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Title: Management Of Post Covid Avascular Necrosis Of Hip (AVNH) With Pulsed Radiofrequency (PRF)Of The Nerves Supplying Hip Joint Followed By Ultrasonography Guided Dry Needling (USGDN) A Case Report
e-poster Number: INSIM122
Category: Pain
Author Name: Dr Satish Girhe
Institute:
Co-Author Name: Dr Lakshmi Vas, Dr Varsha S Suryavanshi, Dr Anis Kangani, Dr Jhanvi Vora
Abstract :
Aim: To describe perspective of Neuromyopathy in AVN.
To describe management of pain, disability with neuromodulation and
USGDN.
Introduction: Reactive arthritis is an emerging complication of COVID-19.
Retrospective studies show 10–30% incidence of AVNH with corticosteroid use
Case report: 29 years male anesthesia resident with history of covid being treated
with methylprednisolone presented with antalgic waddling gait and continuous
incapacitating pain VRS score 10/10, Lower extremity Functional Scale 4 (LEFS) in
right hip refractory to one month of Etoricoxib on orthopedic advice.MRI revealed
bilateral AVNH.
He was continued with oral Etoricoxib and started Pregabalin 75 mg HS.
Underwent PRF of femoral, obturator, superior and inferior gluteal and genicular
nerves. This was followed by USGDN after 4 days on back, buttock, and thigh
muscles
Results: PRF reduced his VRS to 4/10.Introduction of 32G needles in muscles for
USGDN demonstrated multiple local twitch reflexes in the gluteal adductor,
quadriceps and tensor fascia lata muscles. USGDN after 6 sessions gave total pain
relief with improvement in LEFS to 45, allowing him to resume duties.
Discussion: In this patient, pain appeared to be due to neuromyopathy
manifesting through hip muscles as the final common pain generators of hip
pathology via Hilton’s law. While PRF produced pain relief, USGDN provided pain
relief and functional improvement by relaxing the muscles spasms restricting the
joint movements.
Conclusion: Combination therapy with PRF for addressing peripheral sensitization
in nerves and USGDN addressing muscle spasm proved to be safe and effective in
relieving the intense suffering of AVNH.
