73 The role of ultrasound guided pulsed radiofrequency (PRF) for the treatment of Rhizarthrosis: a case report

Background and Aims Rhizarthrosis is a disabling condition of the hand that affects 30% of postmenopausal women1. It commonly treated with physiokinesitherapy, non-steroidal anti-inflammatory drugs, intra-articular corticosteroid injections2 and trapeziectomy. Intra-articular PRF produces an electric field that disrupts smaller pain-carrying fibers of the synovial lining and reduces the levels of cytokines in the joint microenvironment3. Methods This report describes one case in which the ultrasound guided pulsed radiofrequency of the radial nerve offered a safe treatment for the management of chronic rhizarthrosis pain. The case was a 74-years-old man with a 12 month history of severe pain at the thumb basal joint. At his first visit, the VAS measured 8/10. The patient was sitting on the operating table with the trapezium metacarpal joint up. After preparation of the radial region, the sterile linear high frequency probe was longitudinally placed on the joint (figure 1). Then, a 22 G 50 mm radiofrequency needle was introduced near the superficial radial. nerve (figure 2). Subsequently a thermocouple connected to a radiofrequency generator was inserted to reproduce the patient‘s paresthesia via sensitive stimulation (50 HZ), 0.3–0.4 mA. The pulsed radiofrequency treatment was performed with 1200 pulses at 42°C. At the end the patient reported Vas 0. Results The result obtained confirms that the application of PRF on the trapezium-metacarpal joint can effectively reduce pain and paresthesia. Conclusions However, further studies would be needed to assess whether the proposed technique could be considered a legitimate therapeutic tool for pain control as a valid alternative to traditionally applied treatments.