Continuous radiofrequency in post-traumatic trochanteric syndrome
Clinical report
Pathos 2024; 31. 4. Online 2024, Dec 10
_________________________________________________________________________________
Dario Giaime
Dipartimento Emergenza Urgenza ASLCN1
Direttore S.S.D. Terapia Antalgica
e Gestione Accessi Venosi Centrali
_________________________________________________________________________________
Summary
Trochanteritis is a disorder that primarily affects individuals over the age of 50, with a higher prevalence among women. However, it can also occur in other age groups, particularly among athletes engaged in activities such as running, cycling, and brisk walking.
The pain associated with trochanteritis is localised to the hip and upper thigh. If left untreated, it can become a significant source of disability. The following case study presents the clinical course of a patient with trochanteritis who exhibited resistance to drug therapies. TThe patient underwent continuous radiofrequency treatment at our centre, which resulted in positive outcomes in terms of pain and walking.
Riassunto
Riassunto
La trocanterite è un disturbo che colpisce principalmente i soggetti di età superiore a 50 anni, con maggiore prevalenza tra le donne. Tuttavia, può verificarsi anche in altre fasce d'età, in particolare tra gli atleti che praticano attività come la corsa, il ciclismo e la camminata veloce.
Il dolore associato alla trocanterite è localizzato all'anca e alla parte superiore della coscia. Se non trattato, può diventare una fonte significativa di disabilità. Il seguente caso presenta il decorso clinico di una paziente con trocanterite che ha mostrato resistenza alle terapie farmacologiche. La paziente è stata sottoposta, presso il nostro centro, a procedura con radiofrequenza continua con esito positivo sul dolore e sulla deambulazione.
Key words
Trochanteritis, pain, therapies, continuous radiofrequency
Parole chiave
Trocanterite, dolore, terapie, radiofrequenza continua
Introduction
It is estimated that hip pain affects 10-15 per cent of the population over 60, with trochanteric syndrome being the main diagnosis.1-5 A range of treatments are available, including drug therapy, physiotherapy, chiropractic, acupuncture and invasive interventions such as intra-articular injections.6,7 However, it should be noted that procedures are not always effective in treating long-term pain.8-10
Intra-articular pulsed radiofrequency does not appear to be very effective in the treatment of the hip, while there are some cases in the literature of continuous radiofrequency thermolesion of the trochanteric branches of the femoral nerve.1,6,11
Materials and methods
51-year-old female patient with chronic post-traumatic left trochanteritis from an accidental fall occurred approximately 18 months earlier. The patient presents pain in the typical left trochanteric area radiating to the inguinal region and at the left lower limb up to the calf (lengthening in the lateral region of the lower limb) with exacerbation in the left lateral decubitus and deambulation.
Contrast-enhanced nuclear magnetic resonance (NMR) of the hip shows a chondrolabial detachment on the acetabular side in the anterosuperior area.
Pelvic NMR shows a lesion of the medius and minimus gluteus due to signs of trochanteric enthesopathy of the tendons of the left gluteus medius and minimus muscles with signs of partial insertional lesion in the presence of some peritendinous calcific deposits (19 mm) with a thin sub-tendinous-supratrochanteric fluid film in the absence of pathological fluid distension of the homonymous bursa.
Previous treatments
The patient was subjected to systemic drug therapy (NSAIDs, corticosteroids) and, due to the persistence of pain symptoms, after approximately 4 months, to the following therapies:
• infiltration of the greater trochanter;
• intra-articular hip infiltration with anesthetic;
•intra-articular hip infiltration with cortisone;
• intra-articular hip infiltration with hyaluronic acid.
Continuous radiofrequency
Previous treatments produced little benefit and the patient underwent a thermolabelling procedure under local anaesthesia in March 2024.
Before proceeding to thermolesion, a
- sensory stimulation test and evocation of the patient's pain on the superior and inferior gluteal nerves;
- injection of local anaesthetic and cortisone (lidocaine 2% 20 mg + dexamethasone 2 mg on each treated point).
Results
Five days after treatment, the patient achieved a reduction in pain from 8 to 2 (NRS - Numeric Pain Rating Scale) with full resumption of daily and work activities. The analgesic effect remained constant for the next 6 months after the procedure.
Conclusion
The reported case highlights how the use of radiofrequency thermolesion can prove to be an excellent ally in the treatment of chronic persistent post-traumatic pain in the trochanteric region. It is a minimally invasive technique with a low risk of complications. Further experiences will be necessary to confirm this observation.
Conflict of interests
The author declares that the clinical case was written without conflict of interest
Open Access-license (CC BY-NC 4.0)
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Published
10th December 2024
Bibliografia
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