Chronic Neuropathic Pain of Brachial Plexus Avulsion Mistaken for Amputation Stump Pain for 36 Years: A Case Report

Abstract

Following an amputation of the extremities, chronic neuropathic pain and discomfort, such as phantom limb pain (phantom pain), phantom sensation, and stump pain may occur. Clinical patterns of phantom pain, phantom sensation, and pump pain may overlap and these symptoms may also exist in one patient. Serious trauma to the upper limbs can result in brachial plexus avulsion (BPA). If BPA occurs at the same time as severe trauma of the upper extremity and the amputation of the upper limb is performed, chronic neuralgia caused by BPA may be mistaken for chronic amputation pain, such as phantom limb pain or stump pain. No major treatment advances in phantom pain have been made. However, unlike phantom limb pain, chronic neuropathic pain caused by BPA can be effectively treated with dorsal root entry zone lesioning (DREZ)-otomy. We report a patient who suffered for 34 years because the neuralgia caused by BPA was accompanied by an amputation of the arm, and so was thought to be amputation stump pain rather than BPA pain. The patient's chronic BPA pain improved with microsurgical DREZ-otomy.

Dorsal Root Entry Zone Lesioning for Brachial Plexus Avulsion Injuries: Case Series and Literature Review

“…Radiofrequency lesioning was used in 17 studies; Samii et al initially used cordotomy electrodes to perform the DREZ lesioning, but later reported switching to radiofrequency electrodes ( 12 ). Thermal coagulation using bipolar cautery was used in 8 studies ( 6 , 23 , 26 , 28 , 31 , 36 , 38 , 39 ). In one study, Sindou et al reported performing sharp incisions in the dorsolateral sulcus followed by dot coagulation using bipolar cautery ( 6 ).…”

“…Seven case series were based on the same patient population, and only the most recent case series published were included in further analysis (8)(9)(10)(11)(12). The final study list included 31 papers, all of which were case series (6, 7, 10, 12-36) and case reports (37)(38)(39). No randomized controlled trials were identified.…”

Nerve Transfers to the Musculocutaneous and Suprascapular Nerve for Restoration of Elbow and Shoulder Function in Brachial Plexus Avulsion: An Early Experience

“…Brachial plexus avulsion causes characteristic pain and paralysis in the upper extremities but often goes undiagnosed for years due to trauma to the shoulder and arm 5,9,10) . Despite pain surgery for neuropathic pain in brachial plexus avulsion 5,9,10) , no surgical restoration of the function of the elbow and shoulder was possible because it was referred to the authors one year after a shoulder injury. Finally, the authors had an opportunity to identify and treat brachial plexus avulsion in a patient who presented with pain and paralysis in the left arm within 1 year of the injury.…”