The patient a Saudi citizen came to the clinic 07-July-2021 after suffering RTA on March-2021, experienced a left shoulder pain with open wound of the ulnar side of the hand. Closure of the wound was performed at that time.

On examination, the patient feeling pain and numbness left ulnar territory left hand. Tinel sign positive over the left median and ulnar nerves. The motor branch of the ulnar nerve is intact, so the radial side of the little finger and ulnar side of the ring finger, but severe dysesthesia ulnar side of the little finger. Intact vascularity. There is also fixed flexion deformity of the tips of the middle and right finger. There is ugly scar due to operations at the ulnar side of the hand.

The patient was sent for investigation and MRI of the cervical spine showed syringomeylia at C2-6 and D1-2 of no significance. Left Shoulder showed tendinitis. X-ray of the hand ruled out fracture, but having foreign body (glass?). EMG showed also severe left CTS.

Exposure of the ulnar nerve above the pisiform bone and dissection carried down and the incision directed to the ugly scar. The motor branch was identified and neurolysis of the sensory branches of the left ulnar nerve. Using MultiGen it was possible to stimulate the motor branch with 1.8 Volts. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to the ulnar sensory branch supplying the ulnar side of the little finger  was achieved using 2 bended catheters 10 mm exposed length.  The pieces of glasses were removed and K-wire correction and fixation of the tips of the middle and ring fingers. Routine closure of the wound. Smooth postoperative recovery. He was sent to the ward.

MultiGen

The patient admitted and be followed by Dr. Ali Al-Bayyati.

This is the 216th case using MultiGen. This procedure regained routine acceptance.  It became a usual part of the spine and peripheral nerves surgery. Click here for reference.

It is the first time we use such protocol to the sensory branch to the little finger to ameliorate the dysesthesia.

With accumulation of data, it became clear that the irritated nerve with aberrant currents running in the C fibers up, not only causing no change or elevation of the required voltage to achieve motor response, but they could cause the preoperative weakness. Ablation of such currents results in facilitation of the motor response and improvement of function with disappearance of pain.

It is unclear why the roots have several motor response with different patients, despite the fact that the neurological status is the same and the anesthesia protocol also the same.

It could be that the nerve is recovering minute by minute after decompression and this can explain why the motor conductivity is improving after the BPRF application, which require 4 minute session in most cases.

After the 172d case, the elevation of motor stimulation above 5 V was abandoned to avoid delayed dural tear with subsequent CSF leak, which take place at the contact at the lower electrode shaft with the dura below the level of the axilla.