NYU Langone Orthopedic Hospital, Department of Radiology, 301 E 17th St, New York, NY 10003.
NYU Langone Orthopedic Hospital, Department of Radiology, 301 E 17th St, New York, NY 10003.
Acad Radiol. 2020 Apr;27(4):518-527. doi: 10.1016/j.acra.2019.05.014. Epub 2019 Jul 3.
The medial plantar proper digital nerve, also called Joplin's nerve, arises from the medial plantar nerve, courses along the medial hallux metatarsophalangeal joint, and can be a source of neuropathic pain due to various etiologies, following acute injury including bunion surgery and repetitive microtrauma. We describe our clinical experience with diagnostic ultrasound assessment of Joplin's neuropathy and technique for ultrasound-guided therapeutic intervention including both injection and cryoablation over a 6-year period.
Retrospective review of all diagnostic studies performed for Joplin's neuropathy and therapeutic Joplin's nerve ultrasound-guided injections and cryoablations between 2012 and 2018 was performed. Indications for therapeutic injection and cryoablation, were recorded. Studies were assessed for sonographic abnormalities related to the nerve and perineural soft tissues. Post-treatment outcomes including immediate pain scores, clinical follow-up, and periprocedural complications were documented.
Twenty-four ultrasound-guided procedures were performed, including 15 perineural injections and nine cryoablations. With respect to sonographic abnormalities, nerve thickening (33%) and perineural hypoechoic scar tissue (27%) were the most common findings. The mean pain severity score prior to the therapeutic injection was 6.4/10 (range 4-10) and 0.25/10 (range 0-2) following the procedure; mean follow-up was 26.2 months (range 3-63 months). All of the cryoablation patients experienced sustained pain relief with a mean length follow-up of 3.75 months (range 0.2-10 months).
Therapeutic injection of Joplin's nerve is a safe and easily performed procedure under ultrasound guidance, with high rates of immediate symptom improvement. For those experiencing a relapse or recurrent symptoms, cryoablation offers an effective secondary potential treatment option.
内侧足底固有趾神经，也称为 Joplin 神经，发自内侧足底神经，沿大踇趾跖趾关节的内侧走行，可因各种病因引起神经病理性疼痛，包括急性损伤（如拇囊炎手术和反复微创伤）。我们描述了我们在 6 年期间使用诊断性超声评估 Joplin 神经病和超声引导治疗干预（包括注射和冷冻消融）的临床经验。
回顾性分析了 2012 年至 2018 年间所有因 Joplin 神经病而行的诊断性研究，以及行 Joplin 神经超声引导注射和冷冻消融的治疗性研究。记录了治疗性注射和冷冻消融的适应证。评估了与神经和神经周围软组织有关的超声异常。记录了治疗后的即时疼痛评分、临床随访和围手术期并发症。
共进行了 24 例超声引导下的手术，包括 15 例神经周围注射和 9 例冷冻消融。在超声异常方面，神经增厚（33%）和神经周围低回声瘢痕组织（27%）最为常见。治疗性注射前的平均疼痛严重程度评分为 6.4/10（范围 4-10），治疗后为 0.25/10（范围 0-2）；平均随访时间为 26.2 个月（范围 3-63 个月）。所有冷冻消融患者均获得持续的疼痛缓解，平均随访时间为 3.75 个月（范围 0.2-10 个月）。
Joplin 神经的治疗性注射在超声引导下是一种安全且易于操作的程序，可立即改善症状，且改善率较高。对于那些经历复发或症状再发的患者，冷冻消融是一种有效的二线潜在治疗选择。
