Management of painful scar-tethered cutaneous nerves of the upper limb

Abstract

We report the results of treatment by division and proximal relocation of 44 painful, scar-tethered cutaneous nerves of the upper limb in 22 patients. In all patients, neuropathic pain had developed either following surgery or trauma, but without apparent direct nerve injury. The mean duration of pain symptoms prior to relocation was 17 (range 7-44) months. Adequate treatment involved relocation of 35 nerves at a first operation for each of the 22 patients, with six patients requiring further surgery to relocate 9 nerves. At a minimum follow-up of 6 months, nerve relocation resulted in complete resolution of all forms of pain at the primary site in 21/22 (95%) patients and no pain or hypersensitivity at the final relocation site in 19 of the 22 patients (86%).

Keywords: Cutaneous nerve; Douleur; Douleur nerveuse; Douleur neuropathique; Nerf cicatriciel; Nerf cutané; Nerve pain; Nerve périphérique; Nerve relocation; Neurogenic pain; Pain; Peripheral nerve; Réimplantation proximale des nerfs; Scar-tethered nerve.