[Show abstract][Hide abstract] ABSTRACT: The aim of this retrospective study was to present and investigate axillary nerve injuries associated with sports.
This study retrospectively reviewed 26 axillary nerve injuries associated with sports between the years 1985 and 2010. Preoperative status of the axillary nerve was evaluated by using the Louisiana State University Health Science Center (LSUHSC) grading system published by the senior authors. Intraoperative nerve action potential recordings were performed to check nerve conduction and assess the possibility of resection. Neurolysis, suture, and nerve grafts were used for the surgical repair of the injured nerves. In 9 patients with partial loss of function and 3 with complete loss, neurolysis based on nerve action potential recordings was the primary treatment. Two patients with complete loss of function were treated with resection and suturing and 12 with resection and nerve grafting. The minimum follow-up period was 16 months (mean 20 months).
The injuries were associated with the following sports: skiing (12 cases), football (5), rugby (2), baseball (2), ice hockey (2), soccer (1), weightlifting (1), and wrestling (1). Functional recovery was excellent. Neurolysis was performed in 9 cases, resulting in an average functional recovery of LSUHSC Grade 4.2. Recovery with graft repairs averaged LSUHSC Grade 3 or better in 11 of 12 cases
Surgical repair can restore useful deltoid function in patients with sports-associated axillary nerve injuries, even in cases of severe stretch-contusion injury.
[Show abstract][Hide abstract] ABSTRACT: Different analgesic modalities have been used to treat pain after abdominal surgery, including intravenous patient-controlled analgesia (IVPCA) and thoracic epidurals. A single-shot transverse abdominis plane (TAP) block with a local anesthetic solution under sonographic guidance is often used for pain management after abdominal incisions in combination with a systemic opioid regimen. However, if a TAP block is perpetuated by use of a catheter, continuous analgesia can be achieved with the technique of intermittent boluses. As such, the overall consumption of supplemental systemic opioid usage is decreased. We report a case of severe abdominal pain compromising ventilation in which the placement of TAP plane catheters under sonography indeed proved efficacious. Written informed consent was obtained from our patient to present our findings.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 05/2010; 29(5):855-8. · 1.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Shoulder pain following thoracotomy is a common postoperative complaint and can be difficult to treat. This article explores how to select patients who would benefit from a suprascapular nerve block for post-thoracotomy shoulder pain. A retrospective case review of 178 patients who underwent thoracotomy at our institution was performed. Only patients with elicitable local signs of musculoskeletal shoulder pain were offered a suprascapular nerve block with 10 cc of 0.25% bupivicaine. Of 178 patients, 92 (51.7%) complained of post-thoracotomy shoulder pain. Of these patients, 34 (37.0%) had localizing signs of musculoskeletal shoulder pain and underwent suprascapular nerve block. Twenty-nine of 34 (85.3%) patients obtained satisfactory pain relief. We estimate a true-positive rate of 85.3% with a 95% confidence interval of (68.9%, 95.0%) for those patients who received relief from suprascapular nerve block after localizing signs on physical examination of the shoulder. Patients post-thoracotomy with local signs of shoulder pain on physical examination may benefit from suprascapular nerve blocks in the immediate postoperative period.
American journal of therapeutics 03/2010; 18(4):309-12. DOI:10.1097/MJT.0b013e3181d35be8 · 1.13 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Phantom limb pain is defined as pain localised in a body part that is no longer there (Mishra et al. ; Flor et al. ; Mayo Clinic Staff ). It is believed that amputation of an extremity is required for phantom pain and sensations to occur (Nikolajsen and Jensen ). However, we report a case in which a severed nerve to an “intact extremity” resulted in phantom limb-like pains and sensations which responded to a treatment regimen identical to that for phantom limb pain. It is important for clinicians to entertain the idea of phantom limb-like pain in cases when a nerve is severed to any extremity and as such, provide pain relief to this subgroup of patients.