Sensory disturbances and pain complaints after brachial plexus root injury: A prospective study involving 150 adult patients

Abstract

After injury of the brachial plexus, sensory disturbance in the affected limb varies according to the extent of root involvement. The goal of this study was to match sensory assessments and pain complaints with findings on CT myelo scans and surgical observations. One hundred fifty patients with supraclavicular stretch injury of the brachial plexus were operated upon within an average of 5.4 months of trauma. Preoperatively, upper limb sensation was evaluated using Semmes-Weinstein monofilaments. Pain complaints were recorded for each patient. With lesions affecting the upper roots of the brachial plexus, hand sensation was largerly preserved. Sensory disturbances were identified over a longitudinal bundle on the lateral arm and forearm. In C8-T1 root injuries, diminished protective sensation was observed on the ulnar aspect of the hand. If the C7 root also was injured, sensation in the long finger was impaired. Eighty-four percent of our 64 patients with total palsy reported pain, versus just 47% of our 72 patients with upper type palsies. This rate dropped to 29% in the 14 patients with a lower-type palsy. C8 and T1, when injured, always were avulsed from the cord; when avulsion of these roots was the only nerve injury, pain was absent. Hand sensation was largely preserved in patients with partial injuries of the brachial plexus, particularly on the radial side. Even when T1 was the only preserved root, hand sensation was mostly spared. This indicates that overlapping of the dermatomal zones seems much more widespread than previously reported.

Segmental Spinal Root Avulsion in the Adult Rat: A Model To Study Avulsion Injury Pain

“…Behavioral tests were performed on days 0 (immediately prior to surgery), 1,3,5,7,9,11, and 14 for the naïve (n = 6), sham SRA (n = 6), and SRA (n = 6) groups, and on days 0, 5,7,11,13,14,18,20,21, and 25 for groups treated with amitriptyline (n = 6), carbamazepine (n = 6), or vehicle (n = 6). Six animals that underwent SRA were tested for pain behavior on days 5,7,18,25,32,39,48,53, and 60, to observe whether the pain persisted at longer time points.…”

Distal Sensory Nerve Transfers in Lower-Type Injuries of the Brachial Plexus

“…Lesions affecting the 3 lower roots of the brachial plexus tended to exhibit more extended sensory loss. 1 However, even in such extended lesions, sensation over the thenar region was preserved, allowing for the use of the palmar cutaneous branch of the median nerve as the donor. In 3 patients, transfer of cutaneous branches of the median nerve, either combined with or separate from fascicles of the ulnar proper digital nerve to the index finger, restored 2-point discrimination on the tip of the little finger.…”

“…In lower-type injuries of the brachial plexus, sensation in the territory of the dorsal branch of the ulnar nerve is impaired. 1 Hence, using the entire superficial radial nerve would produce complete anesthesia on the dorsal side of the hand. Alternatively, branches of the superficial radial nerve to the thumb could have been used, as proposed elsewhere for pure median nerve lesions.…”

“…1 Loss of sensation on the ulnar side of the hand predisposes to injury, because the ulnar side usually is used to support the hand while the radial fingers carry out manipulation. Sensation on the ulnar border of the hand is particularly important if the hand is ever placed on a potentially damaging surface, such as a hot stove.…”

Brachial Plexus Injury

“…49 Approximately 80% of the patients with an avulsion injury have chronic pain. 50,51 Pain is more commonly seen in adults and is not routinely observed in children. 51 Formation of a neuroma may be a source of pain after trauma to the brachial plexus.…”