Effects of 4% Ethanol Sclerosing Injection on Morton's Neuroma: A Histologic Study

Background Nonoperational treatments for Morton's neuroma remain controversial because it is believed that sclerosing injections do not change nerve fibers on a cellular level. Up to 80% success rates with 4% ethanol sclerosing have been documented, and the remainder required operational removal of the painful nerve. We sought to evaluate the histologic characteristics of Morton's neuromas treated with 4% ethanol sclerosing injection versus corticosteroid injection alone in patients who required removal of the nerve for pain relief. Methods A retrospective histologic review was performed of 23 consecutive patients who were treated with either sclerosing injection or nonsclerosing injection and underwent nerve removal between September 1, 2012, and February 28, 2015. Results Of 19 patients who met the inclusion criteria, eight received sclerosing injections and 11 received nonsclerosing injections. Intraneural fibrosis was more severe in the nonsclerosing injection group (P = .008). Conclusion Histologic changes are seen in Morton's neuroma with the use of 4% ethanol sclerosing injection, contrary to findings from previous studies.

Ultrasound-Guided Sclerosing Treatment in Patients With Patellar Tendinopathy (Jumper’s Knee)

Background: A randomized controlled study has shown good clinical results after treatment with sclerosing injections into the area with neovessels in patients with patellar tendinopathy, but no study has investigated medium- or long-term outcomes. Purpose: This study investigates the effect of sclerosing treatment 44 months (range, 42-47 months) after start of treatment. Study Design: Case series; Level of evidence, 4. Methods: Patients with a diagnosis of jumper’s knee and neovascularization corresponding to the painful area were recruited and treated with ultrasound-guided sclerosing injections using polidocanol. Primary outcome was Victorian Institute of Sport Assessment (VISA) score, which was recorded before the start of treatment, after 12 months, and 44 months after the start of the study period. Results: Twelve of the 29 patients (14 tendons) who were followed up at 44 months had undergone arthroscopic surgery after sclerosing treatment, either to the patellar tendon (n = 6) or for other intra-articular lesions (n = 8). For patients who did not receive additional treatment after the sclerosing injections (n = 23 tendons), VISA score was 55 (range, 28-71) at baseline and 81 (range, 39-100) at 12-month follow-up ( P < .001 vs baseline).Their VISA score at 44 months’ follow-up was 89 (range, 73-100; P = .047 vs 12 months). For patients who went through arthroscopic tendon surgery, VISA score was 53 (range, 39-71) at baseline and 71 before surgery (range, 48-98; P = .14 vs baseline). Their VISA score at 44 months was 91 (range, 76-100; P = .0.16 vs 12 months; P = .005 vs baseline). For patients who went through non–tendon surgery, VISA score was 45 (range, 15-69) at baseline and 57 (range, 32-95) before surgery ( P = .29 vs baseline). Their VISA score at 44 months was 92 (range, 72-100; P = .006 vs before surgery; P < .001 vs baseline). Conclusion: Sclerosing treatment with polidocanol was effective for the majority of the patients. Nevertheless, one-third elected to seek additional treatment through arthroscopic surgery during the 44-month follow-up period.