The possible role of regenerating axons in pain persistence after brachial plexus grafting

Bertelli, Jayme Augusto; Ghizoni, Marcos Flávio

doi:10.1002/micr.20788

Cited by 14 publications

(10 citation statements)

References 21 publications

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“…This left us with eight patients with either moderate or severe, persistent pain, who had initially experienced pain relief shortly after surgery 14. In another study,16 we re‐evaluated these eight patients with persistent pain for a longer period. Following tourniquet and anesthetic blocks, we have concluded that after grafting, regenerating axons, which have attained the periphery, might be responsible for the persistence of pain.…”

Section: Discussionmentioning

confidence: 99%

Slow Cardiac Myosin Regulatory Light Chain 2 (MYL2) was Down‐Expressed in Chronic Heart Failure Patients

Tang

et al. 2010

Clinical Cardiology

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BackgroundGenetic studies have shown that many slow cardiac myosin regulatory light chain 2 (MYL2) gene mutations can cause hypertrophic cardiomyopathy, which is one of the most common causes of heart failure (HF). But until now there has been no pathological or histological evidence that MYL2 may be associated with HF development. Recent microarray studies indicated that myosin heavy chain expression changed in the pathological process of HF. Because MYL2 is a regulatory component of myosin heavy polypeptide, the role of MYL2 protein in HF needs to be studied.HypothesisThe level of expression of MYL2 may change in the heart tissue of patients with chronic HF.MethodsWe collected 28 human right auricle samples, 16 from chronic HF patients and 12 from healthy control subjects. Immunohistochemistry was carried out to observe the tissue‐expression pattern of the MYL2 protein and Western blot methods were performed to quantify the relative MYL2 expression level.ResultsIn chronic HF patients, the MYL2 protein level decreased significantly compared with normal controls (t test P < 0.05). Among the 16 HF patients, MYL2 expression in the severe HF group (New York Heart Association [NYHA] class III or IV) was even lower than that of the moderate HF group (NYHA class II) (t test P < 0.05).ConclusionsMYL2 was down‐expressed in HF tissues, and our findings suggested that MYL2 may play a role in the development and progression of chronic HF. Copyright © 2008 Wiley Periodicals, Inc.The first two authors contributed equally to this work. This study was supported by the National Natural Science Foundation of China (30800457, 30900803) and the Natural Science Program of Hubei Province (2009CDZ013). This study has no relationship with any kind of industry. The authors have no other funding, financial relationships, or conflicts of interest to disclose.

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Section: Discussionmentioning

confidence: 99%

Slow Cardiac Myosin Regulatory Light Chain 2 (MYL2) was Down‐Expressed in Chronic Heart Failure Patients

Tang

et al. 2010

Clinical Cardiology

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“…This left us with eight patients with either moderate or severe, persistent pain, who had initially experienced pain relief shortly after surgery. 14 In another study, 16 we re-evaluated these eight patients with persistent pain for a longer period. Following tourniquet and anesthetic blocks, we have concluded that after grafting, regenerating axons, which have attained the periphery, might be responsible for the persistence of pain.…”

Section: Painmentioning

confidence: 99%

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

2010

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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.

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“…We have postulated that pain in brachial plexus injuries stems from ruptured rather than avulsed roots, [12] challenging current concepts which blame deafferentation as the origin of pain [13]. In patients who have been grafted but pain persists, we have attributed pain to the growth of axons, because this process is associated with the large production of neurotrophic factors that produce pain [14,15]. B) Without graft-able roots In these patients, not only are there no roots available for grafting, but donor nerves for transfer -like the accessory and phrenic nerve -may not be available either.…”

Section: Total Palsymentioning

confidence: 99%

Results and current approach for Brachial Plexus reconstruction

Bertelli

Ghizoni

2014

J Brachial Plex Peripher Nerve Inj

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We review our experience treating 335 adult patients with supraclavicular brachial plexus injuries over a 7-year period at the University of Southern Santa Catarina, in Brazil. Patients were categorized into 8 groups, according to functional deficits and roots injured: C5-C6, C5-C7, C5-C8 (T1 Hand), C5-T1 (T2 Hand), C8-T1, C7-T1, C6-T1, and total palsy. To restore function, nerve grafts, nerve transfers, and tendon and muscle transfers were employed. Patients with either upper- or lower-type partial injuries experienced considerable functional return. In total palsies, if a root was available for grafting, 90% of patients had elbow flexion restored, whereas this rate dropped to 50% if no roots were grafted and only nerve transfers performed. Pain resolution should be the first priority, and root exploration and grafting helped to decrease or eliminate pain complaints within a short time of surgery.

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The possible role of regenerating axons in pain persistence after brachial plexus grafting

Cited by 14 publications

References 21 publications

Slow Cardiac Myosin Regulatory Light Chain 2 (MYL2) was Down‐Expressed in Chronic Heart Failure Patients

Slow Cardiac Myosin Regulatory Light Chain 2 (MYL2) was Down‐Expressed in Chronic Heart Failure Patients

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

Results and current approach for Brachial Plexus reconstruction

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