Facet Joint Injection, Thoracic Spine

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…

Medial Branch Block, Thoracic Spine

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…

Epidural Steroid Injection, Cervical Spine

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…

Selective Nerve Root Block, Cervical Spine

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…

Facet Joint Injection, Cervical Spine

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:…

Medial Branch Block, Cervical Spine

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…

Common Peroneal Neuropathy

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

Median Neuropathy

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

Ulnar Neuropathy

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

Femoral Neuropathy

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

Hypertrophic Neuropathy

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…

Peripheral Neurolymphomatosis

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

Traumatic Neuroma

KEY FACTS Terminology Amputation neuroma (stump neuroma) Subtype of traumatic neuroma following traumatic or surgical amputation Morton neuroma: Traumatic neuroma between metatarsal heads 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

Brachial Plexus Traction Injury

KEY FACTS Terminology Synonyms: Brachial plexus stretch injury, brachial plexus avulsion, avulsion pseudomeningocele Stretch injury or avulsion of ≥ 1 cervical roots, brachial plexus 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

Muscle Denervation

KEY FACTS Terminology Secondary muscle injury resulting from denervation following nerve injury 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