Ultrasound Imaging and Guided Hydro-dissection in the Management of a Postamputation Deep Peroneal Neuroma

Wei-Ting Wu, Ke-Vin Chang, Levent Özçakar
Pain Practice: the Official Journal of World Institute of Pain 2020 April 1
In amputees, the majority of residual limb pain ensues due to neuroma(s). Recently, high-resolution ultrasound (US) has substantially facilitated the morphological evaluation of nerves and the surrounding soft tissues/scars contributory in entrapment syndromes. We reported a 57-year-old male, who had received below-knee amputation due to osteomyelitis three years ago, was seen for continuous stabbing and burning sensation at the left residual limb. US examination showed that the terminal end of the deep peroneal nerve was enlarged and encircled by hypoechoic scars. US-guided hydro-dissection was conducted besides the epineurium of the neuroma. After the injection, the numerical rating scale score decreased from 8 to 3, and the numbness was also relieved when putting on the prosthesis. It is noteworthy that one of the superiorities of dextrose (over corticosteroid) is the possibility to use higher volumes for adhesiolysis of the twisting scars. Herein, treatment success lies in introducing the needle at the upper and lower borders of the neuroma to ensure complete relief of the adhesions.

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