Open AccessPhantom Pain in a Patient with Brachial Plexus Avulsion Injury
Author(s) -
Shankar Hariharan,
Hansen Jared,
Thomas Kisha
Publication year - 2015
Publication title -
pain medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.893
H-Index - 97
eISSN - 1526-4637
pISSN - 1526-2375
DOI - 10.1111/pme.12635
Subject(s) - medicine , brachial plexus , brachial plexopathy , neuroma , avulsion , amputation , sensation , phantom limb , phantom pain , upper limb , surgery , anesthesia , physical medicine and rehabilitation , neuroscience , biology
Objective Phantom limb pain is a painful sensation perceived in the absent limb following surgical or traumatic amputation. Phantom limb sensations, which are nonpainful, occur in nearly all amputees. Deafferentation can also produce similar symptoms. Here we report the presence of phantom pain in a deafferented limb. Design Case report. Setting Hospital‐based outpatient clinic. Patient A 65‐year‐old man was referred to the pain clinic for management of upper extremity pain secondary to brachial plexus avulsion (BPA) following a motor vehicle accident. Initially he noticed a feeling of growing and shrinking of his arm. Following this, the pain started gradually from his elbow extending to his fingertips covering all dermatomes. He described the pain as continuous, severe, and sharp. He also described the arm as being separate from his existing insensate arm and felt as though the fist was closed with the thumb pointing out. On physical examination, he had no sensation to fine touch or pressure below the elbow. There were no consistent areas of allodynia. He had diffuse muscle wasting in all the muscle groups of his left upper extremity, besides winging of the scapula. Electrodiagnostic studies showed a left brachial plexopathy consistent with multilevel nerve root avulsion sparing the dorsal rami. Conclusion This is a report of phantom limb sensations and phantom pain following BPA in an intact but flaccid and insensate limb.