&lt;p&gt;Case Report Of Cryoneurolysis For The Treatment Of Refractory Intercostobrachial Neuralgia With Postherpetic Neuralgia&lt;/p&gt;

Weber, Garret; Saad, Kenneth; Awad, Motaz; Wong, Tiffany H.

doi:10.2147/lra.s223961

Cited by 8 publications

(4 citation statements)

References 20 publications

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“…12 There are case reports of the use of cryoneurolysis therapy and topical gallium maltolate cream which was successful in significantly reducing pain in PHN patients. 13,14 Interventional treatments that can be performed in cases of refractory PHN include epidural injection with metiprednisolone and bupivacaine, paravertebral nerve block, sympathetic nerve block, and ozone therapy. 12 In addition to invasive interventional treatments, there are also non-invasive interventional therapies that can be used to treat PHN pain such as the use of lasers.…”

Section: Discussionmentioning

confidence: 99%

High-Intensity Laser Therapy to Treat Neuropathic Pain in Post-Herpetic Neuralgia

Suherlim

Widyadharma

Adnyana

et al. 2022

MNJ

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Post-herpetic neuralgia (PHN) is chronic neuropathic pain that is felt for at least 3 months or more at the site of the rash due to herpes zoster infection. Epidemiological studies get a prevalence of 0.49 cases of PHN per 1000 people per year. The clinical manifestation of PHN is chronic pain on the skin lesions due to herpes zoster infection. The therapy that is commonly used as the first line is the provision of pharmacotherapy such as gabapentin or pregabalin. An 83-year-old male patient with a diagnosis of PHN that had been felt for 5 years. He has been taking drugs for 5 years but the pain has not improved. The patient is given high-intensity laser therapy. After 5 treatments with an interval of 1-2 weeks, pain was significantly reduced from an 8/10 scale to 4/10. The frequency of occurrence of severe pain is also reduced from 5 times per day to only 1 time per day. The use of high-intensity laser therapy is not commonly used as a therapy for PHN. Based on its mechanism of action, the use of high-intensity laser therapy is worth considering because of its effectiveness in treating pain in a shorter time than low-intensity laser therapy.

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Section: Discussionmentioning

confidence: 99%

High-Intensity Laser Therapy to Treat Neuropathic Pain in Post-Herpetic Neuralgia

Suherlim

Widyadharma

Adnyana

et al. 2022

MNJ

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“…Cryoneurotomy percutaneously induces selective neurolysis of a motor nerve to manage spasticity, similar to other injectable and surgical modalities, such as partial neurotomy and chemodenervation by alcohol or phenol ( 2 , 3 ). In cryoneurotomy, the axons and myelin of peripheral nerves are disrupted by the tip of the cryoprobe which may reach −70°; however, the epineurium is maintained allowing for nerve regeneration ( 3 , 4 , 13 ). Cryoneurotomy carries less risk of damage to surrounding tissue than phenol or alcohol chemodenervation ( 3 ).…”

Section: Discussionmentioning

confidence: 99%

“…The use of a mini-invasive percutaneous cryoneurotomy to induce disruption of the axon and myelin is an emerging technique for managing spasticity ( 3 ). There is substantial evidence of the efficacy of cryoanalgesia in the pain literature; however, literature outlining the use of cryoneurotomy for spasticity treatment is limited ( 3 , 4 ). There is no literature available on functional outcomes of cryoneurotomy in the pediatric population ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Case Report: Perspective of a Caregiver on Functional Outcomes Following Bilateral Lateral Pectoral Nerve Cryoneurotomy to Treat Spasticity in a Pediatric Patient With Cerebral Palsy

Scobie

Winston

2021

Front. Rehabilit. Sci.

