botulinum neurotoxin (BoNT) injection is a safe and effective therapy for limb spasticity that is also widely accepted and used for focal limb dystonia. Onabotulinum toxin-A (Botox, Allergan/AbbVie, North Chicago, [onabotA]) is US Food and Drug Administration approved for treatment of upper and lower limb spasticity and is commonly used off-label for the treatment of upper limb focal dystonia. 1

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Comparing Electrical Stimulation With and Without Ultrasound Guidance for Phenol Neurolysis to the Musculocutaneous Nerve

Abstract: IV.

Cited by 18 publications

References 20 publications

Phenol Neurolysis for Management of Focal Spasticity in the Distal Upper Extremity

Phenol Neurolysis for Management of Focal Spasticity in the Distal Upper Extremity

Numerical investigations of multicomponent process lightweight design for joining gearwheels by lateral extrusion

Comparison of Ultrasound and Electrical Stimulation Guidance for Onabotulinum Toxin‐A Injections: A Randomized Crossover Study

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