Search Results (38)

Background: Midportion Achilles tendinopathy (Mid-AT) is a complex condition that may be exacerbated by anatomical variations of the plantaris tendon. Recent anatomical studies, particularly the classification proposed by Olewnik et al., have enhanced the understanding of plantaris–Achilles interactions and their clinical implications. Objective: This review aims to assess the anatomical types of the plantaris tendon, their imaging correlates, and the impact of the Olewnik classification on diagnosis, treatment planning, and surgical outcomes in patients with Mid-AT. Methods: We present an evidence-based analysis of the six anatomical types of the plantaris tendon and their relevance to Achilles tendinopathy, with emphasis on MRI and ultrasound (USG) evaluation. A diagnostic and therapeutic algorithm is proposed, and clinical outcomes of both conservative and operative management are compared across tendon types. Results: Types I and V were most strongly associated with symptomatic conflict and showed the highest benefit from surgical resection. Endoscopic approaches were effective in Types II and III, while Type IV typically responded to conservative treatment. Type VI, often misdiagnosed as tarsal tunnel syndrome, required combined neurolysis. The classification significantly improves surgical decision-making, reduces overtreatment, and enhances diagnostic precision. Conclusions: The Olewnik classification provides a reproducible, clinically relevant framework for individualized management of Mid-AT. Its integration into imaging protocols and treatment algorithms may improve therapeutic outcomes and guide future research in orthopaedic tendon pathology. Full article

Background/Objectives: Thoracic outlet syndrome (TOS) is a rare and difficult-to-diagnose condition in children, characterized by the compression of neurovascular structures in the thoracic outlet. Neurogenic TOS (nTOS) often presents with nonspecific symptoms such as paresthesia, weakness, and upper extremity discomfort. While anterior scalene muscle block (ASMB) has been used in adults as a diagnostic adjunct, its role in pediatric patients remains underreported. Methods: We present two adolescent female patients with suspected neurogenic thoracic outlet syndrome (nTOS) who were referred to the acute pain service for further evaluation. Both patients underwent ultrasound-guided ASMB. Results: Following the block, both patients experienced rapid and marked relief of symptoms. Subsequently, each underwent first rib resection with brachial plexus neurolysis. At follow-up, both patients reported a complete resolution of symptoms and a return to baseline function. Conclusions: These cases suggest that ASMB may serve as a functional diagnostic tool and short-term therapeutic test in pediatric nTOS patients. It also helps guide surgical decision-making for invasive treatment. However, as ASMB is not without risk, its role should be considered supportive rather than confirmatory. Further studies are needed to better define its utility and safety in the pediatric population. Full article

Postamputation pain (PAP), including residual limb pain (RLP) and phantom limb pain (PLP), remains a significant and debilitating complication after limb loss. Despite advances in pharmacological management, many patients experience inadequate pain relief, underscoring the need for alternative therapeutic strategies. Objective: This narrative review critically synthesizes current interventional therapies for PAP, focusing on mechanisms, clinical efficacy and practical application. Methods: A literature search was conducted in PubMed, EMBASE, Scopus and Web of Science databases for studies published between 2015 and 2025. Relevant articles on peripheral nerve interventions as well as different neuromodulation techniques were included. Results: Peripheral interventions (such as alcohol neurolysis, radiofrequency ablation (RFA) and cryoneurolysis (CNL)) and neuromodulation techniques (including spinal cord stimulation (SCS), dorsal root ganglion (DRG) stimulation and cauda equina stimulation (CES)) demonstrate promising outcomes for PAP. Peripheral nerve stimulation (PNS) shows favorable safety and efficacy profiles and may help prevent the chronification of pain. Conclusions: Contemporary interventional therapies represent valuable options in the multidisciplinary management of PAP. Nevertheless, further research is required to standardize clinical algorithms, optimize therapeutic decision-making and improve long-term outcomes and quality of life for individuals with PAP. Full article

Background/Objectives: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and various surgical techniques are used for its treatment. Extended open carpal tunnel release (EOCTR) has been proposed for improved nerve decompression. This study compares the clinical and functional outcomes of open carpal tunnel release (OCTR) and EOCTR in severe CTS, hypothesizing superior functional outcomes and lower pain levels with EOCTR. Methods: This retrospective study included 53 patients (45 females, 8 males) with severe CTS confirmed by electromyography. Patients underwent either OCTR (n = 28) or EOCTR (n = 25) between January 2020 and February 2023. The EOCTR techinque involved additional neurolysis of the recurrent motor branch and palmar cutaneous branch of the median nerve. Functional outcomes were assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), the Visual Analog Scale (VAS) for pain, and hand strength measurements. Complications and recovery parameters were also analyzed. Results: EOCTR resulted in significantly lower postoperative VAS scores (3.31 vs. 3.78, p < 0.001), DASH scores (16.54 vs. 20.68, p < 0.001), and BCTQ symptom scores (1.87 vs. 2.01, p < 0.001). No significant differences were found in grip strength (p = 0.52) or pinch strength (tip-to-tip: p = 0.54, lateral: p = 0.061, 3-point: p = 0.17). No major complications occurred, and pillar pain was similar in both groups (p = 0.82), resolving with conservative treatment. Conclusions: EOCTR with additional palmar cutaneous branch of the median nerve neurolysis may provide better short-term functional outcomes and lower pain levels compared to OCTR in severe CTS. Further prospective studies are needed to validate the long-term benefits and safety of this surgical approach. Full article

