RESUMO
We investigated the effect of delay before nerve repair on neuropathic pain after injury to the brachial plexus. We studied 148 patients, 85 prospectively and 63 retrospectively. The mean number of avulsed spinal nerves was 3.2 (1 to 5). Pain was measured by a linear visual analogue scale and by the peripheral nerve injury scale. Early repair was more effective than delayed repair in the relief from pain and there was a strong correlation between functional recovery and relief from pain.
Assuntos
Plexo Braquial/lesões , Neuralgia/cirurgia , Adolescente , Adulto , Plexo Braquial/fisiopatologia , Plexo Braquial/cirurgia , Emprego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia/etiologia , Neuralgia/fisiopatologia , Medição da Dor/métodos , Estudos Prospectivos , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de TempoRESUMO
Seventy-six patients with severe brachial plexus avulsion injuries were studied using pain questionnaires and quantitative sensory testing. There was significant correlation between pain intensity and the number of roots avulsed prior to surgery (P=0.0004) and surgical repairs were associated with pain relief. Sensory recovery to thermal stimuli was observed, mainly in the C5 dermatome. Allodynia to mechanical and thermal stimuli was observed in the border zone of affected and unaffected dermatomes in 18% of patients assessed early (<6 months) and 37% patients at later stages. Pain and sensations referred to the original source of afferents occurred at a later stage (>6 months) in 12% of patients and were related to nerve regeneration. By contrast, "wrong-way" referred sensations (e.g. down the affected arm while shaving or drinking cold fluids) were reported by 44% of patients and often occurred early, suggesting CNS plasticity. Understanding sensory mechanisms will help develop new treatments for severe brachial plexus injuries.
Assuntos
Neurite do Plexo Braquial/fisiopatologia , Plexo Braquial/lesões , Microcirurgia , Regeneração Nervosa/fisiologia , Complicações Pós-Operatórias/fisiopatologia , Radiculopatia/cirurgia , Células Receptoras Sensoriais/fisiopatologia , Pele/inervação , Raízes Nervosas Espinhais/lesões , Vias Aferentes/fisiopatologia , Plexo Braquial/fisiopatologia , Plexo Braquial/cirurgia , Feminino , Humanos , Masculino , Transferência de Nervo , Exame Neurológico , Plasticidade Neuronal/fisiologia , Medição da Dor , Dor Pós-Operatória/fisiopatologia , Radiculopatia/fisiopatologia , Reimplante , Limiar Sensorial/fisiologia , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/cirurgia , Raízes Nervosas Espinhais/fisiopatologia , Raízes Nervosas Espinhais/cirurgiaRESUMO
Forty-four patients with severe traction brachial plexus avulsion injuries were studied following surgical repairs. In eight patients, re-implanting avulsed spinal roots directly to the spinal cord was performed with other repairs and motor recovery in the proximal limb was similar to that achieved by conventional nerve grafts and transfers when assessed using the MRC clinical grades, Narakas scores, EMG and Transcranial Magnetic Stimulation (TMS). Thirty-four of the 37 patients had co-contractions of agonist and antagonist muscle groups. Spontaneous contractions of limb muscles in synchrony with respiration, the "breathing arm", were noted in 26 of 37 patients: in three patients, the source of the breathing arm was from spinal cord re-connection, providing evidence of regeneration from the CNS to the periphery. Our study shows that re-connection of avulsed spinal roots can produce good motor recovery and provides a clinical model for developing new treatments which may enhance nerve regeneration.