Traction lesions of the brachial plexus are becoming more frequent. Many of the lesions involve avulsion of nerve roots from the spinal cord. This very often results in severe pain which is associated with deafferentation. Although reference to this pain and the difficulty in its management has been made in several reports in the literature, there has been no long-term study of the natural history of this pain and the effects of various attempts to mitigate it. This series reports on a long-term follow-up of 275 patients of which is 108 had evidence of avulsion lestions. Of these 108, 98 suffered significant pain. There is a remarkably constant description of the pain and the various activities that may affect it. Drugs are of very limited use and the most valuable method of treatment found in this series was transcutaneous electrical stimulation--although, only one-third responded dramatically to this treatment. The single most effective manoeuvre that reduces pain is absorption by the patient in work. There remains a significant number of young men with severe pain who may expect to suffer such pain indefinitely. There is urgent need for new methods to be developed to control this pain.
Technique for re-educating sensory function after median nerve lesions at the wrist is described. Results of re-education of Twenty-three patients are presented. The functional results are good and belie the traditional view of sensory function after nerve suture. Recent advances in sensory neuro-physiology are discussed which may explain the successes of this technique.
The author reviews the diagnosis and treatment of avulsion injuries of the brachial plexus. He discusses the nature of the pain and the use of transcutaneous nerve stimulation for its relief.
In view of several case reports of relief of various neuralgias by propranolo, a double-blind cross-over trial using this drug was conducted in 10 patients with severe persistent pain and paraesthesiae following upper limb peripheral nerve injuries. The patients received up to 240 mg of propranolol per day. Only one patient reported pain relief, but this patient withdrew from the trial. An open trial of propranolol was conducted in 6 other patients with a variety of peripheral nerve lesions. Of these, neuroma tenderness was transiently reduced in one patient and the hyperaesthesia of a painful scar was relieved in another. Routine use of propranolol in such patients cannot be recommended.
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