Brachial Plexus Traction Injury: Quantification of Sensory Abnormalities

Abstract

Stretch injury to the brachial plexus may occur following traumatic flexion-extension of the cervical spine often seen in motor vehicle accidents or falls. Radiologic and conventional nerve conduction studies are negative in many cases. The present study was undertaken in an attempt to simplify, standardize, and quantify the positive and negative sensory abnormalities that are most often seen during the clinical examination. Quantitation of thresholds for thermal detection and pain, vibration, pressure pain and elevated arm stress test was performed in a series of 38 patients with the clinical picture of brachial plexus traction injury as well as a group of age and sex matched control subjects. Significant decreases in all evoked pain thresholds, except for heat pain, along with increases in sensory detection thresholds were found in the patient group compared with controls. Quantification of sensory findings may greatly facilitate and substantiate the diagnosis of this type of injury. The data are consistent with the hypothesis that brachial plexus traction injury causes dysfunction of small sensory fiber systems and results in a form of neuropathic pain.