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Radiation-Induced Digital Neuropathy in an Interventional Physiatrist: Rapid and Durable Relief after Targeted
Jonathan Kallini1, Drew Barron1, Sloan Nesbit1
1Mayo Clinic Alix School of Medicine, Scottsdale, AZ.
Background:
Hands are frequently closest to the primary beam during fluoroscopy and can sustain cumulative exposure. Case reports of focal digital neuropathy in proceduralists are rare; imaging may be nondiagnostic, and treatment pathways unclear.
Case Report:
A 36-year-old interventional physiatrist developed 9 months of cyclical, severe allodynia localized to the radial half of the right index distal phalanx. Infectious/inflammatory treatments and hand therapy were ineffective. MRI was nonspecific; ultrasound showed focal hyperemia. Given typical hand positioning during procedures, radiation-induced digital neuropathy was suspected. A targeted radial digital nerve block at the distal interphalangeal level achieved near-complete pain relief by day 10 with durable benefit at 12 months.
Conclusion:
In clinicians with focal fingertip allodynia and nondiagnostic imaging, consider radiation-induced digital neuropathy. When conservative care fails, a targeted digital nerve block may provide rapid, durable relief and underscores best-practice radiation safety.
