Radiofrequency ablation of the first carpometacarpal joint for osteoarthritis: a technical report.

Abstract

Background: Chronic pain associated with the first carpometacarpal (CMC) joint can significantly impair thumb mobility and grip strength. Radiofrequency nerve ablation (RFA) offers a promising minimally invasive intervention for managing refractory pain when resistant to conventional treatments. We report a novel approach of targeting articular branches supplying the CMC joint utilizing RFA, leading to prompt pain relief.

Case presentation: Radiofrequency nerve ablation was performed on a patient with a medical history of chronic CMC joint pain refractory to traditional interventions. The procedure involved ultrasound guidance in conjunction with fluoroscopy, facilitating precise needle placement at the articular branches supplying the CMC joint while avoiding surrounding structures. After surrounding structures were identified and the position of interest was confirmed, ablation was achieved by delivering controlled thermal energy through a 22-gauge RF needle. The intraoperative course proceeded without any blood loss or complications, providing immediate pain relief. Following the procedure, a combination of Depo-Medrol (80 mg) and 0.25% Marcaine was injected to enhance pain management further.

Conclusion: This unique approach highlights using RFA as a safe, minimally invasive alternative for refractory CMC joint pain. With ultrasound guidance and fluoroscopy confirmation, RFA may offer a valuable option for patients who have exhausted traditional treatments with little to no improvement in functionality.