Alcohol for Neuroma Injection

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Hi,

I am looking to offer my patients that do not respond to steroid and biomechanical intervention alcohol injections for their neuromas. I can find lots of papers on the subject but I am not 100% sure what form of alcohol to order from my pharmacist to actually inject.

If anybody can let me know exactly what i request from my pharmacist I would greatly appreciate it.

Mathew

 

Hi stranger
I don't know personally but I know Ian Reilly was doing these a while back. Think he's on here-maybe drop him a line
Hope you're ok x

 

Matthew,

Long time no see (Edinburgh Pub with Kevin)

My concern here is insurance, have you been trained to use alcohol injections? I use glucose prolotherapy and have a really good success rate.
Do some research on the net!

Do I need to book in to come and do it? Not been to Cardiff yet -

Angie

 

Hi Matthew,

I have been using alcohol injections for years with good success.

First of all the mixture is a 4% ethyl alcohol/96% local anaesthetic. (You can remove 2cc from a 50cc vial of local anaesthetic and replace it with 2 cc of absolute ethyl alcohol)

Secondly, this does not kill the nerves, but rather stimulates it to heal. So do not mix corticosteriods with this injection. However, if there is adhesions/scar tissue around the nerve corticosteroid injections should be done first until this is resolved and then follow up at a seperate visit with the alcohol injections.

The location of the injection is determined by finding a positive Tinel's sign.

I deposit 1cc/linear inch of nerve damage.

If this is due to a traumatic incident, 1 injection usually suffices. If it is due to a biomechanical issue, then the biomechanical issue needs to be addressed.

In the case of a Morton's neuroma, the 4th metatarsal cuboid joint needs to be addressed. Follow this with an orthosis that supports this area (with a metatarsal pad and something under the 5th metatarsal head), and balance out the shortage if it exists on that side.

In the last 15 years, the only Morton's neuromas I had to remove were those that were previously treated by another podiatrist.

I hope this helps.

Regards,

Stanley

 

Agree with Stanley above. However, I prefer 8% alcohol mix with ultrasound guidance- just add 4cc instead if you want to try this. I started using the 8% before the 4% caught on. I usually perform injections two weeks apart up to four injections.

I am still waiting for a placebo controlled study to come out on this treatment option. If anyone knows of one or wants to do one that would be great.

 

Hi Matt

absolute alcohol, when i get a mo i will dig out the box. Been doing them for 15 years but never got Dock Dockery's results. There's a real knack to it.

Dock say to inject the normal nerve proximal to the swelling. Have gone off them due to the increased number of shots required, but am interested in the outcomes for prolotherapy too. I hear good things about it from colleagues.

In an ideal world i would just be doing the surgery and not doing any injections myself! LOL

AB

Ian