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Background and Aims 50 years old, with a left fibula exceresis, immediate postoperative period the patient reported severe intense pain. Patient with diagnostic criteria of CRPS type 2, in view of the surgical history, a nerve MRI was requested which reports extensive neuropathy of the superficial peroneal branch grade 3 with areas Sunderland grade 4 with the presence of small nodular images reminiscent of continuity neuromas with involvement of the blood-neural barrier. The extension of the neuropathy is approximately 12cm. No discontinuity of the epineurium was identified. Fibrotic changes surrounding the nerve branch the most significant at the level of its passage to the subcutaneous space.

Methods Multiple interventional treatments were performed without response, so we perform a approach of superficial peroneal nerve and pulsed radiofrequency plus a ultrasound-guided intranervous PRP infiltration, the patient reported 80% improvement of symptoms, maintained for 8 months with subsequent recurrence, we perform again the same approach without response.

Results Intraneural injection of PRP has been used for the treatment of compressive neuritis,¹ platelet activity once activated favor the release of cytoplasmic granules that promote a potential therapeutic effect to promote nerve repair.² The exact molecular mechanism by which PRP produces nerve repair is not elucidated, multiple mechanisms have been proposed.

Conclusions In our patient the symptoms reappeared, taking into account the extensive neural damage, we suppose that the failure to respond is due to progression of the damage, more studies with this technique are needed to validate this observation.

References

1. Bejarano MC, et al.Cureus. 2023 Jul 20;15(7):e42223.

2. Sánchez M, et al. Expert Opin Biol Ther. 2017 Feb;17(2):197–212.