Prevalence of Neuropathic Pain after Traumatic Superficial Radial Nerve Injury: A Cross-Sectional study
Romy Bosman, MD1, Mirte Langeveld, MD, MPH2, Caroline A. Hundepool, MD, PhD2, Liron S. Duraku, MD, PhD3, Christopher McGhee, BNurs1, Samuel George, MD1, Tahseen Chaudhry, MD1, Michiel Zuidam, MD, PhD4 and Dominic Power, MD1, 1Queen Elizabeth University Hospital, Birmingham, West Midlands, United Kingdom, 2Erasmus Medical Center, Rotterdam, Netherlands, 3Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, Netherlands, 4Plastic, Reconstructive and Hand surgery, Erasmus Medical Center, Rotterdam, Netherlands
Background
The susceptibility of the Superficial Radial nerve (SRN) to form painful neuromas has been documented in previous literature. However, no epidemiological studies using validated questionnaires have been conducted to evaluate the prevalence of neuropathic pain and neuroma formation after injury to the SRN. This study aims to assess the prevalence of neuropathic pain after traumatic SRN injury.
Methods
This cross-sectional study included patients diagnosed with SRN injuries between 2016 and 2021. The Visual Analog Scale (VAS) for pain, Douleur Neuropathique 4 (DN4) to assess neuropathic pain, Patient Rated Hand, and Wrist evaluation (PRWHE), and EQ5D for quality of life were filled out via telephone interviews. Univariate analyses were performed to identify prognostic factors associated with neuropathic pain.
Results
A total of 52 patients completed the questionnaires. Twenty-five percent (95%CI 14%-40%) reported significant pain; in 21% (95%CI 11%-35%), the pain was classified as neuropathic. Neuropathic pain was significantly associated with quality of life and hand function. However, according to the regression analysis, gender, age at surgery, type of trauma, time between injury and surgery, and type of surgery (repair, no repair, repair with graft) were not associated with neuropathic pain development.
Conclusion
This study indicates that a significant proportion of patients suffer from neuropathic pain following traumatic SRN injury despite surgical management, impacting hand function and quality of life. The identification of predictive and prognostic characteristics for neuropathic pain development remains challenging. Future prospective studies should focus on surgical management to prevent neuropathic pain development after a traumatic injury of the nerve.
Contribution to practice
The superficial radial nerve in the forearm is known to be ‘unforgiving’. However, it was unknown how many patients develop neuropathic pain after trauma to this nerve. This study provides cross-sectional data of the considerable prevalence of neuropathic pain after SRN trauma despite surgical repair, highlighting the importance of preventive management.
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