Pain Relief after Surgical Decompression of the Distal Brachial Plexus

Richard Morgan; Iain Elliot; Vibhu Banala; Christopher Dy; Briana Harris; Elizabeth Anne Ouellette

doi:10.1055/s-0040-1716718

Journal of Brachial Plexus and Peripheral Nerve Injury, Table of Contents

CC BY 4.0 · J Brachial Plex Peripher Nerve Inj 2020; 15(01): e22-e32
DOI: 10.1055/s-0040-1716718

Original Contribution

Pain Relief after Surgical Decompression of the Distal Brachial Plexus

Authors

Richard Morgan

¹Department of Physical Medicine & Rehabilitation, Larkin Community Hospital, Miami, Florida, United States
Iain Elliot

²Department of Orthopedics and Sports Medicine, University of Washington, Seattle, Washington, United States
Vibhu Banala

³Department of Orthopedic Surgery, Montefiore Medical Center, Bronx, New York, United States
Christopher Dy

⁴Department of Orthopedic Surgery, Washington University, School of Medicine, St. Louis, Missouri, United States
Briana Harris

⁵Department of Orthopedic Surgery, Miami Orthopedics and Sports Medicine Institute, Baptist Health Medical Group South Florida, Miami, Florida, United States
Elizabeth Anne Ouellette

⁵Department of Orthopedic Surgery, Miami Orthopedics and Sports Medicine Institute, Baptist Health Medical Group South Florida, Miami, Florida, United States

Abstract

Background Brachial plexopathy causes pain and loss of function in the affected extremity. Entrapment of the brachial plexus terminal branches within the surrounding connective tissue, or medial brachial fascial compartment, may manifest in debilitating symptoms. Open fasciotomy and external neurolysis of the neurovascular bundle in the medial brachial fascial compartment were performed as a surgical treatment for pain and functional decline in the upper extremity. The aim of this study was to evaluate pain outcomes after surgery in patients diagnosed with brachial plexopathy.

Methods We identified 21 patients who met inclusion criteria. Documents dated between 2005 and 2019 were reviewed from electronic medical records. Chart review was conducted to collect data on visual analog scale (VAS) for pain, Semmes-Weinstein monofilament test (SWMT), and Medical Research Council (MRC) scale for muscle strength. Pre- and postoperative data was obtained. A paired sample t-test was used to determine statistical significance of pain outcomes.

Results Pain severity in the affected arm was significantly reduced after surgery (pre: 6.4 ± 2.5; post: 2.0 ± 2.5; p < 0.01). Additionally, there was an increased response to SWMT after the procedure. More patients achieved an MRC rating score ≥3 and ≥4 in elbow flexion after surgery. This may be indicative of improved sensory and motor function.

Conclusion Open fasciotomy and external neurolysis at the medial brachial fascial compartment is an effective treatment for pain when nerve continuity is preserved. These benefits were evident in patients with a prolonged duration elapsed since injury onset.

Keywords

brachial plexus - brachial plexopathy - medial brachial fascial compartment - outcomes - surgery - pain - entrapment - compression - neuropathy

Full Text

References

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