Disclosures: Nicholas Spinuzza, MD: Nothing to disclose

Case Description: 8-3MHz curvilinear transducer visualizes the anterior hip in transverse axis at the level of incisura acetabuli with patient in supine position, visualizing abObtN; femoral vascular bundle seen 2-3 cm superficial to abObtN. Then, with the transducer’s lateral end anchored down, the transducer’s medial end was pivoted upward to the iliopectineal-AIIS interval (IAi) visualizing abFN. Prognostic block performed by guiding 22-gauage, 3-1/2” needle in-plane, lateral-to-medial approach injecting local anesthesia around the abObtN, then withdrawn to a subcutaneous position before re-advancing the needle in the plane visualizing abFN to inject local anesthesia. The RFA procedure performed using the same technique with a 22-gauge, 100mm RF probe on a separate date, set at 70 degrees Celsius for 90 seconds, followed by the injection anesthetics and 10mg of dexamethasone.

Setting: Femoral nerve articular branches (abFN) and obturator nerve articular branches (abObtN) fluoroscopically-guided (FG) radiofrequency ablation (RFA) treatment is well-validated for chronic intractable hip pain but has the disadvantage of two separate needle entries to target abFN and abObtN, no direct femoral vasculature visualization, and radiation exposure. Existing ultrasound-guided (UG) techniques are only able to treat abFN.

Patient: 32M with intractable residual right anterior hip pain with underlying labral tear s/p repair/femoroplasty.

Assessment/Results: Baseline numerical analog score (NAS) and Oxford Hip Score (OHS) were 5/10 and 18/48, respectively, and were 3/10 and 30/48 respectively at 4-week follow-up.

Discussion: Decreased pain score and increased function validate successful treatment. Improvement over current techniques: 1) direct femoral vasculature visualization throughout the entire procedure, a safety improvement over FG RFA techniques; 2) this is the first hip UG RFA technique that treats both the abFN and the abObtN; 3) minimizes patient discomfort via one needle entry; and 4) no radiation exposure.

Conclusion: UG RFA to the abFN and abObtN with a SNE is an effective technique that improves patient safety and comfort.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/single-needle-entry-ultrasound-guided-pulse-radiofrequency-treatment-of-hip-joint-articular-nerves/