Clinical Judgement

Examination of a Patient with Multiple Nerve Injuries and Neuropathic Pain Following a Laceration at the Distal Forearm

Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.

Examining patients with multiple nerve injuries and neuropathic pain can be difficult due to the number of nerves that have overlapping sensory territories. As well, it is important to distinguish pain from nerve compression (needing just simple decompression) versus pain from a neurotmetic injury (requiring neurectomy with proximal transposition or repair). Through a systematic method of assessment, one can create a management strategy that will help patients understand their injury and propose an operative plan for treating their neuropathic pain. In this case, a 69-year-old patient suffered a deep laceration injury to her distal forearm, which transected several flexor/extensor tendons, “radial sensory” nerve, and 50% of her median nerve. These structures were primarily repaired within hours of her injury and overtime the patient has recovered her median nerve sensation and motor function. However, she presented to our institution two-years following with complaints of significant neuropathic pain with diminishing strength. This examination video is a step-by-step assessment of this patient with neuropathic pain and includes tips for prioritizing and distinguishing the involved sensory territories. This video also discusses an operative plan that includes a staged neurectomy and proximal transpositions of the palmar cutaneous branch of the median nerve (PCM) and lateral antebrachial cutaneous nerve with a radial sensory nerve decompression and brachioradialis tenotomy.

Presentation

Examination

5 Comments

  1. Thanks a lot for these highly informative videos
    It really helped me
    Your approach to such difficult and relatively common cases is very interesting
    You changed my way of approaching and analyzing vague pain and weakness syndromes
    Please keep sharing your knowledge

  2. Mohamed, thank you for the kind comment. This lets me know that this type of video format is helpful teaching clinical knowledge and will look into creating more of these videos.

    Happy new year.

  3. This is truly an amazing resource. I’m especially interested in seeing more collapse testing with in depth comments to instruct the novice like myself in how to correctly reproduce this type of testing reliably. Again, thank you for such incredible work putting this together.

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