Team Approach: Upper-Extremity Numbness

Merrill, Christian A.; Ferreira, Joel; Parrino, Anthony; Moss, Isaac L.

doi:10.2106/jbjs.rvw.17.00166

Cited by 4 publications

(4 citation statements)

References 62 publications

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“…SPINE20, which is a well-recognized advocacy group for spinal disability, published a recommendation to adopt value-based interprofessional spine care as an approach to improve patient outcomes and reduce disability 30 . Further, some efforts with conduct a multidisciplinary approach with patients with DCM have been reported 31,32 . However, there have been no reported attempts to reduce residual symptoms of paresthesia through a multidisciplinary approach.…”

Section: Discussionmentioning

confidence: 99%

“…30 Further, some efforts with conduct a multidisciplinary approach with patients with DCM have been reported. 31,32 However, there have been no reported attempts to reduce residual symptoms of paresthesia through a multidisciplinary approach. Finally, detailed and precise preoperative explanations regarding the symptoms of paresthesia might positively influence treatment satisfaction.…”

Section: Cervical Spinementioning

confidence: 99%

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Residual Paresthesia After Surgery for Degenerative Cervical Myelopathy

Tamai,

Terai,

Iwamae

et al. 2023

Spine

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Study Design. Multi-center, prospective cohort study Objective. The current study aimed to identify the incidence of residual paresthesias after surgery for degenerative cervical myelopathy (DCM), and to demonstrate the impact of these symptoms on clinical outcomes and patient satisfaction. Summary of Background Data. Surgery for DCM aims to improve and/or prevent further deterioration of physical function and quality-of-life (QOL) in the setting of DCM. However, patients are often not satisfied with their treatment for myelopathy when they have severe residual paresthesias, even when physical function and QOL are improved after surgery. Methods. We included 187 patients who underwent laminoplasty for DCM. All patients were divided into two groups based on their visual analog scale score for paresthesia of the upper extremities at 1 year postoperatively (>40 vs ≤40 mm). Preoperative factors, change in clinical scores and radiographic factors, and satisfaction scales at 1 year postoperatively were compared between groups. We used mixed-effect linear and logistic regression modeling to adjust for confounders. Results. Overall, 86 of 187 patients had severe residual paresthesia at 1 year postoperatively. Preoperative patient-oriented pain scale scores were significantly associated with postoperative residual paresthesia(P=0.032). A mixed-effect model demonstrated that patients with severe postoperative residual paresthesia showed significantly smaller improvements in QOL (P=0.046) and myelopathy (P=0.037) than patients with no/mild residual paresthesia. Logistic regression analysis identified that residual paresthesia was significantly associated with the lower treatment satisfaction, independent of improvements in myelopathy and QOL (adjusted odds ratio: 2.5, P=0.010). Conclusion. In total, 45% of patients with DCM demonstrated severe residual paresthesia at 1 year postoperatively. These patients showed significantly worse treatment satisfaction, even after accounting for improvements in myelopathy and QOL. As such, in patients who experience higher preoperative pain, multidisciplinary approaches for residual paresthesia, including medications for neuropathic pain might lead to greater clinical satisfaction. Level of Evidence. III

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Section: Discussionmentioning

confidence: 99%

Section: Cervical Spinementioning

confidence: 99%

Residual Paresthesia After Surgery for Degenerative Cervical Myelopathy

Tamai,

Terai,

Iwamae

et al. 2023

Spine

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“…Lumbosacral plexus entrapment syndrome is a problem whose nature is very similar, almost identical, to lumbosacral plexus entrapment syndrome thoracic outlet syndrome, as it is caused by entrapment of the lumbosacral plexuses as they emerge through the psoas major or beneath the piriformis muscles, 1 and may thus result in multifocal entrapment neuropathies. [5][6][7][8][9][10][11][12][13][14] The symptoms of lumbosacral plexus entrapment syndrome may present in quite misleading ways, seemingly unrelated, also similar to TOS and often distal to the main site of entrapment. [1][2][3][4] In this regard, clinical suspicion as well as knowledge of appropriate provocative tests, are all necessary in order to confirm its presence.…”

Section: Discussionmentioning

confidence: 99%

Lumbosacral plexus entrapment syndrome. Part two: Symptomology and rehabilitative trials

