Nerve Pain Surgery Special Issue
With a rapid expansion of ideas, techniques, and products available for surgical treatments of nerve pain problems, it is data, rigorous investigation, and honest reporting that are critical to ensuring high-quality care. In this special issue we take a broad approach, delving into various aspects of how surgeons manage nerve pain, focusing on harder-to-tell and less-often discussed pieces of this growing puzzle.
Nerve Pain SurgeryNerve pain has plagued humanity, in some form, for millennia. Whether due to trauma, post-traumatic changes, compression, metabolic abnormalities, infections, inflammatory pathologies, or another neuropathic etiology, consistent and reliable treatments for these nerve pain issues are still needed. Throughout history, as science and technology have changed, so have the proposed treatments. Yet one of the main limitations to overall progress is that we still do not truly understand the nature of many nerve pain problems, making finding a proper treatment even more difficult.
Multiple Concurrent Decompressions for the Treatment of Upper Extremity PainNeuropathic pain can be life altering and difficult to treat. Nerves can be compressed along their path in the upper extremities, resulting in chronic neuropathic pain. This study was performed to evaluate the effectiveness and safety of multiple concomitant distal nerve decompressions for the treatment of upper extremity nerve pain.
High-Transhumeral Amputation: Targeted Muscle Reinnervation and Soft Tissue Coverage With Pedicled Latissimus Dorsi FlapThe introduction of targeted muscle reinnervation has improved amputation pain outcomes and the control of upper-extremity myoelectric prostheses. However, patients with proximal transhumeral amputation levels and soft tissue deficits present a unique challenge. Existing described targeted muscle reinnervation techniques in transhumeral amputees rely on recipient motor nerves from the biceps and triceps; however, these may be absent in patients with more proximal injuries. Here, we describe the use of the pedicled latissimus dorsi flap for both soft tissue coverage and additional motor targets in patients with high-transhumeral amputation with complex soft tissue deficits.
Use of Vascularized, Denervated Muscle Targets for Prevention and Treatment of Upper-Extremity NeuromasNeuroma formation following upper-extremity peripheral nerve injury often results in persistent, debilitating neuropathic pain with a limited response to medical management. Vascularized, denervated muscle targets (VDMTs) offer a newly described surgical approach to address this challenging problem. Like targeted muscle reinnervation and regenerative peripheral nerve targets, VDMTs are used to redirect regenerating axons from an injured nerve into denervated muscle to prevent neuroma formation. By providing a vascularized muscle target that is reinnervated via direct neurotization, VDMTs offer some theoretical advantages in comparison with the other contemporary surgical options.
Changes in Patient-Reported Pain Interference After Surgical Treatment of Painful Lower Extremity NeuromasPainful neuromas commonly cause neuropathic pain, in up to 1 in 20 cases of traumatic or iatrogenic nerve injury. Despite the multiple surgical treatment types that reduce pain, no type has been universally accepted.
Selective Thumb Carpometacarpal Joint Denervation for Painful Arthritis: Follow-Up of Long-Term Clinical OutcomesThumb carpometacarpal (CMC) joint osteoarthritis is a common problem affecting up to 85% of patients over the age of 70. The most common presenting symptom for patients with CMC arthritis is pain with joint loading. Loss of function due to subluxation or joint destruction is comparatively rare. Carpometacarpal joint denervation is a relatively novel method for managing CMC arthritis, treating the most impactful symptom: pain.