Publications by authors named "Caroline Brennick"

3 Publications

  • Page 1 of 1

Simplicity Radiofrequency Ablation Demonstrates Greater Functional Improvement Than Analgesia: A Prospective Case Series.

Pain Physician 2021 Mar;24(2):E185-E190

Department of Anesthesiology, UT Health San Antonio, San Antonio, TX.

Background: Pain originating from the posterior sacroiliac complex is notoriously difficult to effectively treat due to its complex anatomy and variable innervation. Data on radiofrequency ablation (RFA) is limited. The Abbott Simplicity probe creates 3 monopolar lesions along the medial aspect of the sacroiliac joint and 2 bipolar lesions between the active portions of the probe. This device has been studied previously with improvement of pain-associated disability and pain reduction, but insufficient data is present to determine its utility at this time. Using the most recent literature for the potential innervation of the posterior sacroiliac joint, it is reasonable to explore this novel device and its ability to treat sacroiliac joint pain.

Objectives: Identify the percentage of improved posterior sacroiliac complex pain and improved function in patients who completed posterior sacroiliac complex radiofrequency ablation using the Simplicity probe.

Study Design: Prospective case series.

Setting: A single outpatient pain clinic.

Methods: This prospective case-series occurred at an outpatient pain clinic. Data were analyzed after completion of follow-up appointments. Inclusion criteria included 2 successful lateral branch blocks. Fourteen patients with posterior sacroiliac complex pain were examined and completed sacroiliac ablation with the Simplicity probe. The numeric rating scale and the Modified Oswestry Disability Index were used as outcome measures for pain and function, respectively. The primary outcome measures were improvement in the numeric rating scale score by a reduction of 2.5 points and an improvement in Modified Oswestry Disability Index by 15% based upon previous studies demonstrating these values as the minimal clinical important difference . Patients were followed at a 3 to 6 month interval and 12 month interval (an average of 88 and 352 days, respectively).

Results: In total, 14 patients were examined. At the first follow-up, 29% of patients had analgesia and 38% functionally improved. At the second follow-up, 15% of patients had analgesia and 31% functionally improved.

Limitations: Considering data were collected retrospectively, this study relied on completed charts. Therefore, data points of interest were limited to what was previously documented, which included multiple answers or the absence of numerical data points. In addition, patients were disproportionately female (71.4%). Data were also affected by patients lost to follow-up. Also, this study examined a relatively small number of patients, therefore the results should be carefully considered.

Conclusions: Radiofrequency ablation of the posterior sacroiliac complex with the Simplicity probe resulted in more functional improvement than analgesia. This study provides more data for clinicians to utilize in managing posterior sacroiliac complex pain. IRB: Protocol number 20170342HU. Not registered in clinical trials.
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March 2021

Innervation of the Posterior Hip Capsule: A Cadaveric Study.

Pain Med 2021 Feb 10. Epub 2021 Feb 10.

Department of Anesthesiology, UT Health San Antonio Joe R. & Theresa Lozano Long School of Medicine.

Objective: Recent studies of hip anatomy have turned to the posterior hip capsule to better understand the anatomic location of the posterior capsular sensory branches and identify nerves with potential for neural blockade. Current literature has shown the posterior hip capsule is primarily supplied by branches from the sciatic nerve, nerve to quadratus femoris, and superior gluteal nerve (1, 2). This cadaveric study investigated the gross anatomy of the posterior hip, while also identifying potential targets for hip analgesia, with emphasis on the superior gluteal nerve and nerve to quadratus femoris.

Design: Cadaveric study.

Setting: University of Texas Health San Antonio Anatomy Lab.

Methods: 10 total cadavers (18 hips total), were posteriorly dissected identifying nerve to quadratus femoris, superior gluteal nerve, and sciatic nerve. Nerves were labeled with radio-opaque markers. Following the dissections, fluoroscopic images were obtained as sequential angles to identify neural anatomy and help expand anatomic knowledge for interventional pain procedures.

Results: The posterior hip capsule was supplied by the sciatic nerve in 1/16 hips, the nerve to quadratus femoris in 15/18 hips, and the superior gluteal nerve in 6/18 hips.

Conclusions: The nerve to quadratus femoris reliably innervates the posterior hip joint. Both the sciatic nerve and superior gluteal nerve may have small articular branches that may be involved in posterior hip innervation, but not this is not seen commonly. The results of this study may elucidate novel therapeutic targets for treatment of chronic refractory hip pain (i.e., the nerve to quadratus femoris).
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February 2021

Quantitative analysis of the distal, lateral, and posterior articular branches of the axillary nerve to the shoulder: implications for intervention.

Reg Anesth Pain Med 2019 Jul 8. Epub 2019 Jul 8.

Cellular and Structural Biology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.

Introduction: The terminal sensory branches innervating the shoulder joint are potential therapeutic targets for the treatment of shoulder pain. This cadaveric study investigated in detail the anatomic pathway of the posterior terminal sensory branch of the axillary nerve (AN) and its relationship to nearby anatomic structures for applications, such as nerve block or ablation of the shoulder joint.

Methods: For this study, nine shoulders were dissected. Following dissection, methylene blue was used to stain the pathway of the terminal sensory branches of the AN to provide a visual relationship to the nearby bony structures. A transparent grid was overlaid on the humeral head to provide further detailed information regarding the innervation to the shoulder joint.

Results: Eight of the nine shoulders displayed terminal sensory branches of the AN. The terminal sensory branches of the AN innervated the posterolateral head of the humerus and shoulder capsule and were deep and distal to the motor branches innervating the deltoid muscle and teres minor muscle. All terminal branches dissected innervated the shoulder capsule at the posteroinferior-lateral aspect of the greater tuberosity of the humerus. All specimens displayed innervation to the shoulder joint in the lateral most 25% and inferior most 37.5% before methylene blue staining.

Conclusion: The terminal sensory branches of the AN consistently innervate the inferior and lateral aspects of the posterior humeral head and shoulder capsule. These nerves are easily accessible and would provide a practical target for nerve block or ablation to relieve shoulder pain without compromising motor integrity.
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July 2019