CASE REPORT Interventional treatment for neuropathic pain due to combined cervical radiculopathy and carpal tunnel syndrome: a case report Simone Vigneri 1,2 , Gianfranco Sindaco 2 , Matteo Zanella 2 , Elisabetta Sette 3 , Valeria Tugnoli 3 & Gilberto Pari 2 1 Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC), University of Palermo, Palermo, Italy 2 Santa Maria Maddalena Hospital and Advanced Algology Research, Occhiobello, Italy 3 Department of Neuroscience/Rehabilitation, Neurophysiology Unit, Arcispedale Sant’Anna, University of Ferrara, Ferrara, Italy Correspondence Simone Vigneri, Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC), University of Palermo, Palermo, Italy. and Santa Maria Maddalena Hospital and Advanced Algology Research, Occhiobello, Italy. Tel: +39 333 4289420; Fax: +39 0541 489926; E-mails: [email protected]and [email protected]Funding Information Advanced Algology Research. Received: 23 July 2016; Revised: 3 November 2016; Accepted: 5 January 2017 Clinical Case Reports 2017; 5(4): 414–418 doi: 10.1002/ccr3.840 Key Clinical Message The coexistence of median and cervical nerve root damage might hide a com- plex pathophysiology. Here, we describe and discuss the case of a patient suffer- ing from numbness and painful tingling of the hand, whose symptoms were effectively treated with pulsed radiofrequency and epidural administration of bupivacaine and morphine. Keywords Carpal tunnel syndrome, dorsal root ganglion, double-crush syndrome, epidural treatment, pulsed radiofrequency. Introduction Carpal tunnel syndrome (CTS) occurs following the com- pression of median nerve, due to its passage through the flexor retinaculum at the wrist. Symptoms involve numb- ness and painful tingling of palm and first three fingers or even weakness of the affected hand, although diagnosis may become more challenging if symptoms extend proxi- mally to the arm or sensitization signs occur [1]. More- over, the clinical picture may be complicated by the overlapping presence of peripheral neuropathy or cervical radiculopathy, worsening the outcome of common treat- ments [2]. The failure of decompression surgery might be subsequent to incorrect diagnosis or incomplete release of the transverse carpal ligament promoting persistent symp- toms, whereas recurrent symptoms seem to be related to fibrous proliferation and subtle palmar subluxation of the median nerve [3]. This report assesses whether some cases of CTS with poor response to treatments might actually be misdiag- nosed due to a different pathophysiology, therefore requiring different therapeutical approaches. Moreover, this clinical case evaluates how the development of inter- ventional treatments such as pulsed radiofrequency or epidural administration of drugs may promote symptom improvement in patients with complicated CTS. Case History A 69-year-old woman with unremarkable medical history was suffering for one year from progressive painful tin- gling sensation in the fingertips of her right hand. Most 414 ª 2017 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
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CASE REPORT
Interventional treatment for neuropathic pain due tocombined cervical radiculopathy and carpal tunnelsyndrome: a case reportSimone Vigneri1,2 , Gianfranco Sindaco2, Matteo Zanella2, Elisabetta Sette3, Valeria Tugnoli3 &Gilberto Pari2
1Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC), University of Palermo, Palermo, Italy2Santa Maria Maddalena Hospital and Advanced Algology Research, Occhiobello, Italy3Department of Neuroscience/Rehabilitation, Neurophysiology Unit, Arcispedale Sant’Anna, University of Ferrara, Ferrara, Italy