a 75-year - old male patient who had undergone above - knee amputation 50 years before visited the institution with a chief complaint of pain in the right leg stump , which had been exacerbated in the past 30 years . the underlying diseases of the patient were hypertension , atrial fibrillation , bronchial asthma , and lumbar spinal stenosis . at the time of the visit , the patient scored 8 - 9/10 on the visual analogue scale ( vas ) . even though his orthosis had been re - adjusted many times , the incidence of a breakthrough pain had increased and the patient had therefore become unable to wear it . the physical examination did not reveal any infection or ulcer at the stump , but a palpable mass was found . the tinel 's sign test proved positive . magnetic resonance imaging ( mri ) revealed the first neuroma measuring 8  2.4  2.2 cm at the proximal part of the sciatic nerve and the second one of about 0.6 cm at the proximal part of the tibial nerve , 2.8 cm below the first neuroma ( fig . 1% lidocaine 5 cc was injected under ultrasound guidance around the neuroma , following which the pain was decreased ( vas 2 - 3/10 ) and the symptoms evidenced by the tinel 's sign test disappeared . the plain radiograph did not permit any particular findings . in order to differentiate stump pain caused by neuroma from radiating pain caused by lumbar spinal stenosis , an electromyography ( emg ) and a nerve conduction velocity ( ncv ) test were performed . the results showed that bilateral radiculopathy was mainly confined to the left side , while the right leg pain was localized to the stump , and the decrease of the stump pain from the ultrasound - guided injection of the local anesthetic was significant . therefore , the patient was diagnosed with stump pain from stump neuroma and was subsequently referred to the department of orthopedics to receive surgical treatment . however , considering the high recurrence rate after excision of a neuroma , the potential complications of massive dissection , and the associated difficulties in the recovery of the damaged stump , a conservative treatment was recommended instead . although codeine phosphate 20 mg / d , ibuprofen 400 mg / d , acetaminophen 500 mg / d , and gabapentine 600 mg / d were administered for two weeks , there was no improvement in the symptoms . rather , side effects from the drugs became manifest , and the drug treatment therefore had to be discontinued . in light of this , we decided to perform ultrasound - guided pulsed radiofrequency ablation at the first neuroma stalk of the sciatic nerve . under ultrasound guidance , a 10 cm - long needle with a 5 mm active tip was installed as closely as possible to the distal part of the sciatic nerve neuroma stalk , whose diameter was about 6 mm ( fig . 2 ) . after 3 ml of 0.5% mepivacaine hcl were injected , pulsed radiofrequency ablation was performed three times at 42 for 120 seconds each , and 10 mg triamcinolone were then injected . one week after the pulsed radiofrequency ablation , the tinel 's sign test was negative , and the patient 's pain had decreased to a vas score of 2 - 3/10 . in particular , the incidence of the breakthrough pain which occurred when the patient wore the orthosis was decreased to a level of 30% or less , and the vas score was also significantly decreased to 4 - 5/10 . the effect of the pulsed radiofrequency ablation has persisted without any exacerbation of the symptoms during the follow - up period of the past six months . the patient in this case report did not receive any particular treatment for the stump pain which had first become severe 20 years after his above - knee amputation . when the patient became unable to wear the orthosis due to the exacerbated pain , he visited the pain clinic . on the basis of the results of the tests performed during his visit his pain was decreased by about 70 - 80% after pulsed radiofrequency ablation was performed at the neuroma stalk . the tunnel through which the axon fiber of the proximal part is extended is not formed by schwann cells , and neurotrophins are not generated . as a result , the axon fiber of the proximal part may extend in random directions to form a bulbous neuroma . the case where transplantation of a toe to an amputated finger with a painful neuroma not only recovered the functions of the hand but also eliminated the pain caused by the neuroma supported the hypothesis that neuroma is caused by the loss of a target organ to which the axon fiber of the proximal damaged nerve extends . however , since a case has been reported in which a neuroma was caused even after a diagnostic biopsy of the nerve , it is presumed that many mechanisms are involved in the formation of a neuroma . ultrasound enables us to examine the abnormalities of a soft tissue which are not visible through magnetic resonance imaging ( mri ) or computerized tomography ( ct ) due to the compactness of the tissue . the ultrasound technique also makes it possible to verify inflammatory changes such as fluid collection in a soft tissue . ultrasound may be used to verify the correlation between a neuroma and a proximal nerve , to determine the surgical range in a surgical approach so as to minimize dissection , and to perform diagnostic nerve block through injection of a local anesthetic , as well as neurolysis through injection of a neurolytic such as phenol . nerve fiber growth may be inhibited by the injection of alcohol , steroid , formalin , pepsin , nitrogen mustard , hydrochloric acid , and phenol , and the repeated injection of procaine to a neuroma is also recommended for pain oppression . in a surgery , ligation , electrocautery , and freezing of the nerve stumps are employed to reduce the size of the neuroma , and a laser - based method has recently been found effective . in a case report where the decrease in the vas score was compared after a surgical neuroma excision and after ultrasound - guided neurolysis , the vas score appeared to be decreased more significantly after ultrasound - guided neurolysis . there is a case report in which stump pain was effectively treated through neurolysis of a stump neuroma stalk by using a neurolytic . however , in the study on neurolysis of a stump neuroma stalk by using phenol , it was reported that the dose of the used neurolytic affected the result . therefore , the use of a large amount of neurolytic was considered as a potential successful treatment for the giant neuroma in this case . however , determining the dose of an appropriate neurolytic was difficult , and possible side effects such as local soft tissue necrosis caused by a neurolytic were also an important concern . although there is no existing case - to - case comparative study comparing the use of a neurolytic with pulsed radiofrequency ablation in the treatment of pain caused by a stump neuroma , there is a case in which pulsed radiofrequency ablation was performed on the morton`s neuroma patient group , which is a subject group for a surgical treatment , and the vas score was decreased by more than 70% in 85% of the patients , as well as a case in which pulsed radiofrequency ablation performed for the treatment of a stump neuroma produced excellent results . since pulsed radiofrequency treatment is a non - neurodestructive method , we assumed that pulsed radiofrequency ablation may present a low risk of symptom recurrence due to recombination of the remaining stalks in the ablated distal part with the proximal nerve and the formation of a new neuroma at the neurolyzed terminals , which can occur in the case of neurolysis using a neurolytic . these considerations led us to perform pulsed radiofrequency ablation for the treatment of the stump neuroma . there are reports of cases in which pulsed radiofrequency ablation was performed directly on a neuroma and results similar to those obtained in this study were obtained ; however , there is scarcely a case of pulsed radiofrequency ablation of a neuroma stalk as performed in this case . dismemberment patients are continuously generated by traffic accidents , industrial accidents , wars and other causes , and their age is very variable . in addition , dismemberment patients often complain of phantom limb , phantom pain , or stump pain . as evidenced in this case , performing ultrasound - guided pulsed radiofrequency ablation on a patient complaining of a dismemberment stump pain may be of great help in decreasing the patient 's pain .
amputation neuroma can cause very serious , intractable pain . 
 many treatment modalities are suggested for painful neuroma . 
 pharmacologic treatment shows a limited effect on eliminating the pain , and surgical treatment has a high recurrence rate . 
 we applied pulsed radiofrequency treatment at the neuroma stalk under ultrasonography guidance . 
 the long - term outcome was very successful , prompting us to report this case .