Article
Contusion Neuropraxia of Cutaneous Sensory Nerves: Early Diagnosis and Treatment Reduces Chronic Pain Syndromes (Early Diagnosis Shortens Recovery Time)
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Authors
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Lingyi Chia
- Tan Tock Seng Hospital, Singapore, Singapore
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Dawn Sinn Yii Chia
- Tan Tock Seng Hospital, Singapore, Singapore
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Fok Chuan Yong
- Tan Tock Seng Hospital, Singapore, Singapore
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: Contusion neuropraxia of cutaneous sensory nerves in the upper limb is an under-recognised cause of chronic neuropathic pain. This study recommends a diagnostic criteria, and assesses if early diagnosis and treatment can lead to better outcomes.
Methods: Thirteen patients with contusion neuropraxia of cutaneous sensory nerves in the upper limb were recruited. Each case had clear inciting injury: blunt trauma, stretch injury, or chronic repetitive compression. Two of three were present: (1) local hyperalgesia, (2) distal paraesthesia and (3) a positive Tinel's sign. Clinical findings corresponded to a cutaneous nerve in the upper limb. Patients with concurrent fractures, muscle, tendon, ligamentous or open wound injuries were excluded from the study. All patients were treated conservatively and assessed at monthly intervals for up to three months.
Results and Conclusions: All patients experienced neuropathic pain with local hyperalgesia and sensitivity at the site of nerve injury. Ten participants (76.9%) fulfilled two out of three criteria with the rest of the participants (23.1%) fulfilling all three criteria. The interval between injury and definitive treatment averaged 9.5 weeks (range 0 - 48 weeks). The superficial radial nerve was the most commonly involved nerve (38.5%) followed by the median antebrachial cutaneous nerve (30.8%). At the end of the study period, four patients achieved excellent outcome (30.8%) and nine patients achieved good outcome (69.2%). Amongst patients who achieved an 'excellent' outcome, patients who presented earlier (mean 6.5 weeks, range 5 - 8 weeks) achieved their final outcome earlier than those who presented later (mean 21.70 weeks, range 8 - 48).
Contusion neuropraxia of cutaneous sensory nerves is a disease entity that can result in significant neuropathic pain that interferes with quality of life. Early recognition and definitive treatment can expedite the recovery process, lead to better outcomes, and avoid progression to complex regional pain syndrome. This diagnosis should be considered in all patients with a history of trauma who experience unremitting neuropathic pain and fulfil our diagnostic criteria.
