Ultrasound-guided peri-brachial plexus polydeoxyribonucleotide injection for a patient with postherpetic brachial plexopathy

Abstract

Rationale: Although most complications of herpes zoster (HZ) are associated with the spread of varicella-zoster virus from the initially involved sensory ganglion, motor nerve impairment, such as limb weakness, is a rare but severe complication that is difficult to treat. Patient concern: A 73-year-old female presented with sudden left upper limb pain and weakness after HZ. Diagnosis: Brachial plexopathy following HZ (postherpetic brachial plexopathy). Intervention: Despite alleviation of the vesicles with antiviral treatments, the left upper limb weakness and neuropathic pain did not improve. After obtaining patient's consent, ultrasound-guided polydeoxyribonucleotide (PDRN) injection was performed around the left brachial plexus. Outcomes: The patient showed marked improvement in left arm pain from numerical rating scale (NRS) 9 to 4, 1 day after PDRN injection. Subsequently, the pain improved to NRS 3, and motor weakness improved to Medical Research Council grade 2 to 4. Lessons: PDRN can be considered a viable substitute for corticosteroid injection in treatment of motor weakness and neuropathic pain after HZ.

Applications of Marine Organism-Derived Polydeoxyribonucleotide: Its Potential in Biomedical Engineering

“…Moreover, two studies investigated the effects of Om-PDRN and HA co-administration as a potential treatment for osteoporosis [ 59 , 60 ]. A total of 29 patients experiencing persistent knee joint pain and 98 OA patients were intra-articularly injected with HA alone or a combination of Om-PDRN and HA.…”

Polydeoxyribonucleotide Regulation of Inflammation

“…91 Recently, PDRN was shown to be a viable alternative to corticosteroids for the management of postherpetic brachial plexopathy. 92 Ultrasoundguided PDRN in a patient with cervical nerve root injury, a complication of traumatic cervical spine fracture, improved motor weakness and sensory symptoms after the second injection. 93 The safety profile of PDRN has prompted its use in patients with metabolic syndromes, such as diabetes, a clinical condition for which corticosteroids have glucose-related adverse effects.…”

Does polydeoxyribonucleotide has an effect on patients with tendon or ligament pain?

“…For observational studies, the Newcastle-Ottawa scale was used for quality assessment of the prospective observational studies, with 3 aspects of selection: selection of subjects, comparability of groups, and assessment of outcome. [17] The quality of each study was graded as low (0-3), moderate (4)(5)(6), and high (7)(8)(9). All disagreements were resolved by consensus.…”

“…Recently, several studies have reported that polydeoxyribonucleotide (PDRN) has an effect on musculoskeletal pain, especially in the tendons or ligaments, such as rotator cuff tendinopathy, lateral epicondylitis, pes anserinus, and plantar fasciitis. [ 6 – 11 ] PDRN is a compound formed by deoxyribonucleotide polymers of different lengths ranging from 50 to 2000 base pairs and nucleosides derived from salmon sperm. [ 12 , 13 ] The structure of PDRN consists of a low molecular weight fraction of deoxyribonucleic acid, which is composed of a linear polymer of deoxyribonucleotides with phosphodiester bonds, in which the monomer units are represented by purine and pyrimidine nucleotides.…”

“…Recently, several studies have reported that polydeoxyribonucleotide (PDRN) has an effect on musculoskeletal pain, especially in the tendons or ligaments, such as rotator cuff tendinopathy, lateral epicondylitis, pes anserinus, and plantar fasciitis [6–11] . PDRN is a compound formed by deoxyribonucleotide polymers of different lengths ranging from 50 to 2000 base pairs and nucleosides derived from salmon sperm [12,13] .…”