Pericapsular hip chemical denervation with phenol: A case report suggesting the interest of this new tool in rehabilitation medicine

Abstract

Introduction

Hip pain is a frequent complaint in Physical and Rehabilitation Medicine. The cause is often joint degradation, often exacerbated by the consequences of neurological or orthopedic conditions. Surgical treatment is not always feasible in fragile patients. When medical treatment is insufficient, the result is loss of autonomy. Based on an innovative technique of locoregional anaesthesia (PEricapsular Nerve Group block or PENG block) and recently adapted with phenol, our multidisciplinary team used it to improve function.

Observation

The case reported here is that of a 25-year-old woman presenting with luxating dysplasia of the right hip in the context of Costello syndrome. The main symptom reported was right hip pain with functional discomfort on walking. Medical treatment was only temporarily effective. The benefit/risk balance was unfavorable to surgery due to the young age and degree of dysplasia. In this context, phenol neurolysis of the hip pericapsular nerve group was performed, preceded by a prognostic anesthetic block. The procedure resulted in complete disappearance of hip pain and resumption of walking.

Discussion

The achievement of complete analgesia and recovery of the previous functional level in this case give this procedure prospects for use in clinical practice in physical medicine and rehabilitation. Chemical denervation of the anterior hip joint capsule is a simple, inexpensive procedure whose efficacy can be assessed beforehand by a prognostic anesthetic block. This procedure provides pain relief for frail patients, minimizing their loss of function while avoiding the risks of surgery.

Conclusion

Pericapsular hip chemical denervation appears to be an interesting alternative in the management of hip pain in therapeutic impasse, as it is likely to improve autonomy and even restore previous functional status.