Musculoskeletal aetiologies account for most patients presenting with chest pain. Intercostal neuralgia is a lesser-known cause of musculoskeletal chest pain, which can present a diagnostic challenge with nonspecific imaging findings. We report a case of a 31-year-old male who presented with severe lower thoracic and chest wall pain following a suspected viral infection, where Magnetic Resonance Imaging (MRI) revealed characteristic features of denervation oedema within the affected intercostal muscles. This pattern of imaging findings in intercostal neuralgia is sparely described in the current literature. MRI along with history and examination was crucial in diagnosing the condition and excluding other potential causes of musculoskeletal chest wall pain on this occasion. The patient\'s symptoms were subsequently managed conservatively. The case highlights the importance of considering intercostal neuralgia as a potential cause of chest wall pain, particularly in the setting of post viral infection and absence of preceding mechanical musculoskeletal injury and explores an uncommon yet characteristic imaging finding which may be important in diagnosing the condition.
Nustatyti raumenų ir skeleto skausmų priežastį yra aktualu daugumai pacientų, besikreipiančių dėl skausmo krūtinės plote. Tarpšonkaulinė neuralgija yra nedažna raumenų ir skeleto krūtinės srities skausmų priežastis. Ją nustatyti iš gaunamos vaizdinės informacijos gali būti sunku, nes joje nėra jokių išskirtinių požymių.
UNASSIGNED: 31 metų vyras kreipėsi dėl intensyvaus skausmo apatinėje krūtinės ląstos dalyje bei krūtinės sienoje. Skausmas atsirado po, kaip spėjama, virusinės infekcijos. Magnetinio rezonanso tyrimas (MRI) atskleidė įprastinius denervacijos edemos požymius pažeistuose tarpšonkauliniuose raumenyse. Tokios tendencijos vaizdinėje medžiagoje tarpšonkaulinės neuralgijos atveju net ir naujausioje literatūroje yra menkai aprašytos. MRI, ligos istorija ir paciento apžiūra buvo itin svarbios nustatant skausmo priežastį ir atmetant kitas galimas raumenų ir skeleto krūtinės sienos skausmą sukeliančias priežastis šiuo konkrečiu atveju. Anksčiau paciento simptomai buvo išgydyti konservatyviais metodais. Šis atvejis atskleidžia, kaip svarbu atsižvelgti į tarpšonkaulinės neuralgijos galimybę kaip į galimą krūtinės sienos skausmo priežastį, ypač jei buvo persirgta virusine liga ir nėra žinoma buvus jokių ankstesnių mechaninių raumenų ar skeleto traumų. Šiuo atveju ištyrėme nedažną, tačiau vis dėlto standartinę diagnozę, gautą iš vaizdinės medžiagos, kuri gali būti svarbi nustatant šią sveikatos problemą.

BACKGROUND: The shoulder is one of the joints most affected by osteoarthritis, with a prevalence of almost 20% in adults over 65 years of age. Various treatments have been proposed to control osteoarthritis pain, including radiofrequency, pulsed and thermal, and recently cryoanalgesia. We propose in this series of cases a new approach to analgesic therapy with chemical denervation with phenol.
METHODS: Patients who underwent phenolysis for shoulder osteoarthritis at our institutions in Italy and Australia between August 2022 and May 2023 were included. All patients included in our report provided written consent for publication. This chemical neurolysis technique consisted of two injections. First, the anterior shoulder capsule was denervated by a modified deep SHAC (Shoulder Anterior Capsule) approach to cover the anterior terminal articular branches of the axillary nerve, lateral pectoral nerve, and subscapularis nerve. Second, the posterior shoulder capsule was denervated by a posterior glenoid approach to cover the terminal articular branches of the suprascapular nerve (SSN).  Results: We included a total of 11 patients in this case series. Ten of 11 patients were affected by shoulder osteoarthritis, of which three had rotator cuff tendinopathy and three had full-thickness cuff tears. One patient had chronic subluxation of a shoulder prosthesis. After treatment, all patients significantly reduced pain immediately after treatment and, two weeks later, recovered joint movement and improved quality of life. No adverse events or loss of motor function following treatment.
CONCLUSIONS: We presented a novel chemical approach to shoulder denervation, which was shown to be another effective way of improving pain and function in advanced glenohumeral arthritis.

Adduction and internal rotation of the shoulder is a common presentation in post-stroke patients, and can often be caused by spasticity and musculotendinous retraction causing a contracture of the pectoralis major and minor muscles. A post cerebral arteriovenous malfunction rupture patient with severe refractory left shoulder spasticity with contracture was treated with cryoneurolysis to the medial and lateral pectoral nerves, combined with a percutaneous needle tenotomy to the pectoralis major tendon. There was an improvement in shoulder forward flexion, abduction and external rotation immediately and found sustained at 8 weeks by 50°, 45°, and 15°. The patient noted an immediate cessation of limitation of shoulder abduction, a liberation of range of motion of the shoulder, and looseness in their arm and shoulder. They reported a dramatic improvement in their gait, increased independence, and an improvement in overall quality of life in a structured interview 8 weeks after the procedure. The patient relayed a positive experience with the combined neuro-orthopedic procedure of cryoneurolysis and tenotomy for the treatment of their spastic shoulder. This combined treatment could be considered as a management strategy for patients experiencing shoulder spasticity with contracture.