Larsen¹,

Chien

2019

APIC

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Background: Lumbosacral plexus entrapment syndrome (LPES) is a little-known but common cause of chronic lumbopelvic and lower extremity pain. The authors document the clinical course of 61 patients who were diagnosed and treated for LPES between May 2016 and October 2018. The study is aimed to evaluate the efficacy of our proposed diagnostic and conservative treatment protocol for LPES, clinically.Methodology: This is a retrospective cohort study of patients suffering from LPES. Patients were included in this study if they compatible symptoms with LPES with symptoms of low back, pelvic, groin, genital, thigh or calf pain after other more common etiologies have been excluded. Additionally, these patients had at least 5 positive provocative Tinel’s tests applied to various lumbopelvic and lower extremity (LPLE) nerve branches yielding => 7 (numeric rating scale) NRS, and weakness of one or more myotomes of the lower body. The group in its entirety was treated with gentle strengthening of the psoas major and piriformis muscles. The primary outcome measure was patient reported satisfaction and improvement including: Full, significant, moderate, slight, or no improvement in pain and symptoms. Patients were followed for up to two years.Results: The most common complaints amongst the patient pool were low back, groin, pelvic, posterior/lateral calf pain. Additionally, 17 patients (28%) stated that everything in the LPLE hurts, consistent with plexalgia. 13 patients were lost to follow-up as they did not reschedule treatment, for unknown reasons. Amongst the remaining 48 patients, 25 recovered fully (52%), 12 significantly (25%), and five moderately (10,4%). Five patients had a slight improvement (10,4%), and two no improvement whatsoever (4%). The average recovery times were mostly consistent with the time of affliction. Patients with a symptom duration of less than one year, generally recovered within 4 months. One to four years, within 10,5 months. Five to nine years, 7,5 months. And, finally, more than 10 years, within 18 months.Conclusion: Non-specific pain syndromes in the LPLE where other causes have been excluded, may be attributable to underlying LPES. In this study, a high correlation between the diagnostic & interventional protocols, and beneficial patient outcomes were demonstrated. However, more statistical and long-term research is needed.Citation: Larsen K, Chien GCC. Lumbosacral plexus entrapment syndrome. Part Two: Symptomology and rehabilitative trials. Anaesth pain & intensiv care 2019;23(2):138-144

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“…It is a "double crush", i.e. multifocal nerve entrapment neuropathy, [25][26][27][28][29][30][31][32][33][34] often resulting in diffuse neuralgic patterns difficult to pinpoint in the LPLE. 9,39,40 Other frequently used terms for this problem is "Maigne's syndrome", 35 "thoracolumbar junction syndrome", 36 "dorsal ramus syndrome", 37,38 and "piriformis syndrome", which are, in our impression, different perceptions of the same hierarchical problem, as they are frequently seen in tandem.…”

Section: Lumbosacral Plexus Entrapment Syndromementioning

confidence: 99%

Lumbosacral plexus entrapment syndrome. Part one: A common yet little-known cause of chronic pelvic and lower extremity pain

Larsen¹,

Chien

2019

APIC

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Lumbosacral plexus entrapment syndrome (LPES) is a little-known but common cause of chronic lumbopelvic and lower extremity pain. The lumbar plexus, including the lumbosacral tunks emerge through the fibers of the psoas major, and the proximal sciatic nerve beneath the piriformis muscles. Severe weakness of these muscles may lead to entrapment plexopathy, resulting in diffuse and non-specific pain patterns throughout the lumbopelvic complex and lower extremities (LPLE), easily mimicking other diagnoses and is therefore likely to mislead the interpreting clinician. It is a pathology very similar to that of thoracic outlet syndrome, but for the lower body. This two-part manuscript series was written in an attempt to demonstrate the existence, pathophysiology, diagnostic protocol as well as interventional strategy for LPES, and its efficacy.Piriformis syndrome; Nerve entrapment; Double-crush; Pain, Chronic; Fibromyalgia Citation: Larsen K, Chien GCC. Lumbosacral plexus entrapment syndrome. Part one: A common yet little-known cause of chronic pelvic and lower extremity pain. Anaesth pain & intensiv care 2019;23(2):124-137

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Team Approach: Upper-Extremity Numbness

Cited by 4 publications

References 62 publications

Residual Paresthesia After Surgery for Degenerative Cervical Myelopathy

Residual Paresthesia After Surgery for Degenerative Cervical Myelopathy

Lumbosacral plexus entrapment syndrome. Part two: Symptomology and rehabilitative trials

Lumbosacral plexus entrapment syndrome. Part one: A common yet little-known cause of chronic pelvic and lower extremity pain

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