POSTINJURY NEUROPATHIC PAIN SYNDROMES
Section snippets
BRACHIAL PLEXUS TRACTION INJURY
The usual cause of a brachial plexus traction injury is sudden flexion-extension of the cervical spine from a fall or automobile accident.85 Repetitive movements of the arm, particularly overhead, also commonly cause the injury.80 Immediately after the injury and progressing over the next 24 to 48 hours, patients complain of pain across the trapezius ridge that radiates into a C2-3 distribution into the back of the head then down the medial scapular border to its tip (notalgia). Patients are
REFLEX SYMPATHETIC DYSTROPHY (COMPLEX REGIONAL PAIN SYNDROME)
Many patients who have suffered brachial and cervical plexus injuries develop reflex sympathetic dystrophy. This complication most frequently follows injury to the lower trunk because the sympathetics enter the arm in conjunction with these fibers primarily from the T2 sympathetic ganglion.85 The syndromes of reflex sympathetic dystrophy and causalgia have been reclassified as CRPS I if no specific nerve injury can be identified or causalgia (CRPS II) if a specific nerve is damaged.62 CRPS I
Lumbosacral Tunnel Syndrome
The L5 nerve root is most commonly involved by disk disease, spondylosis, or spinal stenosis. It may be entrapped as it crosses the alla of the sacrum under the lumbosacral ligament. A large fibrous band, the lumbosacral ligament originates from the fifth lumbar vertebra and inserts on the upper border and anterior surface of the alla of the sacrum. The fifth lumbar root runs under this ligament in conjunction with branches of the iliolumbar artery and veins and the sympathetic ramus
PAINFUL NEUROMAS
Painful neuromas originate in areas of injured axons. Normal axons in midnerve are unable to generate repetitive impulses and are capable only of impulse propagation. In a neuroma, the end bulbs of sectioned axons and sprouts of injured axons generate nerve impulses.32 Painful neuromas are usually located in amputation stumps, surgical scars, or the oral cavity. They are extremely mechanosensitive as pressure or light percussion elicits paresthesias and lancinating pain in the distribution of
SUMMARY
Pain is clearly one of the most daunting problems of modern medicine. Posttraumatic neuropathic pain syndromes are a major component of the clinical problem. Structural lesions affecting roots, nerves, the plexi, and central structures can be imaged noninvasively. The molecular biology of the intraneural cascades that cause sensitization of the central pain-projecting neurons of the dorsal horn and subsequent allodynia, hyperalgesia, and hyperpathia is a subject of intense inquiry. The role of
References (112)
Neurogenic inflammation in skin and airways
J Invest Dermatol Proc
(1997)- et al.
Pain and the pathophysiology of damaged nerve
- et al.
Response of muscle spindles to stimulation of the sympathetic trunk
Exp Neurol
(1960) - et al.
Scalenus anticus syndrome
Am J Surg
(1947) - et al.
Painful neuropathy: Altered central processing maintained dynamically by peripheral input
Pain
(1992) Neurogenic vasodilatation and plasma leakage in the skin
Gen Pharmacol
(1998)- et al.
Collateral sprouting in skin and sensory recovery after nerve injury in man
Pain
(1987) - et al.
Median nerve entrapment syndrome in the proximal forearm
J Hand Surg
(1979) - et al.
Peripheral CGRP release as a marker for neurogenic inflammation: A model system for the study of neuropeptide secretion in rat paw skin
Pain
(1997) - et al.
The effect of capsaicin on the response characteristic of human C-polymodal nociceptors
J Therm Biol
(1983)
Reflex sympathetic dystrophy: evolution of microcirculatory disturbances in time
Pain
Innervation of normal human sural and optic nerves by noradrenaline and peptide containing nervi vasorum and nervorum: Effect of diabetes and alcoholism
Brain Res
The radial tunnel syndrome
J Hand Surg
Shoulder-arm pain from cervical bands and scalene muscle anomalies
J Neurol Sci
Reflex sympathetic dystrophy of the hand, an excessive inflammatory response
Pain
Psychophysical observations on patients with neuropathic pain relieved by sympathetic block
Pain
The treatment of thoracic outlet syndrome: A comparison of different operations
J Vasc Surg
Peripheral projections of nerve fibers in the human median nerve
Brain Res
Brachial plexus traction injuries
Front Hand Rehabil
Effects of sympathectomy in a model of causalgiform pain produced by partial sciatic nerve injury in rats
Pain
Extra-territorial pain in rats with a peripheral mononeuropathy: Mechano-hyperalgesia and mechanoallodynia in the territory of an uninjured nerve
Pain
Thrombolytic therapy followed by first rib resection for spontaneous (effort) subclavian vein thrombosis
Am J Surg
Response properties of thin myelinated (A-δ) fibers in human skin nerves
J Neurophysiol
Surgical treatment for symptoms produced by cervical ribs and the scalenus anticus muscle
Surg Gynecol Obstet
Abnormalities of cutaneous blood flow regulation in patients with reflex sympathetic dystrophy as measured by laser Doppler fluxmetry
Arch Neurol
Evidence from animal models on the pathogenesis of painful peripheral neuropathy, and its relevance for pharmacotherapy
