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

Richard Morgan
1  Department of Physical Medicine & Rehabilitation, Larkin Community Hospital, Miami, Florida, United States
,
Iain Elliot
2  Department of Orthopedics and Sports Medicine, University of Washington, Seattle, Washington, United States
,
Vibhu Banala
3  Department of Orthopedic Surgery, Montefiore Medical Center, Bronx, New York, United States
,
Christopher Dy
4  Department of Orthopedic Surgery, Washington University, School of Medicine, St. Louis, Missouri, United States
,
Briana Harris
5  Department of Orthopedic Surgery, Miami Orthopedics and Sports Medicine Institute, Baptist Health Medical Group South Florida, Miami, Florida, United States
,
Elizabeth Anne Ouellette
5  Department of Orthopedic Surgery, Miami Orthopedics and Sports Medicine Institute, Baptist Health Medical Group South Florida, Miami, Florida, United States
› Author Affiliations
Funding None.
  

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.

Ethical Approval

This study was approved by the Local Ethics Committee.




Publication History

Received: 17 July 2019

Accepted: 26 July 2020

Publication Date:
16 October 2020 (online)

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Stuttgart · New York