Masticatory muscle hypertrophy is a benign clinical anomaly which leads to facial asymmetry or a squared face appearance. We report a case of masticatory muscle hypertrophy, particularly on the right side, that was successfully treated by neurectomy of the right masseteric nerve through an extra-oral approach. Clinical examination showed significant aesthetic improvement of the facial symmetry with complete paralysis and atrophy of the right masseter muscle. The impaired postoperative function of the frontal branch of the right facial nerve was fully restored 10 weeks postoperatively. The patient no longer experiences headaches or discomfort with eating or sleeping on her right side.

Renal sympathetic denervation (RDN) carries a low risk of renal artery stenosis, and most cases occur within the first year. However, limited data are available on long-term incidence. Here, we present a case of a 68-year-old woman who underwent radiofrequency RDN for resistant hypertension. Ambulatory blood pressure improved following RDN and uptitration of antihypertensive drugs. Between year 3 and 4 after RDN, eGFR reduced from 87 to 50 ml/min per 1.73 m 2 . Ultrasound imaging revealed left renal atrophy, while subsequent magnetic resonance angiography showed a haemodynamically significant stenosis of the left renal artery. The patient remained in good clinical condition with stable blood pressure, while eGFR mildly deteriorated during a 6-year follow-up period. This case of renal artery stenosis occurred in a patient with multiple risk factors. A causal relationship to the RDN procedure cannot be confirmed nor ruled out. Long-term surveillance for adverse events should be considered in all RDN patients.

BACKGROUND: Total knee arthroplasty (TKA) is a reliable and widespread solution for knee osteoarthritis treatment, but about 20% of the patients complains of persisting pain. Neuroma formation in the IPBSN (infrapatellar branch of the saphenous nerve) is an undervalued cause of persistent anterior pain after TKA. The aim of this study was to evaluate the effectiveness of the selective neuroma denervation on patients satisfaction and pain improvement.
METHODS: Between 2014 and 2020, we evaluated 13 patients suffering from persistent anterior knee pain and numbness after TKA who underwent a surgical neurectomy of the IPBSN. After clinical assessment and diagnosis confirmation, we carried out the surgery. Short Form 12 Health (SF12), Oxford Knee Score (OKS), and Numeric Rating Scale (NRS) have been collected before and after the procedure. After the surgical treatment, the symptom\'s resolution and patients\' satisfaction were attested by the achievement of the Minimal ClinicallyImportantDifference(MCID) of the self-administered patient-reported outcome measures (PROMs).
RESULTS: Our results showed a statistically significant improvement (p < 0.05) of patients pain perception (mean NRS improvement -4.2, SD 2.5) and overall satisfaction (with a mean increase in OKS of 14.5 points SD 9.4, and in SF12 of 6.5 points SD 4.0).
CONCLUSIONS: Hence, our study suggests that selective neuroma denervation may be an effective solution to improve the quality of life of patients who develop this complication after TKA.

Total knee arthroplasty is a common operation performed to relieve pain and restore functional activity. While overall widely successful, a subset of patients has continued pain postoperatively with no identifiable cause. Neuroma formation has been identified as a possible contributor to this unexplained pain, often necessitating an additional procedure for neuroma removal. The purpose of our study was to evaluate if prophylactic neurectomy could reduce the occurrence of postoperative pain.
A total of 112 patients were compared, 44 control patients and 68 neurectomy patients. Demographic information, Numerical rating pain scale (NRS) and Knee Society Scores (KSS) were collected pre- and post-operatively. Patients were additional asked if they were overall satisfied with the operation.
There were no differences between groups with respect to age (Median: 71 vs 69 years, p = 0.28), male sex (41% vs 44%, p = 0.85), or body mass index (Median: 32.2 vs 31.3, p = 0.80). When comparing the degree of change following surgery there were no statistically significant differences observed in NRS pain scores (Median change: -7 vs -6, p = 0.89) or KSS scores (Median change: +44 vs +40, p = 0.14). Similarly, there was no statistically significant difference in overall patient-reported satisfaction with the knee replacement (82.5% vs 86.6%, p = 0.59).
We did not find a statistically significant difference in NRS, KSS, or overall patient satisfaction between the prophylactic neurectomy and control patient groups. Larger studies with evaluation of the nerve diameter will be needed to determine which patients are at risk for symptomatic neuroma development following total knee arthroplasty.