Background: Obturator nerve entrapment can result from endogenous and exogenous causes. Due to its long course, which includes both endopelvic and exopelvic segments, the nerve is susceptible to irritation from multiple etiologies. However, as obturator nerve entrapment is relatively uncommon, a thorough understanding of endogenous factors contributing to nerve entrapment is lacking. Nevertheless, understanding the endogenous factors contributing to obturator nerve entrapment is crucial for an effective treatment approach. Material and Methods: We performed a systematic literature search on studies investigating the diagnostic and (surgical) therapeutic approaches to obturator neuropathy due to endogenous causes. Studies were grouped according to the etiology responsible for nerve irritation. Lastly, data were synthesized to create a clinical work-up flowchart for obturator nerve entrapment syndromes due to endogenous causes. Results: Data from 45 studies comprising 175 patients met our inclusion criteria. We were able to summarize these data into six broad etiologies (tumor, obturator hernia, endometriosis, cystic lesions, vascular, and idiopathic causes) responsible for nerve irritation and saw that the most important factors for therapy are the onset of the symptoms and the anatomical localization. MRI emerged as the most valuable diagnostic tool for chronic conditions, especially in identifying the precise etiology and location of nerve compression. Conclusions: This review offers a structured framework for diagnosing and managing obturator nerve entrapment due to endogenous causes. We propose a diagnostic and therapeutic algorithm based on the identified etiologies to facilitate clinical decision-making. Full article

Pancreatic cancer is associated with high rates of morbidity and mortality. Endoscopic ultrasound (EUS)-guided biopsy has become the standard diagnostic modality per the guidelines. The use of EUS has been growing for providing various treatments in patients with pancreatic cancers: biliary and gallbladder drainage for those with malignant biliary obstruction, gastroenterostomy for malignant gastric outlet obstruction, celiac plexus/ganglia neurolysis for pain control, radiofrequency ablation, placement of fiducial markers, and injection of local chemotherapeutic agents. In this review, we explore the recent clinical studies evaluating the EUS-guided treatments in pancreatic cancer. Full article

Celiac plexus (CP) block (CPB) and neurolysis (CPN) are interventional techniques employed in human analgesia to control visceral pain originating from the upper abdomen. Visceral pain is common in animals and its treatment is challenging. A percutaneous ultrasound (US)-guided approach to the CP has been reported in people but not in veterinary species. The objective of this study is to describe a US-guided percutaneous approach to the CP in a porcine cadaveric model. Cadavers were positioned in right lateral recumbency. The vertebral body of the last thoracic vertebra (T15) was identified (in transverse view) with a left cranial abdominal US scan. Under US guidance, an 18 G Tuohy needle was inserted parallel and ventral to the transverse process of T15. The transducer was gently slid and tilted to have an in-plane view while introducing the needle through the epaxial muscle layer. Once the T15 body was contacted, the needle was advanced towards the ventral surface of the vertebra, and if loss of resistance was present, 2 mL of dye (China Ink) was injected. A laparotomy was performed, and the dyed tissue dissected for histological preparation from 14 cadavers. In all samples submitted for histological study, tissue belonging to the CP was found. The percutaneous ultrasound-guided approach to the CP was effective in localizing the CP in all subjects. Future studies are warranted to identify the clinical utility of this technique in veterinary species. Full article

