Lumbosacral plexus entrapment syndrome. Part two: Symptomology and rehabilitative trials

Abstract

Background: Lumbosacral plexus entrapment syndrome (LPES) is a little-known but common cause of chronic lumbopelvic and lower extremity pain. The authors document the clinical course of 61 patients who were diagnosed and treated for LPES between May 2016 and October 2018. The study is aimed to evaluate the efficacy of our proposed diagnostic and conservative treatment protocol for LPES, clinically.Methodology: This is a retrospective cohort study of patients suffering from LPES. Patients were included in this study if they compatible symptoms with LPES with symptoms of low back, pelvic, groin, genital, thigh or calf pain after other more common etiologies have been excluded. Additionally, these patients had at least 5 positive provocative Tinel’s tests applied to various lumbopelvic and lower extremity (LPLE) nerve branches yielding => 7 (numeric rating scale) NRS, and weakness of one or more myotomes of the lower body. The group in its entirety was treated with gentle strengthening of the psoas major and piriformis muscles. The primary outcome measure was patient reported satisfaction and improvement including: Full, significant, moderate, slight, or no improvement in pain and symptoms. Patients were followed for up to two years.Results: The most common complaints amongst the patient pool were low back, groin, pelvic, posterior/lateral calf pain. Additionally, 17 patients (28%) stated that everything in the LPLE hurts, consistent with plexalgia. 13 patients were lost to follow-up as they did not reschedule treatment, for unknown reasons. Amongst the remaining 48 patients, 25 recovered fully (52%), 12 significantly (25%), and five moderately (10,4%). Five patients had a slight improvement (10,4%), and two no improvement whatsoever (4%). The average recovery times were mostly consistent with the time of affliction. Patients with a symptom duration of less than one year, generally recovered within 4 months. One to four years, within 10,5 months. Five to nine years, 7,5 months. And, finally, more than 10 years, within 18 months.Conclusion: Non-specific pain syndromes in the LPLE where other causes have been excluded, may be attributable to underlying LPES. In this study, a high correlation between the diagnostic & interventional protocols, and beneficial patient outcomes were demonstrated. However, more statistical and long-term research is needed.Citation: Larsen K, Chien GCC. Lumbosacral plexus entrapment syndrome. Part Two: Symptomology and rehabilitative trials. Anaesth pain & intensiv care 2019;23(2):138-144

Does thoracic outlet syndrome cause cerebrovascular hyperperfusion? Diagnostic markers for occult craniovascular congestion

“…Scapular retraction and depression narrows the costoclavicular passage and thus obstruct the subclavian artery or vein. 72,73 Similarly, ipsilateral rotation and extension will tauten the scalenus anticus and may consequently obstruct the subclavian artery at its passage through the interscalene triangle. In contrast, to positionally decompress these spaces, the patient should be set into cervical contralateral rotation and flexion (if unilateral) or just in flexion if it is bilateral, with moderate scapular elevation and slight protraction.…”

“…It is essential that common treatment fallacies that promote scapular retraction and depression, as well as scalene muscle stretching, are avoided, as these, although temporary relief may sometimes be experienced, will exacerbate the condition long-term. 71,72,73 The patient should be cued to keep their shoulders up in posture, at least one centimeter higher than that of maximal depression, to decompress the costoclavicular space and disengage the pectoralis minor, as well as gently strengthen their scalenus anticus and medius muscles twice per week. 71,72 With regard to palliative considerations, cerebral blood flow increases significantly when supine.…”