Common peroneal palsy: A clinical electrophysiological review
J Neurol Neurosurg Psychiatry
Continuous procaine block of paravertebral sympathetic ganglions: Observations on one hundred patients
JAMA
The causalgia-dystonia syndrome
Brain
Femoral neuropathy
Development and treatment of the pain syndrome of reflex sympathetic dystrophy: Clinical picture, experimental investigations and new pathological considerations
Der Schmerz
Nociceptor function in intact skin and in neurogenic or non-neurogenic inflammation
Acta Physiol
Reflex sympathetic dystrophy
Causalgia and other reflex sympathetic dystrophies
The scalenus medius band: A contribution to the study of the thoracic outlet syndrome
J Bone Joint Surg Br
The anterior tarsal tunnel syndrome: Report of two cases
J Neurosurg
The localization of lesions affecting cervical, brachial and lumbosacral plexus
Results of excision of a cervical rib in patients with the thoracic outlet syndrome
Br J Surg
Sensory conduction of the sural nerve in poly neuropathy
J Neurol Neurosurg Psychiatry
Painful sequelae of nerve injury
Posterior femoral cutaneous neuralgia
Muscle Nerve
Chronic hyperalgesia and skin warming caused by sensitized C nociceptors
Brain
Interleukin-6-mediated hyperalgesia/allodynia and increased spinal IL-6 expression in a rat mononeuropathy model
J Interferon Cytokine Res
Otolaryngology
Anterior interosseous nerve palsy
J Bone Joint Surg Br
Role of the cubital tunnel in tardy ulnar palsy
Can J Surg
Introduction
Effects of sympathetic lumbar trunk stimulation on the myotactic reflex activity on the quadriceps muscle in decerebrate cat
Boll Soc Ital Biol Sper
Wasting of the hand associated with a cervical rib or band
Ann Neurol
Ongoing activity in severed nerves: Source and variation with time
Brain Res
Cited by (33)
Capsaicin-induced pain sensitivity in short tear break-up time dry eye
2020, Ocular SurfaceCitation Excerpt :Ophthalmic surgery or corneal injury is unavoidably accompanied by nerve damage followed by a variable degree of regeneration depending on the location and extent of the injury [33–35]. Damage to peripheral nociceptive nerve endings can aggravate the nervous system, which may further develop central sensitization [36,37]. Hence, the intractable group is more likely to have corneal nerve damage than the responsive and control groups, explaining the low M-pain and C-pain sensitivity.
Management of Traumatic Brachial Plexus Injuries
2018, Neurocritical Care Management of the Neurosurgical PatientLongitudinal relationships between anxiety, depression, and pain: Results from a two-year cohort study of lower extremity trauma patients
2013, PainCitation Excerpt :Persistent pain is a major public health problem, contributing to high levels of lost productivity [44], disability [10,31], and utilization of health services [29,30,33]. Recent work investigating the persistence of pain beyond the period of healing after an injury [12,13,41,43] or surgery [26,28] implicate a complex interplay between predisposing and evolving biological [20,51] and psychosocial processes in the perpetuation of pain and disability [22,34]. Negative emotions, such as anxiety and depression, increase risk for postoperative and postinjury pain [23,26] as well as new-onset chronic pain [21].
Thoracic outlet syndrome part 1: Clinical manifestations, differentiation and treatment pathways
2010, International Journal of Osteopathic MedicineCitation Excerpt :If sTOS is suspected then specific attention should be made to scapula position both at rest, motion and on loading (Refer to Part 2). Upper limb pain or symptom reproduction after digital palpation and palpation tenderness (mechanical alodynia),51 especially in the supra and infraclavicular fossae, are considered to be useful in the diagnosis of nTOS. Morley test or the brachial plexus compression test (compression of the brachial plexus in the supraclavicular region) is considered “positive” if there is reproduction of an aching sensation and typical localized paraesthesia and not just mere tenderness of the area.23
Thoracic outlet syndrome part 1: Clinical manifestations, differentiation and treatment pathways
2009, Manual TherapyCitation Excerpt :Traumatic bony lesions include bone remodeling after fractures of the clavicle or first rib or posterior subluxation of the acromioclavicular joint. Soft tissue pathologies such as anterior scalene muscle hypertrophy, muscle fibre type adaptive transformation, spasm and excessive contraction particularly post cervical trauma have all been implicated in TOS (Roos, 1982; Machleder et al., 1986; Mackinnon, 1994; Schwartzman and Maleki, 1999; Kai et al., 2001; Pascarelli and Hsu, 2001; Davidovic et al., 2003). Less commonly, upper lung tumors have been implicated in the etiology (Machleder et al., 1986; Makhoul and Machleder, 1992; Barkhordarian, 2007).
Indications for Polypharmacy
2009, Neuromodulation
Address reprint requests to Robert J. Schwartzman, MD, MCP/Hahnemann University, Broad and Vine Streets, MS 423, Philadelphia, PA 19102–1192
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Department of Neurology, MCP/Hahnemann University, Philadelphia, Pennsylvania