Problem: A 28-year-old unmarried woman was involved in an automobile accident 3 years ago when jagged glass partially severed her right median nerve below the antecubital fossa. The nerve was repaired by an expert neurosurgeon and she is left with minimal numbness of the tips of her index and long fingers. She still complains of burning pain along the volar surface of the hand and forearm. The incision site is inordinately tender. Two subsequent explorations have failed to demonstrate a neuroma, and conduction velocity determinations across the site of injury are normal. By the time she is referred to you, she requires 140 mg of codeine daily for relief. She sleeps poorly and she cannot use her arm for many normal activities. She is anxious because the injury is in litigation and she has been unable to support herself during the lengthy waiting interval. She will accept further surgery if it offers her a chance for relief. The pain is related to activity and emotional stress and is relieved by rest. She now avoids social contacts and spends most of her day resting and watching television. What therapies would you suggest? What results might you expect from each?
ASJC Scopus subject areas
- Clinical Neurology