Background: Humeral shaft fractures are relatively common. Complications associated with this type of fracture and its treatment include nonunion and radial nerve palsy. Plate osteosynthesis with autologous bone grafting is considered the gold standard for treating nonunion. However, bone grafts might not always be necessary in cases of hypertrophic nonunion, and treatment should be tailored to the specific type and characteristics of the nonunion. The treatment of radial nerve palsy is debated, with some favoring expectant management based on the nerve’s ability to regenerate, and others preferring early surgical exploration to prevent possible lasting nerve damage. Methods: We present the case of a 46-year-old male patient with a six-year-old humeral shaft fracture resulting in hypertrophic nonunion. We treated the nonunion with anterograde intramedullary nailing without bone grafting. Postoperatively, the patient developed severe radial nerve palsy. After repeated electrophysiological studies, a decision was made to surgically explore the nerve 10 days after the nonunion surgery. The nerve was subsequently found to be intact and treated with neurolysis. Results: Bony union was shown at six months after nonunion surgery. Four months after the nonunion surgery, the patient started to show clinical signs of nerve recovery, and at 12 months he achieved nearly full clinical recovery of radial nerve function. Conclusions: Anterograde intramedullary nailing without autologous bone grafting may be considered an option for treating hypertrophic nonunion. The management of radial nerve palsy requires effective cooperation and communication between patient and physician. Further research is necessary to be able to better predict nerve recovery. Full article

Meralgia paresthetica is a compressive neuropathy of the lateral femoral cutaneous nerve. Surgery is the gold standard for severe cases. However, no high-quality evidence exists on which strategy is best: decompression or neurectomy. Data of a consecutive series of 52 patients treated for meralgia paresthetica over 25 years (1997–2022) were retrospectively collected from medical records and telephone interviews. In total, 27 women and 25 men were operated on; 11 patients had iatrogenic meralgia paresthetica. Decompression was performed on 47 patients, and neurectomy in 8 cases (5 primary neurectomies plus 3 failed neurolysis). Out of the patients who underwent decompression, 41 (87.2%) benefited from the treatment; 3 had pain relief, but no benefit on paresthesia; and 3 reported pain persistence. The latter required neurectomy to resolve symptoms. The eight patients who underwent neurectomy experienced symptom relief but had an obvious anesthetic area persisting over years. Complications were rare (3.8%): a groin hematoma in the post-operative course and an inguinal herniation 6 months after surgery. Surgery, be it neurolysis or neurectomy, offers excellent results with low risks. Decompression has been proven to be adequate in almost all patients, avoiding the side effects of neurectomy. The latter should be confined to failed decompression or to iatrogenic meralgia. Full article

Background: Despite the availability of treatments such as surgery and hormonal therapy, women with endometriosis often endure chronic problems. This review aims to evaluate the effectiveness and safety of neuropelveology. Methods: In a systematic review with a meta-analysis, we searched three electronic databases: MEDLINE (PubMed), Scopus, Embase, and Web of Science (WOS). The search was conducted in January 2024 with no date or language restrictions using a carefully curated set of keywords. We conducted a comprehensive review, including all observational and clinical trials reporting data on neuropelveology approaches in the management of endometriosis, irrespective of geographical location. The studies included in our review were required to be published in peer-reviewed journals and be available in any language, with at least an abstract in English. The data of all included studies were summarized in excel (version 19) and were analyzed by Comprehensive Meta-analysis v3.3 (Biostat) and STATA (version 17). A multilevel meta-analysis was performed on studies with two arms (intervention and control) to evaluate the efficacy of neuropelveology in managing women with endometriosis. Results: After screening 476 records, 30 studies, published from 1952 to 2021, were included in this review, each employing various methodologies. The studies were divided into the following three categories: (a) efficacy of neurectomy or nerve resection (n = 20), (b) efficacy of neurolysis (nerve blocks) (n = 4), and (c) efficacy of neuromodulation (n = 6) in the management of endometriosis. Among the studies evaluating the efficacy of neurectomy or nerve resection, 10 studies (with 18 group comparisons) were included in the random-effects meta-analysis. Treatment success (not occurrence of pain) was higher with neurectomy vs. controls (RR = 0.497, 95% CI = 0.236 to 1.04, p = 0.06 (for experimental studies) and RR = 0.248, 95% CI = 0.14 to 0.43, p < 0.001 (for observational studies)), representing a 50% and 75.2% risk reduction in the recurrence of pain in experimental and observational studies, respectively. Similarly, neurolysis, particularly superior hypogastric plexus blocks and uterine nerve ethanol neurolysis, demonstrated encouraging outcomes in pain reduction and an improved quality of life for women with endometriosis. The efficacy of neuromodulation in managing endometriosis symptoms appears promising but requires further investigation. Conclusions: In conclusion, neuropelveology approaches, such as neurectomy, neurolysis, and neuromodulation, offer significant potential for pain reduction in endometriosis patients, albeit with risks of complications and high recurrence rates, necessitating careful patient selection and long-term monitoring. Full article

