gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

Neurogenic Thoracic Outlet Syndrome: Results from 52 surgically treated patients

Meeting Abstract

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  • presenting/speaker Gerlinde Weigel - Handchirurgie Gänserndorf, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
  • Werner Girsch - University Clinic Graz, Department of Plastic and Reconstructive Surgery, Graz, Austria

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1918

doi: 10.3205/19ifssh0474, urn:nbn:de:0183-19ifssh04740

Published: February 6, 2020

© 2020 Weigel et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objectives/Interrogation: Central nerve stimulation (CNS) already has proved its efficacy for treatment of chronic severe pain. The aim of our clinical study was to prove the effectiveness of Peripheral Nerve Stimulation (PNS) with implanted systems for treatment of chronic neuropathic pain syndrome (CRPS2) of the extremities.

Methods: In sum we selected 31 patients (19 female, 12 male) suffering from CRPS2 for treatment, two patients suffering from causalgia due to complete posttraumatic brachial plexus lesion including root avulsion. Each patient had a history of microsurgical interventions to the nerves and every conservative treatment which was possible, but without any effect on the problem of neuropathic pain. None of the patients was able to use the extremity functionally. In all patients the VAS was in mean 9, even at rest. Stimulation leads were implanted close to the peripheral nerves (fascicles of the brachial plexus or sciatic or femoral nerve) and connected with percutaneous leads for temporary testing. Pain reduction of more than 4 points on the VAS scale gave indication for implantation of a pulse generator for continuous PNS.

Results and Conclusions: 28 patients were supported with the whole system. PNS was effective to reduce pain from VAS mean 9 to VAS mean 3 and to regain functional use of the extremity in most of the cases. Several technical complications, mostly electrode dislocation had to be noted. Relief from pain occurred immediately after onset of stimulation. The positive effect was directly correlated with PNS, and stable over years. On a scale from -5 to +5 patients rated +4.2 in answering the question if they would undergo the procedure again.

PNS reduced pain deriving from peripheral nerves reliable and effective. Regarding our follow up period of 3,5 years PNS produced a stable, nearby pain free interval in all patients. Positioning of the electrodes direct to the fascicles of the brachial plexus and close to the sciatic nerve at mid-thigh allowed movement of shoulder and hip at a nearby normal ROM. PNS seems to represent an important technology for treatment of chronic neuropathic pain in selected cases.