BACKGROUND: Cervical dystonia (CD) is a rare and difficult-to-treat disorder. Various neurosurgical options are available, each with its own set of advantages and disadvantages. We investigated using the modified McKenzie-Dandy operation for a patient with CD who failed selective peripheral denervation (SPD).
METHODS: A 42-year-old man presented left-sided rotational torticollis for 3 years. He was referred for surgery after treating with a variety of oral medications and repeated botulinum toxin injections that became ineffective. For the first operation, the patient underwent SPD (modified Bertrand\'s operation); unfortunately, the postoperative outcome was unsatisfactory, and the operation was considered a failure. After his symptoms did not improve after 6 months, the modified McKenzie-Dandy operation was performed. Immediately following surgery, he experienced satisfactory outcomes. He was able to resume his normal activities and employment after 1 month after recovering from his temporary swallowing difficulties. He only complained of minor neck pain and no recurrence was observed after 3 years follow-up.
CONCLUSIONS: For patients who have failed SPD, a modified McKenzie-Dandy procedure is a feasible and effective option. The procedure is relatively safe when performed properly, and the long-term effects can be maintained.

Chronic scrotal content pain, chronic orchialgia, or testicular pain can present after trauma, vasectomy, and hernia repair, among other triggers. Microsurgical denervation of the spermatic cord is an option for definitive pain control. While this practice is established in adult urology, access to diagnostic intervention and definitive denervation surgery is limited in the pediatric population.
We report a case of definitive resolution of testicular pain with microsurgical denervation of the spermatic cord in a pediatric patient with post-traumatic chronic orchialgia that significantly reduced his daily activities and worsened his anxiety prior to this treatment. The patient underwent attempts at conservative medication-based management, followed by diagnostic spermatic cord nerve block before definitive denervation surgery.
The incidence of chronic pain in pediatrics is substantial and is estimated to be around 20%. Orchialgia remains difficult and problematic to treat. Mental health diagnoses such as anxiety and depression are also significantly associated with chronic pain. Following consideration and implementation of steps for all these concerns, a diagnostic block and microsurgical denervation led to successful resolution of chronic testicular pain in a pediatric patient.
RéSUMé: OBJECTIF: La douleur chronique au niveau du contenu scrotal, l’orchialgie chronique ou la douleur testiculaire peuvent apparaître à la suite d’un traumatisme, d’une vasectomie, et d’une réparation herniaire, entre autres déclencheurs. La dénervation microchirurgicale du cordon spermatique est une option pour le contrôle définitif de la douleur. Bien que cette pratique soit établie en urologie de l’adulte, l’accès à l’intervention diagnostique et à une chirurgie de dénervation définitive est limité pour la population pédiatrique. CARACTéRISTIQUES CLINIQUES : Nous rapportons un cas de résolution définitive d’une douleur testiculaire par dénervation microchirurgicale du cordon spermatique chez un patient pédiatrique souffrant d’orchialgie chronique post-traumatique, laquelle réduisait de manière significative ses activités quotidiennes et empirait son anxiété, avant ce traitement. Le patient a subi plusieurs tentatives de prises en charge conservatrices à l’aide de traitements médicamenteux, suivies d’un bloc nerveux diagnostique du cordon spermatique avant chirurgie de dénervation définitive. CONCLUSION: L’incidence de douleur chronique en pédiatrie est importante et est estimée à environ 20%. L’orchialgie reste difficile et problématique à traiter. Des diagnostics de santé mentale tels que l’anxiété et la dépression sont également associés de manière significative à la douleur chronique. Après examen et mise en œuvre d’étapes pour tenir compte de toutes ces préoccupations, un bloc diagnostique et une dénervation microchirurgicale ont conduit à la résolution réussie de la douleur testiculaire chronique chez un patient pédiatrique.

UNASSIGNED: Cluster headache is a variant of primary neurovascular headaches. some patients with cluster headache are not responsive to medical treatment and may benefit from interventional modalities, including sphenopalatine ganglion block and denervation.
UNASSIGNED: Our purpose was to evaluate the efficacy of sphenopalatine ganglion block/denervation in the treatment of cluster headache.
UNASSIGNED: In this study, we performed the sphenopalatine ganglion block for patients with cluster headaches, intractable to medical therapy, who were referred to our pain clinic between 2014 and 2018. We registered the following information for all patients: demographic data, pain relief, and pain intensity. First, we conducted a prognostic C-arm-guided sphenopalatine ganglion block. If there was at least 50% pain relief within the first 5 h, then we denervated the ganglion by radiofrequency ablation. The main outcome of the study (dependent variable) was pain relief. We followed the patients for 6 months.
UNASSIGNED: Among 23 enrolled patients, 19 consented to interventional treatment. Fifteen out of 19 patients (79%) had an acceptable response to the prognostic block. Ultimately, 11 patients underwent ganglion denervation, and 4 patients did not consent for ganglion ablation. Pain relief at intervals of 48 h, and 1, 3, and 6 months after ganglion denervation was 77, 59, 50, and 31 percent, respectively.
UNASSIGNED: Sphenopalatine ganglion conventional radiofrequency denervation can effectively decrease the pain intensity of the patients with cluster headache for at least several months.