The autonomic nervous system plays an integral role in motion and sensation as well as the physiologic function of visceral organs. The nervous system additionally plays a key role in primary liver diseases. Until recently, however, the impact of nerves on cancer development, progression, and metastasis has been unappreciated. This review highlights recent advances in understanding neuroanatomical networks within solid organs and their mechanistic influence on organ function, specifically in the liver and liver cancer. We discuss the interaction between the autonomic nervous system, including sympathetic and parasympathetic nerves, and the liver. We also examine how sympathetic innervation affects metabolic functions and diseases like nonalcoholic fatty liver disease (NAFLD). We also delve into the neurobiology of the liver, the interplay between cancer and nerves, and the neural regulation of the immune response. We emphasize the influence of the neuroimmune axis in cancer progression and the potential of targeted interventions like neurolysis to improve cancer treatment outcomes, especially for hepatocellular carcinoma (HCC). Full article

The emergence of endoscopic ultrasound (EUS) has significantly impacted the diagnosis and management of pancreatic cancer and its associated sequelae. While the definitive role of EUS for pancreatic cancer remains incompletely characterized by currently available guidelines, EUS undoubtedly offers high diagnostic accuracy, the precise staging of pancreatic neoplasms, and the ability to perform therapeutic and palliative interventions. However, current challenges to EUS include limited specialized expertise and variability in operator proficiency. As the technology and techniques continue to evolve and become more refined, EUS is poised to play an increasingly integral role in shaping pancreatic cancer care. Full article

Celiac plexus block (CPB) and neurolysis (CPN) are used for pain management in people suffering from abdominal tumours or chronic pancreatitis. The fluoroscopically guided approach common in human medicine has not been described in veterinary settings. The aim of this study was to describe a fluoroscopic approach to the celiac plexus (CP) in fresh pig cadavers. Twelve animals were included in the procedure. Cadavers were positioned in sternal position and, under fluoroscopic guidance, a Chiba needle was inserted parasagittal at 6 cm from the spinal midline at the level of the last thoracic vertebra. From the left side, the needle was directed medio-ventrally with a 45° angle towards the T15 vertebral body; once the vertebral body was contacted, the needle was advanced 1 cm ventrally towards the midline. Iodinated contrast was injected to confirm the location. Following this, 2 mL of dye (China ink) was injected. A laparotomy was performed, and dyed tissue was dissected and prepared for both histochemical and immunohistochemical techniques. In 10 out of 12 samples submitted for histological evaluation, nervous tissue belonging to CP was observed. Fluoroscopy guidance allows for feasible access to the CP in swine cadavers in this study. Further studies are warranted to determine the efficacy of this technique in swine and other veterinary species. Full article

Neuralgic amyotrophy, also called Parsonage–Turner syndrome, in its classic presentation is a brachial plexopathy or a multifocal neuropathy, involving mainly motor nerves of the upper limb with a monophasic course. Recently, a new radiological entity was described, the hourglass constriction, which is characterized by a very focal constriction of a nerve, or part of it, usually associated with nerve thickening proximally and distally to the constriction. Another condition, which is similar from a radiological point of view to hourglass constriction, is nerve torsion. The pathophysiology of neuralgic amyotrophy, hourglass constriction and nerve torsion is still poorly understood, and a generic role of inflammation is proposed for all these conditions. It is now widely accepted that nerve imaging is necessary in identifying hourglass constrictions/nerve torsion pre-surgically in patients with an acute mononeuropathy/plexopathy. Ultrasound and MRI are useful tools for diagnosis, and they are consistent with intraoperative findings. The prognosis is generally favorable after surgery, with a high rate of good motor recovery. Full article

Purpose: Up to 12% of paediatric supracondylar humerus fractures (SCHFs) have an associated traumatic nerve injury. This review aims to summarize the evidence and guide clinicians regarding the timing of investigations and/or surgical interventions for traumatic nerve palsies after this injury. Methods: A formal systematic review was undertaken in accordance with the Joanna Briggs Institute (JBI) methodology for systematic reviews and PRISMA guidelines. Manuscripts were reviewed by independent reviewers against the inclusion and exclusion criteria, and data extraction, synthesis, and assessment for methodological quality were undertaken. Results: A total of 51 manuscripts were included in the final evaluation, reporting on a total of 510 traumatic nerve palsies in paediatric SCHFs. In this study, 376 nerve palsies recovered without any investigation or intervention over an average time of 19.5 weeks. Comparatively, 37 went back to theatre for exploration beyond the initial treatment due to persistent deficits, at an average time of 4 months. The most common finding at the time of exploration was entrapment of the nerve requiring neurolysis. A total of 27 cases did not achieve full recovery regardless of management. Of the 15 reports of nerve laceration secondary to paediatric SCHFs, 13 were the radial nerve. Conclusions: Most paediatric patients who sustain a SCHF with associated traumatic nerve injury will have full recovery. Delayed or no recovery of the nerve palsy should be considered for exploration within four months of the injury; earlier exploration should be considered for radial nerve palsies. Full article