KEY FACTS Terminology Selective corticosteroid and long-acting anesthetic injection of lumbar nerve root at level of neural foramen Preprocedure Imaging Single or multilevel involvement Procedure Carefully determine correct level(s) for injection Nerve root exits below pedicle of same numbered vertebral body 2 approaches for lumbar selective nerve root block Angle C-arm toward side to be injected and target beneath pedicle/“eye” of “Scotty dog” Using AP projection,…

KEY FACTS Terminology Injection of corticosteroid and anesthetic into lumbar facet joint Preprocedure Facet joint osteoarthritis Synovial cyst causing neurologic symptoms Procedure Prone Angle C-arm or PA fluoroscopy tube slightly toward side of joint to be injected Generally, lower 1/3 of joint is most amenable to needle entry/injection in arthritic joint Ensure proper level Slowly inject only enough contrast to confirm that needle tip is in…

KEY FACTS Terminology Selective anesthesia of lumbar nerve medial branch in diagnostic evaluation of lumbar facet joint pain Preprocedure Facet joint pain Useful in selecting patients for medial branch radiofrequency ablation procedure Procedure Target: Junction of superior articular process and transverse process Medial branch is numbered along with exiting lumbar nerve root L5 medial branch innervates inferior L4/5 and superior L5/S1 facet joint Patient positioning Prone:…

KEY FACTS Terminology Injection of glucocorticoid/long-acting anesthetic into thoracic epidural space via interlaminar or transforaminal approach Procedure Interlaminar epidural steroid injection (ESI) Define margins of lamina and interlaminar space Transforaminal ESI Ensure good visualization of neural foramen on true lateral view Benefit of CT Improved visualization of osseous structures in severely osteopenic patients Improved visualization of pleura/medial chest cavity Post Procedure Expectation Improvement in pain, or…

KEY FACTS Terminology Selective corticosteroid and long-acting anesthetic injection of thoracic nerve root at level of neural foramen Preprocedure Indications Thoracic radiculopathy Persistent pain after vertebroplasty/kyphoplasty Neoplastic compression of thoracic nerve root Procedure Use nonparticulate steroid to minimize vascular risk C-arm angulation must permit visualization of medial pleural surface of lung during procedure CT offers improved soft tissue and lung visualization Sagittal/coronal reformatted CT may facilitate…

KEY FACTS Terminology Injection of long-acting anesthetic ± corticosteroid into thoracic facet joint Preprocedure Preprocedure imaging Correlate level with prior imaging – Evaluate for 12 ribs &/or transitional vertebral anatomy Indications for procedure and future treatment plan Is facet joint injection or medial branch block more appropriate? Procedure Fluoroscopy Align margins of facet joint to maximize visualization of joint space Contrast is useful to evaluate intraarticular…

KEY FACTS Terminology Selective anesthesia of thoracic spinal nerve medial branch in assessment of thoracic facet joint pain Preprocedure Thoracic facet joint pain Confirm clinical suspicion (diagnostic) Evaluate likelihood of successful facet neurolysis Preprocedure imaging Procedure Target Immediately above transverse process/superior articular process junction – Be sure to avoid lung Carefully approach medial branch as close as possible to lateral aspect of superior articular process Record…

KEY FACTS Terminology Percutaneous injection of glucocorticoid into cervical epidural space Interlaminar: Approach epidural space between lamina Transforaminal: Approach epidural space via neural foramen Preprocedure Indication Cervical pain &/or cervical radiculopathy Coagulopathy Preprocedure imaging Assess adequate epidural space to accommodate needle placement/injection Procedure Loss of resistance/free injection of saline reveals tip in epidural space (or intrathecal) Inject contrast to verify needle tip placement Post Procedure Expectation…

KEY FACTS Terminology Selective anesthesia of cervical nerve root at level of neural foramen Preprocedure Radiculopathy corresponding to cervical dermatome Procedure Target Superior articular process of same number vertebra as nerve being injected (nerve comes out 1 level above) At level of superior articular facet, deflect needle anteriorly into neural foramen Verify needle tip placement within neural foramen in frontal and lateral projections Slowly inject iodinated…

KEY FACTS Terminology Anesthetic ± corticosteroid injection into cervical facet joint Diagnostic study for pain referable to cervical facet joint Preprocedure Indications Chronic or acute on chronic cervical facet osteoarthritis Posttraumatic osteoarthritis Preprocedure imaging Correlate imaging abnormality with patient symptoms Assess degree of bone overgrowth and best place to access joint Procedure Supine, decubitus, or prone depending on level to be injected/anatomic relationships Craniocervical junction Occiput/C1:…

KEY FACTS Terminology Selective anesthesia of cervical nerve medial branch in diagnosis of cervical facet joint pain Preprocedure Facet joint pain Useful in selecting patients for medial branch radiofrequency ablation procedure Need to block level above and below facet joint for effective anesthesia Procedure Preferred patient position: Supine Preferred imaging plane: True lateral view C2/3: 3rd occipital nerve block Target: Immediately above and below C2/3 facet…

KEY FACTS Terminology Tarsal tunnel syndrome You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

KEY FACTS Terminology Synonyms: Common peroneal nerve (CPN) palsy, CPN entrapment Common peroneal nerve entrapment at fibular head You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

KEY FACTS Terminology Pronator syndrome: Nerve entrapment at pronator teres Carpal tunnel syndrome: Nerve entrapment at carpal tunnel You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

KEY FACTS Terminology Suprascapular nerve impingement with muscle denervation You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

KEY FACTS Terminology Synonyms: Ulnar nerve (UN) entrapment, cubital tunnel syndrome Partial fixation, compression, or distortion of UN You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

KEY FACTS Terminology Synonyms: Femoral neuropathy, femoral mononeuropathy, femoral nerve (FN) palsy FN entrapment or injury 2° to direct trauma, compression, stretch injury, or ischemia You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

KEY FACTS Terminology Clinically and genetically heterogeneous group of inherited disorders with focal or diffuse peripheral nerve enlargement Hereditary motor-sensory neuropathy (HMSN) HMSN I (Charcot-Marie-Tooth syndrome type I, CMT1) HMSN II (neuronal-type peroneal muscular atrophy, CMT2) HMSN III (Dejerine-Sottas disease, hypertrophic neuropathy of infancy, congenital hypomyelinating neuropathy) You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If…

KEY FACTS Terminology Synonyms: Peripheral neurolymphomatosis (NL), perineural lymphomatosis Perineural plexus or peripheral nerve lymphomatous infiltration You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

KEY FACTS Terminology Grouping of benign and malignant primary tumors of peripheral nerves You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here