Nerve transfer to relieve pain in upper brachial plexus injuries: Does it work? (original) (raw)

Abstract

Patients with C5 and C6 nerve root avulsion may complain from pain. For these patients, end-to-side nerve transfer of the superficial radial nerve into the median nerve is suggested to relieve pain. Eleven patients (with a primary brachial plexus reconstruction) undergoing end-to-side nerve transfer of the superficial radial nerve into the ulnovolar part of the median nerve were assessed. Pain before surgery was compared to that at 6-month follow-up using visual analog scale (VAS) scores. A significant difference was seen between the mean VAS before (8.5) and after surgery (0.7) (P=0.0). After the six-month follow-up, 6 patients felt no pain according to VAS, notwithstanding 5 patients with a mild pain. The evidence from the present study suggests that end-to-side nerve transfer of the superficial radial nerve into the ulnovolar part of the median nerve is an effective technique in reducing pain in patients with C5 and C6 nerve root avulsion.

Loading...

Loading Preview

Sorry, preview is currently unavailable. You can download the paper by clicking the button above.

References (22)

  1. S.A. Woller, M.A. Hook, Opioid administration following spinal cord injury: Implications for pain and locomotor recovery, Experimental Neurology 247 (2013) 328-341.
  2. S. Andalib, A.M. Naeini, A. Garjani, N.A. Asl, A. Abdollahi, A comparative study pertaining to deleterious effects of diclofenac sodium and meloxicam on kidney tissue in rats, EXCLI journal 10 (2011) 149-154.
  3. J.A. Bertelli, M.F. Ghizoni, L.I. Chaves, D. Preissler, Sensory disturbances and pain complaints after brachial plexus root injury: A prospective study involving 150 adult patients, Microsurgery 31(2) (2011) 93-97.
  4. P. Ciaramitaro, M. Mondelli, F. Logullo, S. Grimaldi, B. Battiston, A. Sard, C. Scarinzi, G. Migliaretti, G. Faccani, D. Cocito, Traumatic peripheral nerve injuries: epidemiological findings, neuropathic pain and quality of life in 158 patients, Journal of the Peripheral Nervous System 15(2) (2010) 120-127.
  5. J.N. Campbell, R.A. Meyer, Mechanisms of neuropathic pain, Neuron 52(1) (2006) 77- 92.
  6. J.A. Bertelli, M.F. Ghizoni, Pain after avulsion injuries and complete palsy of the brachial plexus: the possible role of nonavulsed roots in pain generation, Neurosurgery 62(5) (2008) 1104-1114.
  7. M. Emamhadi, B. Alijani, S. Andalib, Long-term clinical outcomes of spinal accessory nerve transfer to the suprascapular nerve in patients with brachial plexus palsy, Acta Neurochirurgica 158(9) (2016) 1801-1806.
  8. L.J.-S. Yang, K.W.-C. Chang, K.C. Chung, A systematic review of nerve transfer and nerve repair for the treatment of adult upper brachial plexus injury, Neurosurgery 71(2) (2012) 417-429.
  9. K. Doi, K. Muramatsu, Y. Hattori, K. Otsuka, S.-H. Tan, V. Nanda, M. Watanabe, Restoration of prehension with the double free muscle technique following complete avulsion of the brachial plexus, The Journal of Bone & Joint Surgery 82(5) (2000) 652-652.
  10. J.S. Berman, R. Birch, P. Anand, Pain following human brachial plexus injury with spinal cord root avulsion and the effect of surgery, Pain 75(2) (1998) 199-207.
  11. C.B.W. Parry, Pain in avulsion lesions of the brachial plexus, PAIN 9(1) (1980) 41-53.
  12. C. Parry, Thoughts on the rehabilitation of patients with brachial plexus lesions, Hand clinics 11(4) (1995) 657-675.
  13. J.A. Bertelli, M.F. Ghizoni, Use of clinical signs and computed tomography myelography findings in detecting and excluding nerve root avulsion in complete brachial plexus palsy, Journal of neurosurgery 105(6) (2006) 835-842.
  14. S. Waikakul, W. Waikakul, S. Pausawasdi, Management of pain after brachial plexus injury: A parallel study, The Pain Clinic (2013).
  15. D. Tantigate, S. Wongtrakul, T. Vathana, R. Limthongthang, P. Songcharoen, Neuropathic pain in brachial plexus injury, Hand Surgery 20(01) (2015) 39-45.
  16. R.J. Spinner, D.G. Kline, Surgery for peripheral nerve and brachial plexus injuries or other nerve lesions, Muscle & nerve 23(5) (2000) 680-695.
  17. S. Leechavengvongs, K. Ngamlamiat, K. Malungpaishrope, C. Uerpairotkit, K. Witoonchart, S. Kulkittiya, End-to-side radial sensory to median nerve transfer to restore sensation and relieve pain in C5 and C6 nerve root avulsion, The Journal of hand surgery 36(2) (2011) 209-215.
  18. J.D. Loeser, A.A. Ward Jr, L.E. White Jr, Chronic deafferentation of human spinal cord neurons, Journal of neurosurgery 29(1) (1968) 48-50.
  19. P.C. Rinaldi, R.F. Young, D. Albe-Fessard, J. Chodakiewitz, Spontaneous neuronal hyperactivity in the medial and intralaminar thalamic nuclei of patients with deafferentation pain, J Neurosurg 74(3) (1991) 415-21.
  20. J. Privat, Y. Allieu, F. Bonnel, J. De Godebout, Pain following traumatic lesions of the brachial plexus (radicular avulsions and truncular lesions), Neuro-Chirurgie 31(5) (1984) 435-441.
  21. J. Berman, P. Anand, L. Chen, M. Taggart, R. Birch, Pain relief from preganglionic injury to the brachial plexus by late intercostal nerve transfer, J Bone Joint Surg Br 78(5) (1996) 759-760.
  22. N. Kato, M. Htut, M. Taggart, T. Carlstedt, R. Birch, The effects of operative delay on the relief of neuropathic pain after injury to the brachial plexus, Bone & Joint Journal 88(6) (2006) 756-759.