A Case Report Highlighting a Promising Approach to Chronic Neuropathic Pain
Rethinking Treatment for RIBP
Radiation-induced brachial plexopathy (RIBP) is a rare but debilitating consequence of radiation therapy to the head, neck, or chest, affecting the peripheral nervous system. Patients often experience a combination of numbness, paresthesia, weakness, and chronic pain. The challenge? Traditional treatments, ranging from medications to surgical interventions that often offer minimal relief and come with undesirable side effects.
In a newly published case report, Maverick instructor Jon Wilton, DNAP, CRNA, explores the use of a novel approach: ultrasound-guided perineural hydrodissection. This minimally invasive technique, which has gained traction in chronic pain management, may offer new hope for patients living with RIBP.
The Technique: Using Hydrodissection to Relieve Nerve Entrapment
In this case, hydrodissection was performed under ultrasound guidance, allowing for the precise delivery of fluid to separate the affected nerve from surrounding tissues. This “unpinning” can alleviate symptoms by reducing mechanical irritation and improving nerve mobility without the systemic effects of medication or the risks of surgery.
Ultrasounds allowed the providers to visualize the brachial plexus in real time, guide needle placement, and confirm proper fluid dispersion around the nerve. The results in this case showed significant symptom improvement, suggesting that hydrodissection may be a viable option for managing RIBP-related deficits, especially when other therapies fall short.
Clinical Takeaway: A Minimally Invasive Option with Big Potential
While more research is needed to fully establish efficacy, this case report offers encouraging evidence that ultrasound-guided nerve hydrodissection can be both safe and effective in treating RIBP. For anesthesia providers and pain specialists, it’s a reminder of the evolving capabilities of ultrasound in both diagnosis and treatment.
About Jon Wilton
Jon is a clinical expert in pain management and a longtime Maverick Medical Education instructor. He is committed to bringing the most up-to-date treatments to both his patients and fellow providers. As a national instructor and respected voice in the pain management community, Jon continues to influence best practices through research, education, and hands-on instruction.
Explore Jon’s insights in his recent symposium presentation here, he begins at 6:04:10: https://canainc.org/handouts-cana-2025-opioid-epidemic-symposium/
Learn the Techniques with Maverick
Ultrasound-guided hydrodissection is just one example of how ultrasound technology continues to expand its role in patient care. With instructors like Jon Wilton leading the way, Maverick Medical Education is proud to support the advancement of real-world, evidence-based techniques that improve outcomes and elevate clinical practice.
