Shankar Hariharan, Hansen Jared, Thomas Kisha
Department of Anesthesiology, Clement Zablocki VA Medical Center, Milwaukee, Wisconsin, USA; Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Pain Med. 2015 Apr;16(4):777-81. doi: 10.1111/pme.12635. Epub 2014 Dec 19.
Phantom limb pain is a painful sensation perceived in the absent limb following surgical or traumatic amputation. Phantom limb sensations, which are nonpainful, occur in nearly all amputees. Deafferentation can also produce similar symptoms. Here we report the presence of phantom pain in a deafferented limb.
Case report.
Hospital-based outpatient clinic.
A 65-year-old man was referred to the pain clinic for management of upper extremity pain secondary to brachial plexus avulsion (BPA) following a motor vehicle accident. Initially he noticed a feeling of growing and shrinking of his arm. Following this, the pain started gradually from his elbow extending to his fingertips covering all dermatomes. He described the pain as continuous, severe, and sharp. He also described the arm as being separate from his existing insensate arm and felt as though the fist was closed with the thumb pointing out. On physical examination, he had no sensation to fine touch or pressure below the elbow. There were no consistent areas of allodynia. He had diffuse muscle wasting in all the muscle groups of his left upper extremity, besides winging of the scapula. Electrodiagnostic studies showed a left brachial plexopathy consistent with multilevel nerve root avulsion sparing the dorsal rami.
This is a report of phantom limb sensations and phantom pain following BPA in an intact but flaccid and insensate limb.
幻肢痛是指在手术或外伤性截肢后，在已缺失的肢体部位所感知到的疼痛感觉。几乎所有截肢者都会出现非疼痛性的幻肢感觉。去传入神经也可产生类似症状。在此，我们报告一例去传入神经肢体出现幻肢痛的病例。
病例报告。
医院门诊。
一名65岁男性因机动车事故导致臂丛神经撕脱伤（BPA）继发上肢疼痛，被转诊至疼痛门诊。最初，他注意到手臂有肿胀和缩小的感觉。此后，疼痛从肘部开始逐渐蔓延至指尖，覆盖了所有皮节。他将疼痛描述为持续性、剧烈且尖锐的。他还称该手臂与现有的无感觉手臂分离，感觉就像拳头紧握且拇指伸出。体格检查发现，其肘部以下对精细触觉或压力无感觉。不存在一致的感觉异常区域。除了肩胛骨翼状肩胛外，其左上肢所有肌肉群均有弥漫性肌肉萎缩。电诊断研究显示，左侧臂丛神经病变符合多节段神经根撕脱伤，背支未受累。
本文报告了一例完整但松弛且无感觉的肢体在臂丛神经撕脱伤后出现幻肢感觉和幻肢痛的病例。
