Pulsed RF of mixed motor/sensory nerves

[Timeoutofmind]

I have a patient with a cubital tunnel/ulnar nerve issue despite multiple surgeries. +EMG findings. Has failed many injections and meds.

What do you think about pulsed RF of the ulnar nerve? Obviously its an important motor nerve...I know there is some controversy as to if pulsed RF is actually destructive or not. Has anyone pulsed large mixed nerves? Like sciatic or ulnar for instance?

I am very hesitant, but otherwise, hard to think of much to offer...DRG/SCS?

Thanks in advance.

---

Members don't see this ad.

 

[DOctorJay]

DRG is not available for c spine. Please explain the EMG findings. Has the patient seen a surgeon regarding ulnar nerve transposition?


Sent from my iPhone using SDN mobile

 

[Disciple]

I have a patient with a cubital tunnel/ulnar nerve issue despite multiple surgeries. +EMG findings. Has failed many injections and meds.

What do you think about pulsed RF of the ulnar nerve? Obviously its an important motor nerve...I know there is some controversy as to if pulsed RF is actually destructive or not. Has anyone pulsed large mixed nerves? Like sciatic or ulnar for instance?

I am very hesitant, but otherwise, hard to think of much to offer...DRG/SCS?

Thanks in advance.

Ketamine cream may be worth a try.

 

[Timeoutofmind]

DRG is not available for c spine. Please explain the EMG findings. Has the patient seen a surgeon regarding ulnar nerve transposition?


Sent from my iPhone using SDN mobile

People are doing DRG for C spine in some of the academic centers...off label obviously, and I definitely would not at this point...

He is s/p ulnar nerve transposition.

Does not meet Budapest Criteria for CPRS, but his pain is definitely neuropathic

EMG shows mild, chronic, ulnar mononeuropathy at the elbow.

He also has tennis elbow on the same elbow lateral aspect.

He is scheduled for revision ulnar nerve decompression, tennis elbow injection. Surgeon was frank that this will probably not take care of all his pain, so wanted me on board up front.

I did give him a compound cream with ketamine, thanks for that suggestion.

Its worker's comp, but hes still working...

 

[DOctorJay]

interesting (and tough) case, agree with you that trying cervical SCS may be reasonable if he doesn't improve with another surgery

 

[mazinger]

People are doing DRG for C spine in some of the academic centers...off label obviously, and I definitely would not at this point...

He is s/p ulnar nerve transposition.

Does not meet Budapest Criteria for CPRS, but his pain is definitely neuropathic

EMG shows mild, chronic, ulnar mononeuropathy at the elbow.

He also has tennis elbow on the same elbow lateral aspect.

He is scheduled for revision ulnar nerve decompression, tennis elbow injection. Surgeon was frank that this will probably not take care of all his pain, so wanted me on board up front.

I did give him a compound cream with ketamine, thanks for that suggestion.

Its worker's comp, but hes still working...

I have pulsed many many motor nerves in my career includind the DRG. Never had a motor problem with this technique. If it works, it works wonders, if it doesn't then then you can move to other more complex stuff. I doubt more surgery will help.
Good luck getting pRF approved by WC.

 

[Ligament]

I have pulsed many many motor nerves in my career includind the DRG. Never had a motor problem with this technique. If it works, it works wonders, if it doesn't then then you can move to other more complex stuff. I doubt more surgery will help.
Good luck getting pRF approved by WC.

Same here. Never any problems with mixed motor and sensory nerves, including DRG, sphenopalatine ganglion, etc

 

[epidural man]

I've pulsed every named nerve (not really...but probably close). It does nothing to the nerve. The effect is spinal cord mediated (likely). pRF does nothing to the nerve. Have no fear of the electrical field. Have fear of the needle tip and placement.

 

[Orin]

What're you guys doing for pulsed RFs of larger mixed motor/sensory nerves protocol wise?
There seems to be some variability in the parameters folks use in the literature.

 

[unchockey21]

What're you guys doing for pulsed RFs of larger mixed motor/sensory nerves protocol wise?
There seems to be some variability in the parameters folks use in the literature.

We're doing 42 degrees for 120 sec x4.

 

[Ligament]

I do 960 "pulsed doses" on a neurotherm machine.

 

[olafa]

I do 960 "pulsed doses" on a neurotherm machine.

is that 2 pulses per sec and thus 8 minutes total?
I typically does two cycles 2 min starting clock once parameter met volt, temp etc then adjust needle for second cycle

 

[epidural man]

I do 960 "pulsed doses" on a neurotherm machine.

Exactly what I do. 45C at 45V. Sometimes 42C at 45V.

 

[Ligament]

is that 2 pulses per sec and thus 8 minutes total?
I typically does two cycles 2 min starting clock once parameter met volt, temp etc then adjust needle for second cycle

Yes that is correct, takes a while...