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Spasticity is common and difficult to manage complication of cerebral palsy that significantly affects the function and quality of life of patients. This case study reports a 15-year-old male with quadriplegic cerebral palsy, Gross Motor Function Classification System 5 (GMFCS 5), who presented with significant bilateral adducted and internally rotated shoulders as a component of generalized spasticity. Spasticity in the lower limb of the patient had been treated with botulinum toxin A (BoNT-A) injections; however, the shoulder region was spared due to concerns of toxin spread and aspiration risk. Following diagnostic nerve blocks, the patient underwent bilateral cryoneurotomies of the right and left lateral pectoral nerves (LPNs) lasting 3.5 min for each lesion. One month after the cryoneurotomies, the range of motion (ROM) had improved from 86° to 133° on the right and 90° to 139° on the left. Improvements in ROM were retained at 9 months post-procedure. At 8.5 months following the cryoneurotomies, the caregiver reported improvements in upper body dressing, upper body washing, transferring, and the ability of the patient to remain sitting in his wheelchair for extended periods. Cryoneurotomy may be an effective procedure for improving shoulder ROM and specific functional outcomes for caregivers of patients with spasticity arising from cerebral palsy.

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“…The patient also usually has a history of surgery or trauma to the chest. The treatment of this post-surgical neuralgia can range from cryoneurolysis, ultrasound-guided nerve block, steroid injection, and paravertebral nerve block [9,10]. There is a lack of literature available on possible manual therapy treatments of this diagnosis.…”

Section: Open Accessmentioning

confidence: 99%

Intercostobrachial neuralgia—a case of bizzare diagnosis?

Singh¹,

Kumar²

2022

Bull Fac Phys Ther

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Background Intercostobrachial neuralgia is a rare and bizarre diagnosis usually missed by many clinicians. The rare occurrence and absence of clear diagnostic criteria could be a result of this missed diagnosis. The symptoms could range from debilitating pain in the axilla, medial arm, and forearm at rest and with specific shoulder movements. The symptoms are very distinct from axillary web syndrome in which the patient could have thickening of subcutaneous tissue of axilla with affected shoulder mobility but absence of neural symptoms. The diagnostic and treatment procedure involving breast cancer may cause injury or lesion of the intercostobrachial nerve and is of particular interest to the surgeons, pain physicians, and physical therapists. The diagnosis is reached after excluding all the other possible diagnoses. The treatment of this post-surgical intercostobrachial neuralgia can range from cryoneurolysis, ultrasound-guided nerve block, steroid injection, and paravertebral nerve block. Lidocaine injection and avoiding certain positions like flexion and abduction are helpful in certain patients. Unfortunately, there is not much literature available on possible manual therapy treatments of this diagnosis. Therefore, this case report focuses on potential manual therapies to address this intricate diagnosis. Case presentation The patient is a 38-year-old Asian female reported to an outpatient orthopedic physical therapy clinic with left medial arm and forearm pain for the past 5 years. Medical history included left breast lump removal surgery 9 years ago and cervical laminectomy C6–C7 with little success. The quick disability arm and hand scale showed a 36% disability score of function. The manual therapy approach targeted the cervicothoracic junction, second and third costovertebral joint, thoracic spine (T1–T8), and atlantooccipital joint (C0–C1). The patient showed significant improvement in function with a DASH score falling to 0% disability with a hands-on approach. Conclusion The intercostobrachial neuralgia is usually undiagnosed by various practitioners, physicians, and surgeons. The clinicians must consider manual treatments to the second and third rib and soft tissue mobilizations around the axillary region. The patient demonstrated significant improvement in symptoms with this approach.

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<p>Case Report Of Cryoneurolysis For The Treatment Of Refractory Intercostobrachial Neuralgia With Postherpetic Neuralgia</p>

Cited by 8 publications

References 20 publications

High-Intensity Laser Therapy to Treat Neuropathic Pain in Post-Herpetic Neuralgia

High-Intensity Laser Therapy to Treat Neuropathic Pain in Post-Herpetic Neuralgia

Case Report: Perspective of a Caregiver on Functional Outcomes Following Bilateral Lateral Pectoral Nerve Cryoneurotomy to Treat Spasticity in a Pediatric Patient With Cerebral Palsy

Intercostobrachial neuralgia—a case of bizzare diagnosis?

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