Citation

Henriques VM, Torrão FJL, Rosa LAN, Sanches GE, Guedes F. World Neurosurg. 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, Elsevier Publishing)

DOI

10.1016/j.wneu.2023.02.033

PMID

36791879

Abstract

INTRODUCTION: Peripheral nerve injuries remain a major medical problem worldwide. They are associated with multiple causes, such as gunshot wounds (GSWs) which are the second most common cause of the brachial plexus injuries in peacetime, and the main, or even the only cause reported in wartime studies. The ulnar nerve is one of the most affected nerves. Peripheral nerve trauma may cause intense neuropathic pain, which is very difficult to control. Particularly ulnar nerve gunshot injuries, which may impact individual daily life as injuries to this nerve result in both sensory and motor deficits within the hand.

OBJECTIVE: Evaluate the improvement of neuropathic pain after surgical treatment in a consecutive series of twenty patients with ulnar nerve injury due to GSWs METHODS: This study is a single-center, retrospective, consecutive case series review of 20 patients who have suffered ulnar nerve injuries due to GSWs, presenting with excruciating neuropathic pain, and underwent surgical treatment between 2005 and 2017.

RESULTS: Of all injuries, 13 occurred in the right upper limb (65%). Twelve patients had a high ulnar nerve injury (60%). Regarding associated injuries, 8 patients had bone injuries (40%) and 4 patients had arterial injuries (20%). A neuroma in continuity was detected in 8 cases (40%) and 4 patients (20%) had shrapnel lodged with the ulnar nerve. All patients had severe neuropathic pain and functional deficit, with a mean VAS score of 8.45 ± 1.4 and a mean reduction of 6.95 points after 12 months of surgery and 10 patients (50%) had a BMRC score equal or greater than 3.

CONCLUSION: Surgery is an effective treatment for GSWs neuropathic pain and early isolated external neurolysis is associated with better pain management and functional outcomes postoperatively.

Language: en